associated with hypoechoic lesions and prostate cancer.

are calcifications in the peripheral zone exclusively and are located in blood vessels.

pathognomonic for acute prostatitis.

most commonly seen between the transition and peripheral zone of the prostate.

always associated with prostate infection.

Masses in the seminal vesicles are the most common lesion seen on transrectal ultrasonography (TRUS) of the prostate.

Solid masses in the seminal vesicle can be caused by schistosomiasis in endemic regions.

The seminal vesicles are usually asymmetrical and normally measure less than 2╯cm in length in the adult.

A solid mass in the seminal vesicle is always associated with malignancy.

Most cystic masses in the seminal vesicle are malignant and related to prostate cancer.

It should have an intact fat plane between the bladder neck/urethra and the rectum.

It should always be accompanied by biopsies of the perianastomotic area and bladder neck in patients with prostate-specific antigen (PSA) recurrence.

It should show a smooth tapering of the bladder neck to the urethra.

It often reveals a hypoechoic mass anterior to the anastomosis, which usually represents recurrent cancer.

It is contraindicated because of potential disruption of the anastomosis.

There is a poor correlation between radical prostatectomy specimen weights and volume as measured by TRUS.

Planimetry with a stepping device should be used for routine prostate volume determinations.

Prostate cancer is always associated with an increase in overall volume of the prostate.

The mature average prostate is between 20 and 25╯g and remains relatively constant until about age 50, when the gland enlarges in many men.

Only one formula (prolate ellipse) is acceptable to determine prostate volume.

prostate cancer.

hematologic malignancies.

granulomatous prostatitis.

normal urethra.

transition zone, benign prostatic hyperplasia nodules.

Free PSA of less than 10% with a total PSA less than 10╯ng/dL

Routine evaluation of male infertility

Diagnosis of recurrence after radiation therapy in a rising PSA

PSA velocity greater than 0.75 to 1.0╯ng/dL/year

Nodule on digital rectal examination regardless of PSA level

It is typically performed using lidocaine, a long 22-gauge spinal needle, and the biopsy channel of the ultrasound probe.

Intrarectal lidocaine gel is as effective as the injection of lidocaine.

It is best performed using direct injection of lidocaine into the prostate gland.

It is not necessary even with extended-core biopsies owing to the small size of the needle.

It is typically performed using digital guidance to ensure that the base of the prostate near the seminal vesicles is infiltrated.

color and power Doppler should be available to localize the malignant foci.

enemas should not be used before the procedure and may increase the risk of bleeding.

intravenous antibiotic prophylaxis is necessary in all patients to prevent urosepsis.

the left lateral decubitus position is most commonly used.

the dorsal lithotomy position increases the diagnostic accuracy of the prostate biopsies.

the transition zone should be included in all initial biopsies, because of the high incidence of cancer in this area.

isoechoic lesions are rarely cancerous and should not be sampled unless they are calcified.

a minimum of 10 to 12 systematic biopsies is now most

only hypoechoic lesions should be sampled. commonly used.

sextant biopsy represents the standard of care for the diagnosis of prostate cancer today.

It is the most accurate way to diagnose and grade prostate cancer.

It is commonly used outside the United States and has a low morbidity.

Complications are greater than with TRUS needle biopsy techniques.

It is more costly than other TRUS biopsy techniques commonly used.

Diagnostic accuracy in determining Gleason score is superior to that with core needle biopsy.

Epididymitis is the most common infection after TRUS biopsy even if antibiotics are used.

It is not necessary if the probe is sterilized and an enema is given.

Bacteriuria is the only indication for antibiotics after TRUS prostate biopsy.

It eliminates the risk of any infection.

It reduces the risk of febrile urinary tract infection requiring hospitalization.

usually clears immediately after TRUS biopsy.

is eliminated with the routine use of antibiotics.

can persist for up to 4 to 6 weeks after TRUS biopsy.

is eliminated if the probe is held firmly against the prostate after the needle is passed.

usually requires hospitalization.

Transurethral biopsy is the next step after an initial negative biopsy.

They will require repeated biopsy if one of the cores contains seminal vesicle.

Additional biopsies demonstrate decreasing yield of detecting cancer, and the cancer tends to be of lower grade and stage.

They should undergo transperineal biopsy for all future biopsies because these have been shown to be the most accurate approach in large randomized European trials.

They can be assured that no cancer is present.

Ultrasound contrast media appears to enhance the utility of color and power Doppler examinations.

Doppler ultrasonography may be effective in predicting Gleason grade and outcome in prostate cancer.

On color Doppler, red signals indicate arterial flow and blue signals indicate venous flow.

These are the most accurate technologies to use to diagnose prostate cancer on TRUS-directed biopsy.

Power Doppler cannot identify slow-moving blood in vessels.