Prostate

Question 1

How many lobes is the prostate divided into?

Answer 1

Five

Question 2

Carcinoma of the prostate is most often found in the:

Answer 2

Peripheral zone

Question 3

Elevated prostate specific antigen (PSA) is found in patients with?

Answer 3

Carcinoma

Question 4

What is the most common prostate condition in a male over the age of 50?

Answer 4

Benign prostatic hypertrophy (BPH)

Question 5

A 52 year old man presents with Hydronephrosis and asymmetric prostate enlargement. This is most likely consistent with:

Answer 5

Carcinoma

Question 6

The seminal vesicles are located:

Answer 6

Posterior to the bladder,
superior to the prostate,
Lateral to ductus deferens

Question 7

Benign prostatic hypertrophy usually occurs in the:

Answer 7

Transitional zone

Question 8

Transverse images at the base of the prostate are used to:

Answer 8

Image the seminal vesicles

Question 9

A male patient presents sonographically with a hypervascular noncompressible mass noted in the peripheral zone and ejaculatory ducts filled with calculi. The most likely diagnosis is:

Answer 9

Prostatitis

Question 10

Male infertility can result from:

Answer 10

Blocked seminal vesicles, prostatitis, or prostatic lesions

Question 11

What PSA levels would indicate a strong suspicion for cancer?

Answer 11

Greater than 20 ng/mL

Question 12

What zone of the prostate is comprised of 70% glandular tissue and is the most common site for prostate cancer and prostatitis?

Answer 12

Peripheral zone

Question 13

Mr. Smith is a 54-year-old male who presents to the ER with a fever, stating he has been experiencing rectal tenderness accompanied by pain in how lower abdomen for the first time that began a few days ago. Lab results indicate normal PSA and no other abnormal indicators. Sonographic examination reveals a hypoechoic appearance of the peripheral zone. What is the diagnosis?

Answer 13

Acute prostatitis

Question 14

A 30 year old male came in to discuss infertility issues due to him and his wife not being able to conceive for over a year now, and his wife has confirmed that she’s able to have children. The sonographer visualized a heterogeneous peripheral zone and irregularity shaped focal mass with calcifications and hypervascularity within the prostate. What is the most likely diagnosis?

Answer 14

Chronic prostatitis

Question 15

While a 70 year old African American male patient was at his annual physical exam, a palpable mass was detected during the digital rectal exam. The labs revealed that the PSA was elevated to 22 ng/mL. The patient presented sonographically with a thickened bladder wall and a hyperechoic nodule, in the peripheral zone. Color Doppler revealed hypervascularity. What is the most likely prognosis?

Answer 15

Prostate carcinoma

Question 16

Which zone of the prostate is most commonly involved in prostate adenocarcinoma?

Answer 16

Peripheral zone

Question 17

On transrectal ultrasound, which feature is most suggestive of clinically significant prostate cancer ?

Answer 17

Hypoechoic lesion in the peripheral zone with irregular margins.

Question 18

A 64 year old male arrived for an ultrasound exam with complaints of pain. In the scrotum and thighs. He stated he has been experiencing an urgency to urinate frequently. While scanning, you see a heterogeneous focal mass in the peripheral zone with calcifications. What is the likely diagnosis?

Answer 18

Chronic prostatitis

Question 19

The prostate consists of five lobes and four zones that account for glandular tissue. Which zone surrounds the urethra and is more likely for cancer to originate?

Answer 19

Transitional zone

Question 20

What best describes the sonographic appearance of the prostate following a TURP procedure performed for benign prostatic hypertrophy?

Answer 20

Anechoic space in the area of the prostatic urethra in the center of the prostate

Question 21

A 65 year old male presents with difficulty urinating, weak urine stream, and lower back pain. Laboratory results show elevated prostate-specific antigen (PSA) levels, and digital rectal exam reveals a firm, irregular prostate. Sonographic evaluation reveals an asymmetrically enlarged prostate gland with local extension into the seminal vesicles. What is the most likely diagnosis?

Answer 21

Prostate carcinoma

Question 22

A 66 year old man presents with decreased urinary stream and incomplete bladder emptying. Sonographic evaluation reveals a hypoechoic, homogeneous enlargement in the prostates transitional zone. Which type of BPH is most likely?

Answer 22

Stromal hyperplasia

Question 23

A 70 year old man presents with difficulty urinating and receives an ultrasound showing a hypoechoic anlargement surrounding the proximal urethra. The affected zone makes up 5–10% of glandular tissue and is the most common site of benign prostatic hypertrophy. Which zone is most likely involved?

Answer 23

Transitional zone

Question 24

A 50 year old African American male comes in for a transrectal ultrasound for urinary frequency and recurrent lower back pain. His labs also show an increased PSA. When you start the exam, you look at the peripheral zone and see hypoechoic nodules. You also measure his prostate, and it is enlarged. What would be the most likely diagnosis?

Answer 24

Prostate carcinoma

Question 25

A 30 year old male comes in for a checkup, he explains to his doctor that he has been experiencing painful ejaculation and rectal discomfort. He also states that he noticed that there was blood in his sperm last time he ejaculated. The doctor gives him a referral for a prostate ultrasound. The sonographer starts the exam and sees an anechoic cystic structure attached by a stalk extending into the prostate lateral from the midline and superior to the base of the prostate gland. The cystic structure has smooth and regular borders, contains calcifications, and is 4cm in size. What is the most likely diagnosis?

Answer 25

Müllerian duct cyst

Question 26

A 50 year old male patient comes in for a prostate ultrasound. He explains he is there because during a digital rectal exam at his doctors office, a mass was felt on the prostate. His lab work shows a PSA level of 18 ng/mL. Upon examination, you noticed the prostate is enlarged with an increase in blood flow and some hyperechoic nodules. What stage of prostate cancer could this indicate?

Answer 26

T2

Question 27

A man presents to the ER complaining of pain in his scrotum and penis. He also noted that he has had increased frequency to urinate. When asking him how long he has been experiencing the pain and urinary frequency, he states that he has had recurrent episodes over the course of several months. Upon sonographic examination of his prostate, you visualize complex focal masses with calcifications. You also note that the peripheral zone has a heterogeneous appearance. What is the most likely diagnosis?

Answer 27

Chronic prostatitis

Question 28

What shape does the hyperechoic pattern of calculi in the most caudal portion of the transitional zone (TZ) resemble?

Answer 28

Eiffel Tower

Question 29

A 73 year old male comes in for an ultrasound due to some recent urinary problems such as dribbling and difficulty starting a stream. Sonographic examination demonstrates two echogenic nodules in the transitional zone, a compressed central and peripheral zone, along with hydronephrosis. What is the most likely diagnosis?

Answer 29

Benign prostatic hypertrophy (BPH)

Question 30

A 50 year old male presents with pain, fever, and rectal tenderness. They order an ultrasound and the peripheral zone of the prostate has a hyperechoic appearance. What is the most likely diagnosis?

Answer 30

Prostatitis

Question 31

This zone of the prostate comprises 5 to 10% of the glandular tissue, and consists of two small lobules found lateral to the prox urethral segment. What prostate zone is this?

Answer 31

Transitional zone

Question 32

Where do the ejaculatory duct, vas deferens, epididymides, and seminal vesicles originate from?

Answer 32

Wolffian ducts

Question 33

A small pouch found near the opening of the prostatic ducts:

Answer 33

Prostatic utricle

Question 34

Where do the Müllerian ducts fuse?

Answer 34

In the midline caudally

Question 35

What do the Müllerian ducts give rise to?

Answer 35

Prostatic utricle

Question 36

The prostate lies anterior to..

Answer 36

The rectal ampulla

Question 37

Describe the shape of the normal prostate gland

Answer 37

Oval or chestnut

Question 38

Describe the anatomical location of the prostate

Answer 38

Retroperitoneal

Question 39

What are the two main portions of the prostate along with their locations?

Answer 39

Base (superior) Apex (inferior)

Question 40

What arteries supply the prostate?

Answer 40

Prostatitcovesical arteries arising from the internal iliac arteries

Question 41

Describe the flow of blood in the prostate beginning with the internal iliac arteries:

Answer 41

Internal iliac arteries Prostatitcovesical arteries Split into prostate artery Split into the urethral and capsular arteries and inferior vesical arteries Bladder base, seminal vesicles, and ureter

Question 42

T/F The normal prostate displays hypervascularity

Answer 42

False; Moderately vascular

Question 43

The prostate has ___ lobes and ___ zones

Answer 43

5 lobes 4 zones (more commonly used)

Question 44

What are the lobes of the prostate?

Answer 44

Anterior Middle Posterior Two lateral lobes

Question 45

The urethra is the primary anatomic reference point; what two portions does it divide the prostate gland into?

Answer 45

Anterior Fibromuscular portion Posterior Glandular portion

Question 46

What accounts for two-thirds of the prostate and contains four zones?

Answer 46

Glandular tissue

Question 47

List the four zones of glandular tissue:

Answer 47

1 Peripheral zone (PZ) 2 Central zone (CZ) 3 Transitional zone (TZ) 4 Periurethral glandular tissue (PG)

Question 48

What zone occupies the posterior, lateral, and apica portions of the gland?

Answer 48

Peripheral zone

Question 49

What is the largest zone?

Answer 49

Peripheral

Question 50

Verumontanum

Answer 50

Ejaculatory duct entering urethra A mound of the posterior wall of the prostatic urethra representing mid prostatic urethra and apex

Question 51

Where do the ducts of the peripheral zone enter the distal urethra?

Answer 51

Between the verumontanum

Question 52

Describe the sonographic appearance of the normal peripheral zone

Answer 52

Homogeneous, isoechoic echotexture, seporated from the central zone by the surgical capsule

Question 53

Hyperechoic band separating central zone from peripheral zone:

Answer 53

Surgical capsule

Question 54

What zone comprises 25% of glandular tissue and is rarely affected by disease?

Answer 54

Central zone (CZ)

Question 55

Which zone is located at the base of the prostate like a midline wedge between the peripheral and transition zones?

Answer 55

Central zone (CZ)

Question 56

Where do the vas deferens and Seminal vesicles ducts enter ?

Answer 56

The central zone

Question 57

Where do the the ejaculatory ducts pass through before reaching verumontanum ?

Answer 57

Central zone

Question 58

T/F The central zone is more hypoechoic than the peripheral zone

Answer 58

False The central zone is more hyperechoic than the peripheral zone

Question 59

Which zone comprises 5-10% of the glandular tissue and the periurethral glands?

Answer 59

Transitional zone (TZ)

Question 60

What zone consists of two small lobules found lateral to the prox urethral segment

Answer 60

Transitional zone (TZ)

Question 61

The transitional zone follows the long axis of the urethra toward the…

Answer 61

Bladder neck

Question 62

The most causal segment of the of the TZ is located…

Answer 62

At the verumontanum

Question 63

What zone does BPH originate in?

Answer 63

Transitional zone

Question 64

20% of cancer originate…

Answer 64

In the transitional zone

Question 65

BPH may cause the TZ to appear more…

Answer 65

Hypoechoic

Question 66

T/F Transitional zone and peripheral zone have the same echogenicity

Answer 66

True Transitional zone is isoechoic to peripheral zone

Question 67

What is commonly seen in the TZ?

Answer 67

May see hyperechoic pattern of calculi thst resembles the Eiffel Tower in the most caudal portion

Question 68

Small area of tissue that lines the proximal prostatic urethra

Answer 68

Periurethral glandular zone (PG)

Question 69

What are the paired structures which serve as reservoirs for seminal fluid?

Answer 69

The seminal vesicles

Question 70

What do Seminal vesicles appear as when full?

Answer 70

will appear as a large ovoid shaped cystic structures often seen with some low level echoes within the anechoic fluid (Hazy appearance)

Question 71

When are seminal vesicles considered empty?

Answer 71

Post sexual activity

Question 72

What do the seminal vesicles appear as when empty?

Answer 72

Curvilinear, hypoechoic structures that spread out laterally (wings)

Question 73

Prostate is inferior to…

Answer 73

Inferior to seminal vesicles and urinary bladder

Question 74

Prostate is posterior to…

Answer 74

Space of retzius

Question 75

Describe the space of retzius

Answer 75

Retropubic space between the symphasis pubis and bladder

Question 76

The prostate is anterior to…

Answer 76

Denonvilliers fasia

Question 77

What separates the prostate and rectum and serves as an important landmark for radical prostatectomy?

Answer 77

Denonvilliers fasia

Question 78

What is secreted by the prostate and provides a mode of fluid transport for sperm?

Answer 78

Alkaline fluid

Question 79

What produced the majority of ejaculatory fluid volume?

Answer 79

Prostate

Question 80

What is produced by the glandular tissue?

Answer 80

Prostate specific antigen (PSA)

Question 81

Testosterone and dihydrotestosterone regulate…

Answer 81

Prostate growth and function

Question 82

The most accurate method to calculate prostate function is by:

Answer 82

Calculating the prostate specific antigen density (PSAD)

Question 83

Formula for PSAD:

Answer 83

Divide PSA by prostate volume. Volume is calculated by height x width x length x 0.52

Question 84

Normal PSAD volume is:

Answer 84

Less than 20 grams

Question 85

A protein produced by the cells of the prostate with a normal range of 0 — 0.4 ng/mL in blood

Answer 85

PSA Prostate specific antigen

Question 86

What would be considered a strong likelihood for the presence of cancer in terms of PSA?

Answer 86

Greater than 20 ng/mL

Question 87

What percentage of increased PSA in one year is considered abnormal?

Answer 87

20%

Question 88

An increase of _______ ng/mL in one year is an indication of prostatic cancer?

Answer 88

0.75 ng/mL

Question 89

What are the two PSA assays?

Answer 89

Monoclonal and Polyclonal

Question 90

PSA assay pertaining to a protein from a single clone of cells is termed

Answer 90

Monoclonal

Question 91

What is a normal monoclonal value?

Answer 91

4 ng/mL

Question 92

How do you determine the serum prostate specific antigen (SPSA?)

Answer 92

Multiply PSA by 0.12

Question 93

If the SPSA (serum prostate specific antigen) is higher than PPSA (predicted prostate specific antigen), the probability of cancer or prostatitis is greater than…

Answer 93

50%

Question 94

PSA assay pertaining to proteins from more than a single clone of cells

Answer 94

Polyclonal

Question 95

Normal range for polyclonal

Answer 95

0.2 — 2.5 ng/mL

Question 96

Common urinary symptoms that indicate examination:

Answer 96

Frequency Nocturia (due to incomplete emptying ad rapid refilling of the urinary bladder) Dysuria Decreased force of urinary stream Terminal dripple

Question 97

What is the best patient position for a TRUS exam?

Answer 97

LLD with knees flexed towards the chest

Question 98

What should always be performed prior to a TRUS exam?

Answer 98

A digital rectal exam (DRE) This is to ensure there are no rectal abnormalities.

Question 99

Transducer for transabdominal approach

Answer 99

3–5 MHz

Question 100

Transducer for TRUS approach

Answer 100

5-8 MHz

Question 101

Where should the near field / far field be located TRUS?

Answer 101

The image needs to be inverted and then the near field is at the bottom of your image and far field is at the top

Question 102

During a TRUS exam in the sagittal plane, the base of the gland will be located:

Answer 102

To the left of your image

Question 103

During a TRUS exam in the sagittal plane, the apex of the gland will be located:

Answer 103

To the right of your image

Question 104

T/F TRV or axial right and left orientation are flipped for TRUS

Answer 104

False The right and left stay the same, only top and bottom flip

Question 105

During a TRUS exam, the rectal wall can be seen in:

Answer 105

The near field

Question 106

During a TRUS exam, the bladder will be seen in the:

Answer 106

Far field

Question 107

During a TRUS exam, the prostate can be visualized

Answer 107

Between the rectal wall and bladder

Question 108

During a TRUS exam, you need to fan ______________ to find seminal vesicles

Answer 108

Laterally

Question 109

What is the sonographic appearance of a normal prostate during a TRUS exam?

Answer 109

Hypoechoic Symmetrical size and shape Bow-tie appearance

Question 110

The vas deferans can be seen

Answer 110

Between the seminal vesicles

Question 111

Thin-Waller tubular structure entering the base of the prostate in sagittal:

Answer 111

Vas deferans

Question 112

Doughnut shaped structure in Trv during a TRUS exam:

Answer 112

Vas deferans

Question 113

Sonographic appearance of the base of the prostate:

Answer 113

Half moon shaped Homogeneous texture Isoechoic

Question 114

What is see within the center of the prostate gland at the level of the verumtanum?

Answer 114

Periurethral vessels

Question 115

What is seen on the outer perimeter of the prostate gland?

Answer 115

Capsular arteries

Question 116

What is the best disinfectant for the probe after a TRUS exam?

Answer 116

Washed and soaked in antiseptic

Question 117

What is the most commonly used method to determine the size of the prostate?

Answer 117

Prostatic volume 1.57(W x P X L)

Question 118

What is considered a normal prostate volume?

Answer 118

Less than 20 g

Question 119

A small percentage of this pathology starts in the periurethral glandular tissue, but it usually occurs in the transitional zone

Answer 119

benign prostatic hyperplasia

Question 120

What is the surgical procedure done to relieve symptoms of BPH?

Answer 120

TURP (transurethral resection)

Question 121

What might cause a large surgical defect that sonographically appears as an anechoic space in the areas of the prostatic urethra In the center of the prostate?

Answer 121

TURP (transurethral resection)

Question 122

What is considered an enlarged gland in older men?

Answer 122

40 g

Question 123

Name that pathology! Symptoms: -enlarged gland -hypoechoic inner region compared to the peripheral region -may have echogenic nodule in the transitional zone -The central and peripheral zone may be compressed -Calcification and cystic changes may be seen -thickened bladder wall -distended bladder -possible hydronephrosis, hydroureters -asymmetric enlargement which should be evaluated for malignant change.

Answer 123

Benign prostatic hyperplasia (BPH)

Question 124

What are the three primary types of BPH?

Answer 124

Homogeneous stromal hyperplasia Glandular hyperplasia Mixed hyperplasia

Question 125

What type of BPH appears Hypoechoic?

Answer 125

Homogeneus stromal hyperplasia

Question 126

What type of BPH may be hypoechoic or hyperechoic based on cystic changes and gland size?

Answer 126

Glandular hyperplasia

Question 127

The most common type of BPH that appears heterogeneous sonographically.

Answer 127

mixed stronal and glandular hyperplasia

Question 128

Acute inflammation usually seen in the peripheral zone

Answer 128

Acute prostatitis

Question 129

What are the clinical symptoms for prostatitis?

Answer 129

Pain Rectal and prostate tenderness Fever

Question 130

Complications that may occur with prostatitis:

Answer 130

Abscess (Anechoic mass with or without echoes)

Question 131

What is the sonographic appearance for prostatitis?

Answer 131

Usually appears normal Diffuse Hyperechoic appearance of peripheral zone Hypervascularity Can mimic carcinoma in cases of focal infections Hypoechoic mass

Question 132

Recurrent episodes of chronic acute inflammation:

Answer 132

Chronic prostatitis

Question 133

Clinical symptoms for chronic inflammation:

Answer 133

Vary Pain in scrotum, penis, thighs Dysuria Urgency to urinate Infertility due to scarring or bloackage of the ejaculatory ducts

Question 134

Name that pathology! Sonographic appearance: -focal masses of varying echogenicity -calcification -capsular thickening and/or irregularity -hypoechoic halo in periurethral area -Heterogeneous appearance of the peripheral zone due to scarring and necrosis -diffuse or focal hyperemic flow

Answer 134

Chronic prostatitis

Question 135

What is the fifth leading cause of death in men over 45 years of age and the highest leading cause of death in men over the age of 75?

Answer 135

Prostate carcinoma

Question 136

What prostate pathology is most common in African American men and those with a family history?

Answer 136

Prostate carcinoma

Question 137

T/F Prostate carcinoma will have a decreased PSA

Answer 137

False Increased PSA

Question 138

What percent of prostate carcinoma is located in the peripheral vs transitional vs central zone?

Answer 138

70% peripheral 20% transitional 10% central

Question 139

Name that pathology! Sonographic appearance: -small nodules usually hyperechoic and located in peripheral zone -75% occur within 3mm—6mm of the apex -Isoechoic, hyperechoic, or mixed nodules -Enlarged, asymmetric prostate -capsular bulging -thickened bladder wall -distended bladder -bilateral hydroureters and hydronephrosis -loss of smooth contour in the area of the lesion -increased flow and low resistive index in peripheral vessels of cancerous lesion.

Answer 139

Prostate carcinoma

Question 140

What stage of prostate cancer is described as the following? -Not palpable -Not usually sonographically apparent -confined to prostate

Answer 140

Stage T1

Question 141

What stage of prostate cancer is described as the following? -palpable by digital rectal exam -confined to prostate

Answer 141

stage T2

Question 142

What stage of prostate cancer is described as the following? -local extension outsie of prostate into seminal vesicles or periprostatic soft tissue -no other metastatic evidence

Answer 142

Stage T3

Question 143

What stage of prostate cancer is described as the following? -Tumor extension seen on adjacent structures -metastatic evidence

Answer 143

Stage T4

Question 144

What is a common use for transrectal sonography involding ruling out the obstruction of the ejaculatory ducts by scarring, calcifications, or compression from prostatic lesions?

Answer 144

Male infertility exam

Question 145

Obstructing cysts of the seminal vesicles, ejaculatory ducts, or prostate as well as ductal obstruction due to calculi is an indicator for…

Answer 145

male infertility

Question 146

occlusion or absence of vas deferens is an indictor for…

Answer 146

male infertility

Question 147

Direct placement of multiple radioactive seeds

Answer 147

brachytherapy (radiotherapy guidance)

Question 148

freezing the prostate with thermal probes

Answer 148

Cryotherapy (radiotherapy guidance)

Question 149

What are three reasons aside from pathological diagnosis to give a TRUS?

Answer 149

male infertility, prostate biopsy, radiotherapy guidance

Question 150

A 50 year old male presents with recurrent pelvic discomfort, dysuria, pain in the scrotum and thighs, and an increased urinary frequency. He mentions occasional painful ejaculation. His doctor is concerned about chronic prostatitis. A TRUS is ordered to evaluate the prostate. What is the most consistent sonographic finding with chronic prostatitis?

Answer 150

Hypoechoic halo in the periurethral area

Question 151

John, a 50 year old, presents with the following symptoms: dysuria, urgency to urinate, increased frequency to urinate. While performing a TRUS, you find the following image (calcifications) What is the most likely diagnosis?

Answer 151

Chronic prostatitis

Question 152

In what zone of prostate do 20% of cancers originate?

Answer 152

Transitional zone

Question 153

During a transrectal ultrasound, a round, well-defined, anechoic structure is seen with the prostate. It has smooth walls and shows posterior acoustic enhancement. The patient is asymptomatic. What is the most likely diagnosis?

Answer 153

Prostatic cyst

Question 154

What ultrasound finding is most commonly seen in benign prostatic hyperplasia (BPH?)

Answer 154

Enlarged central gland with heterogeneous echotexture

Question 155

What is the largest zone of glandular tissue in the prostate?

Answer 155

Peripheral zone

Question 156

You have a patient come in for a follow up TRUS exam, they have a history of benign prostatic hypertrophy (BPH). While scanning, you see an asymmetrical anechoic structure within the prostate. What would be the reason for the images below (anechoic)

Answer 156

TURP (transurethral resection)