To evaluate the clinical significance of prostatic calculi by assessing their associations with erectile function, pelvic symptoms, and quality of life. This cross-sectional study included 161 male patients who underwent abdominal computed tomography. Seventy-one patients with prostatic calculi and 90 without calculi completed three validated questionnaires: the International Index of Erectile Function-5 (IIEF-5), the Pelvic Pain and Urgency/Frequency (PUF) questionnaire, and the PROMIS-10 Global Health scale. Patients with prostatic calculi had significantly lower erectile function scores (IIEF-5: 11.4 ± 4.8 vs. 21.3 ± 2.5; p < 0.001) and higher pelvic pain scores (PUF: 17.7 ± 10.8 vs. 3.7; p < 0.05). PROMIS mental health scores were lower in the calculi group (45.8 ± 7.9 vs. 53.4 ± 8.2; p < 0.05), whereas physical health scores did not differ significantly (p = 0.278). Calculus size correlated positively with PUF scores (r = 0.562, p < 0.05) and negatively with PROMIS physical health (r = − 0.315, p = 0.008). Prostatic calculi are associated with impaired erectile function, increased pelvic pain, and reduced mental health related quality of life. These findings suggest that prostatic calculi, often considered incidental imaging findings, may have a significant impact on patient-reported outcomes and warrant further clinical attention.