Prostate Sonography & Pathology Review

A comprehensive set of flashcards covering anatomy, sonographic technique, biomarkers, biopsy methods, benign and malignant pathology, and congenital anomalies of the prostate.

What prostate parameters are routinely assessed with sonography?

Size, shape, echogenicity, and vascularity.

Besides normal evaluation, what pathologies can prostate ultrasound help diagnose or assess?

Prostate cancer, benign prostatic enlargement (BPH), prostatitis, prostatic abscess, and congenital anomalies.

Where is the prostate located relative to surrounding structures?

Retroperitoneal; posterior to the pubic bone, anterior to the rectum, inferior to the urinary bladder, and superior to the urogenital diaphragm.

What is the normal prostate volume?

Less than 30 cc (30 mL).

Which artery supplies most of the prostate’s blood flow?

The inferior vesical artery, a branch of the internal iliac artery.

What is the superior portion of the prostate called?

The base (just below the bladder).

What is the inferior portion of the prostate called?

The apex (just above the urogenital diaphragm).

Name the four zones of the prostate according to McNeal.

Peripheral zone, central zone, transitional zone, and anterior fibromuscular stroma.

Which prostate zone contains 70 % of glandular tissue and is the most common site of cancer?

The peripheral zone.

Which zone contains 25 % of glandular tissue and is traversed by the ejaculatory ducts?

The central zone.

Which zone is the origin of benign prostatic hyperplasia (BPH)?

The transitional zone (contains ~5 % of glandular tissue).

What portion of the prostate is nonglandular and not affected by cancer, prostatitis, or hyperplasia?

Anterior fibromuscular stroma.

What is the ‘surgical capsule’ in prostate sonography?

The sonographic demarcation between the inner (central + transitional) and outer (peripheral) gland.

Describe the 'Eiffel Tower sign' on prostate ultrasound.

A shadowing artifact from the prostatic urethra, resembling the Eiffel Tower.

Where are the seminal vesicles located in relation to the prostate and bladder?

Posteroinferior to the bladder, superior-posterior to the prostate, between bladder and rectum.

How do seminal vesicles appear on transrectal ultrasound?

Oval hypoechoic structures 3–5 cm long, 1–2 cm wide; bow-tie shape in axial view.

What structure forms where the ejaculatory ducts open into the urethra?

The verumontanum (a longitudinal urethral ridge).

What is prostate-specific antigen (PSA)?

A single-chain glycoprotein produced by normal and malignant prostate cells, measured in blood.

What is the generally accepted upper limit of normal PSA?

4 ng/mL (nanograms per milliliter).

Define PSA velocity.

The rate of change of PSA levels over time; faster rises suggest higher cancer risk.

Define PSA density.

PSA level divided by prostate volume; higher density indicates greater likelihood of cancer.

List common indications for prostate ultrasound.

Biopsy guidance after abnormal DRE or elevated PSA, prostate volume assessment, brachytherapy seed placement, lower urinary tract symptoms, congenital anomalies, infertility, hematospermia, suspected recurrence post-prostatectomy, ejac. dysfunction.

What bladder preparation is needed for transabdominal prostate ultrasound?

A partially filled bladder (≈500 mL water 1 hour before).

What patient position is used for transrectal prostate ultrasound (TRUS)?

Left lateral decubitus with right knee flexed.

Which transducer is used for transabdominal prostate scanning?

Curvilinear 3–5 MHz transducer.

Which transducer and frequency are typical for TRUS?

Endocavitary sector probe, 6–12 MHz (use highest practical frequency).

How is prostate volume calculated sonographically?

Length × height × width × 0.52.

Why are TRUS images often displayed inverted?

To maintain standard orientation with anterior structures at the top and the rectum at the bottom.

Name the three main prostate biopsy strategies.

Lesion-directed biopsy, systematic sextant biopsy (3 cores each side), and parasagittal sextant biopsy (12 cores including lateral peripheral zone).

What defines benign prostatic hyperplasia (BPH) on ultrasound?

Prostate volume greater than 30 cc with enlargement of the transitional zone.

What are typical urinary symptoms of BPH?

Difficulty initiating voiding, urinary frequency, and weak urinary stream.

What are corpora amylacea?

Prostatic calcifications (seen sonographically as echogenic foci, usually asymptomatic in men >60 yrs).

Where are utricle cysts located and with what conditions are they associated?

Midline pear-shaped cysts at the verumontanum; linked to hypospadias, cryptorchidism, and unilateral renal agenesis.

How do Müllerian duct cysts differ from utricle cysts?

Tear-drop midline cysts extending above the prostate, posterior to bladder, DO NOT communicate with urethra.

What symptoms may accompany paramedian (ejaculatory duct) cysts?

Hematospemia, ejaculatory pain, infertility, pelvic mass, irritative urinary symptoms.

List three major risk factors for prostate cancer.

Increasing age, positive family history (especially brother), and African American race.

What is the current ACS stance on routine prostate cancer screening?

No routine screening; men with ≥10-year life expectancy should make an informed choice after counseling.

Give three common symptoms that could suggest prostate cancer.

Difficulty starting urination, blood in urine/semen, persistent back/hip/pelvic pain (others include nocturia, weak stream, painful ejaculation).

What is the classic sonographic appearance of prostate cancer?

Hypoechoic, peripherally located lesion (though may vary in echogenicity).

What does a high Gleason score (8–10) indicate?

High-grade, highly aggressive prostate cancer with poorer prognosis.

Describe the four basic stages of prostate cancer.

Stage 1: small lesion, low PSA, low Gleason; Stage 2: confined to prostate, medium PSA; Stage 3: extends outside prostate, high PSA; Stage 4: metastatic to lymph nodes/bone/other organs.

With what anomalies is seminal vesicle agenesis associated?

Ipsilateral renal agenesis, vas deferens agenesis, and cystic fibrosis.

What triad defines Zinner syndrome?

Unilateral renal agenesis, ipsilateral seminal vesicle obstruction/cyst, and ipsilateral ejaculatory duct obstruction.

Prostate agenesis is linked to which endocrine/genetic conditions?

5-alpha-reductase deficiency and testicular feminization.

Why is color or power Doppler useful in prostate ultrasound?

It helps identify areas of increased vascularity to target for biopsy.

How is PSA density calculated?

PSA (ng/mL) divided by prostate volume (mL).