Objective: To evaluate the impact of intravesical prostatic protrusion (IPP) and prostatic calcification on medical treatment for male lower urinary tract symptoms (LUTS). Materials and methods: Men over the age of 40 years with total International Prostate Symptom Score (IPSS) ≥ 8 were recruited from January to August 2013. The maximal flow rate, postvoiding residual (PVR) urine volume, total prostate volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), and grades of IPP and prostate calcification were recorded. All patients received α-blocker monotherapy, and Global Response Assessment (GRA) was used to determine treatment response 1 month after the treatment. The primary end point was to compare the treatment results in patients with and without significant IPP or prostate calcification. Univariate and multivariate logistic regression analyses were performed to determine whether IPP and prostatic calcification are predictors of improved outcome (GRA ≥ 1). Results: We enrolled 112 men with a mean age of 65.5 (range, 42–89) years. IPP was significantly positively correlated with TPV, TZV, TZI, and PVR. Prostatic calcification was significantly negatively correlated with total IPSS, IPSS Voiding, and IPSS Storage. After 1-month treatment with α-blockers, the average total IPSS decreased from 18.2 ± 7.4 to 13.1 ± 4.5. Sixty-nine patients (61.6%) reported improved outcomes. Patients with large prostate volumes (TPV ≥ 40 mL) and small prostate volumes (TPV < 40 mL) had similar improved outcome rates (56.5% and 65.1%, respectively). Patients with significant IPP (Grades II and III) had significantly lower improved outcome rates (36.8%) than those without significant IPP (74.3%). Patients with prostatic calcification also had a significantly lower rate of improved outcome (47.9%) than those who did not (71.9%). Multivariate logistic regression analyses showed that IPP and prostatic calcification are predictors of unfavorable outcome (GRA < 1) after adjusting for age, TPV, and total IPSS. Conclusion: Significant IPP and prostatic calcification are unfavorable predictors of successful α-blocker treatment for benign prostatic hyperplasia-induced male LUTS.