Prostate Protocol

Organ/Or Scan Label Landmarks Identified
der Plane
Coronal/ Hypoechoic seminal vesicles joined by
Seminal
Transver SV/VAS DEFERENS hypoechoic vas deferens
Vesicles
se
Most superior portion near bladder
Half-moon shape – homogeneous and
PROSTATE BASE
slightly hypoechoic
CZ and TZ
PZ laterally - homogeneous and isoechoic
to TZ
Coronal/ PROSTATE CZ - slightly hyperechoic to PZ
Prostate Transver MID TZ - homogeneous area on each side of
se urethra – isoechoic to PZ
Verumontanum - anechoic shadow
PROSTATE With width and AP measurements
MID
Most inferior portion
PROSTATE
Mostly PZ – slightly more heterogeneous
APEX
than base
Seminal Lateral and superior to prostate
Vesicles
RT SV & VAS
and Sagittal
DEFERENS
Vas
Deferens
RT PROSTATE Right lateral prostate including CZ and PZ
Anechoic urethra
CZ – posterior to urethra
PZ - posterior to CZ
MID PROSTATE
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
LT SV & VAS
and Sagittal
DEFERENS
Vas
Deferens
Protocol
 The prostate may be evaluated transabdominally or transrectally. The protocol
provided is specific for transrectal examinations

Anatomical/Image Correlation

AK\backup\Abdomen II\protocols
Prostate Protocol

Percentage of
Name Description
Glandular Tissue

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

Located at base within the PZ and surrounds
Approximately 25% the ejaculatory ducts. The CZ accounts for
Central Zone
of the normal roughly 2-5% of prostate cancers although
(CZ)
prostate gland these cancers tend to be more aggressive and
more likely to invade the seminal vesicles.

Transition Zone 4-5% in young men This zone accounts for approximately 20-25%
(TZ) – this amount of carcinomas. The transition zone surrounds
increases with BPH the proximal urethra; its most caudal portion is
involvement the verumontanum. The TZ grows throughout
life and is the zone most affected by BPH.

Normal Measurement Ranges

Structu Area of Plane Measuremen Comments
re Interest t
Prostat Transverse/Cor Calipers placed on outer borders
Width 3-3.5 cm
e onal
AP Transverse/Cor Calipers placed on outer borders
2-3 cm
Diameter onal
Length Sagittal 3.5-4 cm Calipers placed on outer borders
AK\backup\Abdomen II\protocols
Prostate Protocol

Combined Length x width x height x 0.52 =
Prostat Combined
Planes Normal less Volume
e Measurem
than 20 grams
Volume ent
Semina Transverse Only performed if clinically
l AP indicated or if abnormalities are
Less than 1 cm
Vesicle Diameter suspected
s

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

AK\backup\Abdomen II\protocols