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Introduction ⬇

The prostate ultrasound, also known as a transrectal ultrasound, is an imaging study performed to visualize the prostate gland, typically in response to an elevated prostate-specific antigen blood test or as a complement to a digital rectal examination. Ultrasound of the prostate is also performed to check for depth of transmural tumor involvement, as a guidance mechanism for biopsy procedures, and to assist in placement of radioactive implants. Carcinoma of the prostate is the second most common cause of cancer-related death in American men.

The patient typically is instructed to prepare by taking a laxative or administering an enema before the procedure. The patient usually is examined with the use of a small transducer that is inserted into the rectum while the patient is in the left lateral decubitus position with the knees flexed toward the chest. Multiple images of the prostate, rectal walls, prostate urethra, and ejaculatory ducts are taken. Prostatic volumes are calculated from 2D measurements. Doppler evaluation is used to assess blood flow through the prostate or any mass that might be detected.

Procedure ⬆ ⬇

  1. Ask the patient to void and to remove clothing from the waist down.

  2. Position the patient on an examination table in the left lateral decubitus position, with his knees flexed toward the chest and cover with a drape.

  3. Perform a digital rectal examination before inserting the rectal transducer.

  4. Carefully insert a slim endorectal transducer, lubricated and sheathed with a condom, a few centimeters into the rectum.

  5. Perform scans by using a slight rotation of the probe handle. Tell the patient that total examination time is about 15–20 minutes.

  6. See Chapter 1 guidelines for intratest care.

Clinical Alert

  1. If the prostate examination is performed in conjunction with a prostatic biopsy, be certain to obtain a signed, witnessed consent form.

  2. If the patient is latex sensitive, contact the laboratory.

Clinical Implications ⬆ ⬇

Abnormalities that may be detected include:

  1. Prostatic enlargement—increased volume measurements may indicate:

    1. Benign prostatic hypertrophy

    2. Space-occupying lesion (tumor, cyst, abscess)

  2. Prostatic calcifications

  3. Prostatitis

  4. Prostate cancer, classically seen as a low-level echo structure within the outer gland (peripheral and central zones)

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the test.

  2. Assure the patient that no pain is involved, but that a sensation of fullness within the rectum is to be expected. Check for latex sensitivities before the procedure as the transducer is typically draped with a condom.

  3. Administer an enema about 1 hour before the study, if ordered.

  4. Advise the patient to empty the bladder immediately before the study.

  5. Ensure that a signed consent is in the patient’s medical record if an invasive procedure is to be performed.

  6. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Counsel the patient about any identified prostatic abnormalities and need for possible further testing (tissue biopsy with cytologic or histologic examination) and treatment.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

Excess fecal matter in the rectum compromises the study.

Reference Values ⬆

Normal