Thanks to the widespread use of prostatic transrectal ultrasound (TRUS) scanning in uro-andrological practice, there has been an increase in the incidental diagnosis of cystic lesions of the prostate; the mean rate is now 5% (range 0.5–7.9%) in patients with lower urinary tract symptoms (LUTS) (Patel and Rickards, in: Handbook of transrectal ultrasound and biopsy of the prostate, Dunitz, London, 2002, pp. 85–90). The clinical relevance of this finding is still under debate, but cysts have been associated with inflammation, obstruction of the seminal or urinary tract, as well as cancer and infertility. Making a correct differential diagnosis is therefore extremely important. During scanning, also in the final ultrasound (US) report, prostatic cysts often tend to be largely ignored, neglecting to state both their identification and any characterization (Rieger et al., Clin Genitourin Cancer 22:523–534, 2024). In fact, there are no accurate and comprehensive classifications based on ultrasound characteristics. We suggest updated ultrasound criteria in order to obtain a shared and complete classification based on a detailed description of their characteristics for the final US report and useful for clinical management.