3. Sonographic Features of Prostate
Ultrasound
• Best assessed with transrectal ultrasound.
• Some zonal anatomy distinguishable.
• Outer gland (central and peripheral zones) -
uniform low echogenicity but usually more
echogenic than the inner gland.
• 30 mL is a commonly used upper limit for
normal volume.
4. Scanning Technique
Transrectal Ultrasound:
• It is ideal to have a small amount of urine in the bladder.
• Ask the patient to try and relax and "bear down" to open the
sphincter as the transducer is inserted slowly. Ensure the
transducer has a latex free dedicated probe cover with plenty of gel.
The highest frequency sector probe 7-12MHz should be used.
• The scanning begins in the axial plane. The seminal vesicles are
examined initially. As the probe is angled caudally the base of the
prostate is seen.
• Once the prostate is examined in its entirety in this plane the probe
is turned 90degrees in a sagittal plane. The probe is angled from
one side across to the other.
• A volume is taken by measuring height x length in the sagittal plane
and x width in the axial plane and multiply by 0.52.
• Look for changes in the contours and echogenicity in each zone.
5. TRANSABDOMINAL TECHNIQUE:
• The patient lies supine. The patient should
have a half full bladder .500 mls of water 1 hr
before the scan if possible is recommended.
• The probe is angled approximately 30 degrees
caudal using the bladder as a window. Slight
compression to ensure the inferior portion of
the prostate is not obscured by the shadow
artifact from the base of the bladder.
6. Common Pathology
• Cysts
• Benign Prostatic Hyperplasia (BPH)
• Prostate Carcinoma
• Prostatitis
• Enlarged seminal vesicles
• Stones in the seminal vesicles, Prostate or
ejaculatory ducts.
7. Prostate cystic disease
• Prostatic cysts are
common, and ~5-8%
men will develop
one. However they
are much more
common in patients
being investigated
for infertility, with
one study showing a
20% prevalence .
8. Benign prostatic hyperplasia:
• Benign prostatic hyperplasia
(BPH) or benign prostatic
enlargement (BPE) is an extremely
common condition in elderly men
and is a major cause of bladder
outflow obstruction.
Epidemiology:
• By the age of 60, 50% of men have
BPH, and by 90 years of age the
prevalence has increased to 90%.
As such it is often thought of
essentially as a 'normal' part of
aging.
• DISEASE OCCURRENCE IN
PAKISTANI POPULATION:
Pakistan with as many as 50% of the 2
million men older than 65 year are at
risk of bladder outlet obstruction
from BPH.
9. Sonographic Features
• There is an increase in volume of
the prostate with a calculated
volume exceeding 30 mL (width x
height x length x 0.52).
• The central gland is enlarged, and
is hypoechoic or of mixed
echogenicity.
• Calcification may be seen both
within the enlarged gland as well
as in the pseudocapsule
(representing compressed
peripheral zone).
• Post-micturition residual volume is
typically elevated
• Associated bladder wall
hypertrophy and trabeculation
due to chronically elevated filling
pressures.
10. Prostatic carcinoma
• Prostatic carcinoma ranks as
the most common malignant
tumor in men and the second
most common cause of cancer-
related deaths In men.
Epidemiology:
• It is primarily a disease of the
elderly male. In the United
States, approximately 200,000
new cases are diagnosed each
year.
• Prevalence in Pakistan:
The prevalence of prostate
cancer in males ranged from 2 to
8% with overall
pooled prevalence of 5%.
11. Sonographic Features
• On ultrasound,
prostate cancer is
usually seen as a
hypoechoic lesion
(60-70%) in the
peripheral zone of
the gland, but can
be hyperechoic or
isoechoic (30-40%
of lesions).
12. Prostatitis
• Prostatitis refers to an
infection or inflammation
of the prostate gland that
presents as several
syndromes.
Ultrasound:
• Focal hypoechoic region in
the peripheral zone of the
gland. Discrete fluid
collection suggests abscess
formation. Color Doppler
ultrasound demonstrates
increased flow in the
periphery of the abscess.