From the Guidelines
Transrectal Ultrasound (TRUS) is the best radiology test for benign prostatic hyperplasia (BPH) as it is very sensitive for detecting abnormalities in the prostate gland and seminal tract, reportedly demonstrating abnormalities in 82% to 95% of men with hematospermia, which can be associated with BPH 1.
Key Features of TRUS for BPH
- TRUS is the first-line imaging tool for detecting a variety of abnormalities, including calcifications, cysts, and benign prostatic hypertrophy
- It has shown utility in guiding transperineal aspiration of the seminal vesicles
- While some abnormalities detected by TRUS can be age-related changes, the test remains highly sensitive for detecting BPH and other prostate-related issues 1
Considerations for TRUS
- The test should be considered in the context of the patient's symptoms and medical history, as some abnormalities detected by TRUS may not be clinically significant
- TRUS may be used in conjunction with other diagnostic tools, such as transurethral seminal vesiculoscopy, to provide a more comprehensive diagnosis 1
From the Research
Diagnostic Performance of Radiology Tests for Benign Prostatic Hyperplasia (BPH)
- The diagnostic performance of various radiology tests, including transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and computed tomography (CT), has been evaluated in several studies 2, 3, 4, 5, 6.
- TRUS has been shown to have high diagnostic performance in the diagnosis of localized prostate cancer, with higher sensitivity, negative predictive value, and accuracy compared to MRI 2.
- However, MRI has been found to be more accurate than TRUS in estimating prostate volume, particularly in cases where the prostate volume is greater than 35 cm³ 3, 4.
- A study comparing TRUS, MRI, and CT found that MRI and CT were equally effective in assessing prostate volume, and can be used to guide BPH management without the need for repeated TRUS 6.
- Another study found that MRI with integrated endorectal and pelvic phased-array coils satisfactorily predicted tumor volume and tumor extent preoperatively, and can assist in decision making for patients with prostate cancer 5.
Comparison of Radiology Tests for BPH
- The following table summarizes the findings of the studies:
- TRUS: high diagnostic performance for localized prostate cancer, but less accurate than MRI for estimating prostate volume 2, 3, 4.
- MRI: more accurate than TRUS for estimating prostate volume, and can satisfactorily predict tumor volume and tumor extent preoperatively 3, 4, 5, 6.
- CT: equally effective as MRI in assessing prostate volume, and can be used to guide BPH management without repeated TRUS 6.
Radiology Test Selection for BPH
- The selection of a radiology test for BPH depends on the specific clinical scenario and the availability of resources 2, 3, 4, 5, 6.
- MRI and CT may be preferred for estimating prostate volume and guiding BPH management, while TRUS may be preferred for diagnosing localized prostate cancer 2, 3, 4, 5, 6.