Prostate

Protocol

Protocol
• The prostate may be evaluated transabdominally or transrectally. The protocol provided is specific for
transrectal examinations

Organ/Order Scan Plane Label Landmarks Identified

Seminal Coronal/ Hypoechoic seminal vesicles joined by hypoechoic
SV/VAS DEFERENS
Vesicles Transverse vas deferens
Most superior portion near bladder
Half-moon shape – homogeneous and slightly
PROSTATE BASE
hypoechoic
CZ and TZ
PZ laterally - homogeneous and isoechoic to TZ
CZ - slightly hyperechoic to PZ
Coronal/ PROSTATE
Prostate TZ - homogeneous area on each side of urethra –
Transverse MID
isoechoic to PZ
Verumontanum - anechoic shadow
PROSTATE With width and AP measurements
MID
PROSTATE Most inferior portion
APEX Mostly PZ – slightly more heterogeneous than base
Seminal Lateral and superior to prostate
Vesicles and Sagittal RT SV & VAS DEFERENS
Vas Deferens
RT PROSTATE Right lateral prostate including CZ and PZ
Anechoic urethra
CZ – posterior to urethra
MID PROSTATE PZ - posterior to CZ
Prostate Sagittal
TZ surrounding urethra
Anterior fibromuscular tissue – anterior to TZ
MID PROSTATE With length measurement
LT PROSTATE Left lateral prostate including CZ and PZ
Seminal Lateral and superior to prostate
Vesicles and Sagittal LT SV & VAS DEFERENS
Vas Deferens

Anatomical/Image Correlation

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 Prostate Protocol

Percentage of Glandular
Name Description
Tissue

Located at the posterior, lateral, and apical portions of the

Comprises up to 70% of
Peripheral Zone gland and surrounds the distal urethra. More than 70% of
the normal prostate
(PZ) prostate cancers originate from the PZ. PZ is also a
gland in young men
common location for prostatitis.

Located at base within the PZ and surrounds the

Approximately 25% of
ejaculatory ducts. The CZ accounts for roughly 2-5% of
Central Zone (CZ) the normal prostate
prostate cancers although these cancers tend to be more
gland
aggressive and more likely to invade the seminal vesicles.
Transition Zone 4-5% in young men – this This zone accounts for approximately 20-25% of
(TZ) amount increases with carcinomas. The transition zone surrounds the proximal
BPH involvement urethra; its most caudal portion is the verumontanum. The
TZ grows throughout life and is the zone most affected by
BPH.

Normal Measurement Ranges

Structure Area of Plane Measurement Comments

Interest
Transverse/Coronal Calipers placed on outer borders
Width 3-3.5 cm

Transverse/Coronal Calipers placed on outer borders
Prostate AP Diameter 2-3 cm

Sagittal Calipers placed on outer borders
Length 3.5-4 cm

Combined Planes Length x width x height x 0.52 = Volume
Prostate Combined Normal less than

Volume Measurement 20 grams

Seminal Transverse Only performed if clinically indicated or if
AP Diameter Less than 1 cm
Vesicles abnormalities are suspected

Tips
• A transabdominal exam can be used to detect gross abnormalities and to obtain a prostate volume
• A transrectal exam is done with the patient on his side in a fetal position
• Seminal vesicles will vary in size and appearance due to amount of seminal fluid they contain – they will be
hypoechoic when empty and large and anechoic when full of seminal fluid
• It can be difficult to differentiate the zones sonographically – use your surrounding landmarks
• Evaluate the prostate for focal masses, echogenicity, symmetry, and continuity of margins
• Evaluate the seminal vesicles for size, shape, position, symmetry, and echogenicity

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