Purpose <p>To evaluate the predictive value of Prostate Spherical Volume Ratio for Lower urinary tract symptoms and clinical progression of Benign prostatic hyperplasia. And compared with other prostatic anatomical parameters.</p> Methods <p>A total of 154 patients with Benign prostatic hyperplasia who underwent MRI and urodynamics were included in the study, while prostate anatomical parameters such as prostate spherical volume ratio, prostate volume, intravesical prostatic protrusion, prostatic urethral length and presumed circle area ratio were determined based on MRI measurements. Average length of follow-up was 12&#xa0;months. The primary outcome was follow-up for the clinical progression of Benign prostatic hyperplasia, defined as an increase in the International Prostate Symptom Score of at least 4 points, Benign prostatic hyperplasia-related prostatic surgery. Univariate and multivariate linear regression analyses were conducted to identify risk factors for lower urinary tract symptoms. Logistic regression analyses were conducted to identify risk factors for clinical progression of Benign prostatic hyperplasia.</p> Results <p>Multivariate linear regression highlighted the significant association of prostate spherical volume ratio with lower urinary tract symptoms. In multivariable logistic regression analysis prostate spherical volume ratio is an independent risk factor for the clinical progression of Benign prostatic hyperplasia to an increase in the International Prostate Symptom Score of at least 4 points (OR = 1.53 <i>p</i> = 0.016) and Benign prostatic hyperplasia -related prostatic surgery (OR = 5.15 <i>p</i> = 0.020).</p> Conclusion <p>Prostate spherical volume ratio has been significantly correlated with Lower urinary tract symptoms, and it was an independent risk factor for the clinical progression of Benign prostatic hyperplasia.</p> This trial is registered on ClinicalTrials.gov <p>NCT06448533</p>