Technical and anatomical essentials for transrectal ultrasound of the prostate

Abstract

Transrectal ultrasound (TRUS) of the prostate is a specific urological examination. This morphological imaging technique is often capable of identifying the cause for raised values of prostate-specific antigen (PSA) or of clarifying hard tissue regions found during rectal palpation. Particulary in view of constantly increasing number of patients undergoing PSA tests, there is a rising need for further prostate diagnostics in otherwise asymptomatic men. Especially in the gray zone between 4 and 10 ng/ml the tissue marker PSA is frequently influenced by benign alterations, so that it is not possible--on the basis of the PSA value alone--to differentiate between benign and malignant causes. Only a clearly increased serum PSA value (>20 ng/ml) indicates the presence of a prostate carcinoma at a very high probability. However, it is necessary that all patients whose PSA is elevated, undergo a bioptical tissue sample procedure in order to try to diagnose prostate cancer. Today, we regard the technique of TRUS-based transrectal prostate biopsy, carried out with a semi-automatic coil spring device and an 18-gauge needle, as the gold standard. The core problem of visual TRUS assessment lies in its lack of specificity, especially if the examiner has only limited experience. There can be low-echo, cancer-suspicious areas that may be histologically either benign or malignant. Benign prostatic hyperplasia (BPH), vessels, centers of prostatitis as well as shadows and artefacts can often also be low in echo-density. Only adequate application of this technology and experience with this method can lead to satisfying biopsy and diagnostic results.

EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction

“…A large body of evidence documents the accuracy of TRUS in calculating PV. TRUS is superior to suprapubic (transabdominal) PV measurement because all three distances for the prostate can be measured more accurately via the transrectal approach [78,79]. The presence of a middle lobe protruding into the bladder may guide the treatment choice in patients scheduled for a minimally invasive approach.…”

Tiny percutaneous needle biopsy: An efficient method for studying cellular and molecular aspects of skeletal muscle in humans

“…We became convinced that we had to employ a needle smaller in diameter than that of the Edwards NAB, but which could nonetheless give us samples of sufficient quality and quantity to further our work. We used a semi-automatic needle that had previously been employed principally in the clinical investigation of patients with mammary (15), lung (14), or prostate cancer (16) and also musculoskeletal masses (21), and to obtain samples for immunocytochemistry and immunohistochemistry. A small automatic needle had earlier been used for purification of human muscle satellite cells (18).…”

“…This device has already been employed to sample various tissues including the liver, the mammary gland, the breast, the prostate (14)(15)(16), and the muscle (17). Indeed, Magistris et al (18), used an automatic biopsy device to sample SM in the course of histological and genetic studies.…”

In vivo trans-rectal ultrasound coupled trans-rectal near-infrared optical tomography of canine prostate bearing transmissible venereal tumor

“…Most of the prostate cancers are diagnosed at earlier stage now with the use of the sensitive prostate-specific antigen (PSA) test [2] aided by the digital rectal exam (DRE). Prostate biopsy, guided by trans-rectal ultrasound (TRUS), is performed when the pathological evidence is needed to confirm or rule out the onset of carcinoma in prostate [3].…”