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7 - Transrectal ultrasound imaging of the prostate

Published online by Cambridge University Press:  23 December 2009

By
Mark L. Pe ,
Edouard J. Trabulsi  and
Ethan J. Halpern
Edited by
Hedvig Hricak  and
Peter Scardino
Hedvig Hricak
Affiliation:
Memorial Sloan-Kettering Cancer Center
Peter Scardino
Affiliation:
Memorial Sloan-Kettering Cancer Center
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Summary

Introduction

Over 186 000 men will be diagnosed with prostate cancer in 2008, accounting for approximately 25% of newly diagnosed cancers in the US male population [1]. In the era of prostate-specific antigen (PSA) screening, prostate cancer has undergone a significant downward stage and risk migration, with an increasing proportion of low-risk, organ-confined disease being diagnosed [2].

Transrectal ultrasound (TRUS) imaging of the prostate has played a fundamental role in the diagnosis, staging, and management of prostate cancer. During the past decade, technological innovations have improved the detection of prostate cancer. Clinical research continues to focus on methods to accurately and efficiently identify clinically significant neoplasms. In this chapter, we describe contemporary techniques for TRUS imaging and detection of prostate cancer.

Sonographic anatomy

Accurate evaluation and assessment of the prostate during TRUS requires a fundamental understanding of the underlying sonographic anatomy and histopathology of the gland. The prostate gland is anatomically divided into zones, originally described by McNeal in 1981 [3]. Zonal architecture of the prostate is defined anatomically with respect to glandular drainage into the prostatic urethra, and consists of a total of four glandular zones – the periurethral zone, the transition zone, the central zone, and the peripheral zone – as well as the anterior fibromuscular stroma. The anterior fibromuscular stroma does not contain any glands, whereas the peripheral zone comprises approximately 70% of the glandular tissue in the normal prostate.

Type
Chapter
Information
Prostate Cancer , pp. 102 - 119
Publisher: Cambridge University Press
Print publication year: 2008

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