Discuss embryologic development, differentiation of structures, and hormones influencing maturation of the prostate gland.
Identify surface, relational, and internal prostate anatomy to include differentiating the four prostate zones.
Demonstrate routine scanning procedures to include patient preparation; patient instructions; patient position; transrectal and transabdominal scanning, biopsy techniques; technical considerations; and common scanning pitfalls.
Describe the pathology, etiology, clinical signs, symptoms, and sonographic appearance of cysts in the male pelvis to include Müllerian duct and utricle cysts, seminal vesicle cysts, prostatic cysts (prostatic abscess), and diverticula of the ejaculatory ducts and vas deferens.
Explain the pathology, etiology, clinical signs and symptoms, and sonographic appearance of benign prostatic hyperplasia.
Identify the pathology, etiology, clinical signs and symptoms, and sonographic appearance of prostate calcifications.
Categorize the pathology, etiology, clinical signs and symptoms, and sonographic appearance of prostatitis to include acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis.
Recognize sonographic characteristics of benign and malignant conditions of the prostate gland.
Briefly discuss the multiparametric ultrasound (mp-US) approach of combining B-mode and Doppler ultrasound (US) with volume imaging (3D), contrast-enhanced US (CEUS) and shear wave elastography (SWE) to improve the diagnostic performance in detecting prostate cancer (PCa).
Discuss the role of sonography in providing guidance for biopsy procedures.
Discuss the role of sonography in evaluation of suspected male infertility.
inferior portion of the prostate gland, located superior to the urogenital diaphragm
superior portion of the prostate gland, located below the inferior margin of the urinary bladder
calcifications commonly seen in the inner gland of the prostate
shadowing artifact created in the area of the urethra and verumontanum
duct that passes through the central zone and empties into the urethra; originates from the confluence of the vas deferens and the seminal vesicle
calculi formation within the substance of the prostate
calculi found in the urethra
paired simple tubular glands that extend from an outpouching of the vas deferens; located superior and posterior to the prostate, between the urinary bladder and rectum
a demarcation between the inner gland (central and transitional zones) and outer gland (peripheral zone), which is normally hypoechoic but may be echogenic if corpora amylacea or calcifications are present
reproductive duct that extends from the epididymis to the ejaculatory duct; also known as the ductus deferens
a longitudinal elevation or ridge of tissue on the posterior prosthetic urethral wall where the orifices of the ejaculatory ducts are located
of the gland to the midline where it joins the urethra at the verumontanum, a longitudinal ridge on the posterior wall of the prostatic urethra.1,8 This structure is located at the midpoint of the prostatic urethra near the apex and is laterally flanked by the openings of the ejaculatory ducts (Fig. 14-2B). The utricle, a small epithelium-lined diverticulum at the apex of the verumontanum, is a fetal remnant of the urogenital sinus and is homologous to the female uterus6,8,9 (Fig. 14-2C). Abnormal dilatation, cysts, or calcifications can occur at this level, and they are usually associated with urinary tract symptoms. This structure accounts for the “Eiffel Tower” appearance on transverse images of the prostate gland obtained at this level1,10 (Fig. 14-3).
FIGURE 14-3 Verumontanum. A coronal sonogram of the normal prostate. The “Eiffel Tower” sign (arrow) is seen at the level of the prostatic utricle.
that sweep around the acini. Only about 5% of prostate carcinomas arise within the central zone. Sonographically, the echogenicity of the central zone is normally brighter than that of the peripheral zone.
FIGURE 14-5 Parasagittal view of the prostatic venous plexus and neurovascular bundle. (Reprinted from Ohori M, Scardino PT. Localized prostate cancer. Curr Probl Surg. 2002;39(9):843-957. Copyright © 2002 Elsevier. With permission.)
TABLE 14-1 Prostate Zones
FIGURE 14-7 A drawing of the funnel-shaped central zone illustrates the ejaculatory ducts’ entrance into the prostate.
FIGURE 14-8 This drawing depicts the saddlebag-shaped transitional zone and its relationship to the urethra.
are reservoirs for seminal fluid that fluctuate in size and shape secondary to levels of sexual activity. When void of seminal fluid, they appear as curvilinear, hypoechoic structures that flare out laterally. When these structures fill with seminal fluid, they become large, ovoid-shaped cystic structures. Sonographically, low-level echoes are often appreciated within the anechoic fluid.16,20
TABLE 14-2 Clinical Role of Prostatic Evaluation
FIGURE 14-9 A transabdominal, transverse sonogram of the prostate (arrow). The urinary bladder (Bl) was used as an acoustic window to evaluate the gland. Only gross abnormalities were diagnosed using this technique.
FIGURE 14-10 Scanning technique of the endorectal approach currently used to evaluate the prostate. An endorectal, end-fire transducer is used to acquire transverse and sagittal images of the prostate.
FIGURE 14-11 Transverse sonogram of the normal prostate. A: The base of the normal prostate gland is half moon-shaped. B: The verumontanum (arrow) is visualized at the level of the midgland. C: The apex is the most inferior aspect of the prostate.
FIGURE 14-12 Sagittal sonogram of the normal prostate. A: The midline section shows the urethra (arrow) coursing through the gland. B: The right lobe of the prostate can be identified.