Prostate Ultrasound
A prostate ultrasound is a diagnostic method that provides images of the prostate gland and surrounding structures using ultrasound waves. These waves reflect off body tissues, producing echoes that are turned into images.
General Description
A prostate ultrasound is a diagnostic method that uses ultrasound to capture images of the prostate gland and surrounding tissues to evaluate its morphology and function. The device used is called a sonograph, which consists of a manual probe (transducer) that emits ultrasound waves. When these waves bounce off the prostate tissue, they create an echo that is returned to the transducer and sent to a computer, which processes the information and displays moving images in real time.
There are two main modalities for performing prostate ultrasound:
- Abdominal or Suprapubic Prostate Ultrasound: The transducer is placed on the skin of the abdominal region. This is usually the first option as it is simpler. Occasionally, a bladder study (vesico-prostatic ultrasound) is conducted at the same time.
- Transrectal Prostate Ultrasound: In this case, the transducer is inserted into the rectum. It is a more invasive technique but offers much higher quality images. This method is recommended when the rectal exam or abdominal route is inconclusive or as part of early cancer detection protocols.
When Is It Indicated?
A prostate ultrasound is commonly requested in the following situations:
- There are urinary problems.
- Elevated PSA (prostate-specific antigen) levels in the blood.
- A nodule or abnormal mass is detected during a routine physical exam.
- There are sexual or fertility problems.
- Pain is felt in the groin, pelvic area, or genital region.
- The patient reaches the age for inclusion in early cancer detection programs (usually from 50 years old).
The ultrasound helps identify any abnormalities in the prostate area, mainly:
- Prostate enlargement (benign prostatic hyperplasia) and its impact on the bladder and kidneys.
- Presence of cysts, nodules, abscesses, calcifications, or tumors.
- Cancer.
- Infection and inflammation of the prostate (prostatitis).
Additionally, the transrectal prostate ultrasound is used as a guide during a prostate biopsy.
How Is It Performed?
For an abdominal prostate ultrasound, the patient must lie on their back on an examination table. Before starting the test, a gel is applied to the skin in the suprapubic region to facilitate the movement of the transducer, act as a sound conductor, and eliminate air pockets that could interrupt the reception of the ultrasound waves and affect the image clarity. However, for a transrectal prostate ultrasound, the patient must lie on their side with their knees bent toward their chest. Before inserting the transducer through the anus, it is covered with a latex protective sleeve, and the area is lubricated with gel.
In both cases, the specialist gently moves the transducer in different directions to capture various perspectives of the prostate, which are shown in real-time on the monitor.
Risks
The abdominal prostate ultrasound is an extracorporeal, painless procedure with no risk to the patient, as ultrasound waves are harmless and no radiation or anesthesia is used.
On the other hand, for the transrectal ultrasound, it is common, though not severe, for rectal bleeding to occur in patients with hemorrhoids or anal fissures. In both cases, it is very rare, but an allergic contact dermatitis could develop due to the use of the ultrasound gel.
What to Expect from a Prostate Ultrasound
Before the examination begins, the patient must remove clothing covering the examined area, wear the provided gown, and lie in the correct position on the table. They should also remain as still as possible during the test. The abdominal prostate ultrasound is completely painless, although the patient may feel a cold sensation when the gel is applied and slight pressure as the doctor moves the transducer. The procedure lasts between five and ten minutes.
However, the transrectal prostate ultrasound can be painful, as the transducer's passage through the sphincter may be difficult due to tightness or the presence of fissures or other anal injuries. In such cases, sedation or local anesthesia may be applied. The study is typically completed in less than 20 minutes.
After the examination, any gel residue on the skin is cleaned with a disposable wipe. Both procedures are outpatient, so the patient can leave normally after the test with no need for further care.
Specialties That Request Prostate Ultrasound
The main specialties that commonly request a prostate ultrasound are urology, oncology, and assisted reproduction.
How to prepare
A prostate ultrasound does not require complicated preparation, although some steps must be followed:
- If the test is performed through the abdominal route, the patient must come with a full bladder, so they may be instructed to drink several glasses of water before the examination.
- If performed transrectally, it is generally required that the bladder contain urine retained after urination. Also, the rectum needs to be clean for an effective examination, so it is recommended to use an enema in the hours before the test to fully empty the intestine.
