TRANSRECTAL ULTRASONOGRAPHY (TRUSS)

A Transrectal Ultrasound (TRUS) scan is a safe, effective, and detailed imaging test used to examine the prostate gland and its surrounding tissues. It is a cornerstone of urological diagnostics, providing physicians with crucial information that other tests may not reveal. The primary purpose of a Transrectal Ultrasound (TRUS) Scan is to help diagnose conditions such as an enlarged prostate (Benign Prostatic Hyperplasia or BPH) or, most commonly, to provide real-time visual guidance for a prostate biopsy.

At Cadabams Diagnostics, we understand that any medical procedure can cause anxiety. We want to assure you that a TRUS scan is a minimally invasive procedure performed by experienced professionals. It provides real-time, moving images of your prostate, allowing for a thorough and accurate assessment.

If your doctor has recommended a TRUS scan, this guide will walk you through everything you need to know. For personalized care and scheduling, contact Cadabams Diagnostics today.

What is a Transrectal Ultrasound?

A Transrectal Ultrasound uses sophisticated technology to create detailed pictures without any radiation. The procedure involves a small, specialized probe, called a transducer, which is about the width of a finger. This transducer is gently inserted a short distance into the rectum.

Once in position, the transducer emits high-frequency sound waves that travel through the rectal wall and into the prostate gland. These sound waves bounce off the tissues of the prostate and surrounding structures, creating echoes. The transducer then captures these returning echoes, and a powerful computer translates them into precise, real-time images displayed on a monitor. This technology allows the radiologist to see the prostate's size, shape, and internal structure with exceptional clarity. A key benefit is that, unlike X-rays or CT scans, a Transrectal Ultrasound (TRUS) Scan does not use any ionizing radiation, making it an extremely safe imaging method.

Types of TRUS Scans

A Transrectal Ultrasound (TRUS) Scan is performed in two primary ways, depending on the clinical question your doctor needs to answer.

Diagnostic Scan

This type of TRUS is used purely for imaging purposes. The main goal is to gather information about the prostate gland without taking any tissue samples. The radiologist will focus on measuring the prostate's size and total volume, checking for any visible structural abnormalities like cysts or calcifications, and assessing its overall condition. This is often used to confirm a diagnosis of Benign Prostatic Hyperplasia (BPH) or to investigate urinary symptoms.

Biopsy-Guided Scan

This is the most common reason for performing a TRUS scan. In this procedure, the ultrasound is not just for looking; it serves as a real-time map to guide a biopsy. If your PSA levels are high or a lump was felt during a DRE, a TRUS guided prostate biopsy is the definitive way to determine if cancer cells are present. The live image on the screen allows the urologist to precisely guide a very fine, spring-loaded needle to specific areas of the prostate, including any suspicious-looking lesions, to collect small tissue samples. These samples are then sent for analysis. You can learn more about this analysis process on our page.

During your Transrectal Ultrasound (TRUS) Scan, the radiologist meticulously evaluates several key parameters to build a complete picture of your prostate's health:

• Prostate Volume and Size: The scan provides an extremely accurate measurement of the prostate's dimensions, which are used to calculate its volume in cubic centimeters (cc). This is crucial for diagnosing and grading the severity of an enlarged prostate (BPH).
• Echotexture: This refers to the uniformity and character of the ultrasound echoes returning from the gland's tissue. Healthy tissue typically has a uniform, or homogeneous, echotexture. An uneven, or heterogeneous, pattern can indicate inflammation (prostatitis), benign changes, or other conditions.
• Presence of Nodules/Lesions: The radiologist carefully scans the entire gland for any distinct areas that look different from the surrounding tissue. Suspicious areas, which may be cancerous, often appear hypoechoic (darker than the surrounding tissue) on the ultrasound because they reflect sound waves differently.
• Symmetry: A healthy prostate gland is generally symmetrical. Asymmetry can sometimes be a sign of an abnormal growth on one side of the gland.
• Seminal Vesicle Appearance: The TRUS scan also provides clear images of the seminal vesicles, which are glands attached to the prostate that produce fluid for semen. The radiologist will evaluate them for signs of inflammation, cysts, or other abnormalities.

To summarize, the core reasons your doctor may order a Transrectal Ultrasound (TRUS) Scan include:

• To investigate the underlying cause of an elevated PSA blood test result.
• To get a precise ultrasound to check prostate size and volume, which is essential for diagnosing BPH.
• To serve as an indispensable guide for performing a TRUS guided prostate biopsy to accurately sample tissue for cancer detection.
• To evaluate for less common conditions such as prostate abscesses, cysts, or congenital abnormalities.
• To help in staging prostate cancer by assessing if the cancer appears to be contained within the gland.

When and Who Needs to Take a TRUS Scan?

A doctor will typically recommend a TRUS scan for several specific reasons, usually related to evaluating the health of the prostate gland. You may need this scan if you have:

• An elevated Prostate-Specific Antigen (PSA) blood test result: PSA is a protein produced by the prostate gland. While levels can rise for many reasons, an elevated result often requires further investigation, and a TRUS scan is a common next step. You can learn more about this on our [Link to: Prostate-Specific Antigen (PSA) Test] page.
• An abnormality found during a digital rectal exam (DRE): If your physician feels a lump, hard area, or other irregularity on your prostate during a routine DRE, a TRUS scan can provide a much more detailed view of the area of concern.
• Urinary symptoms: Men experiencing symptoms like difficulty starting or stopping urination, a weak stream, frequent urination (especially at night), or a feeling that the bladder isn't completely empty may need a TRUS scan to determine if an enlarged prostate is the cause.

Benefits of Conducting the Test

The decision to undergo a TRUS scan comes with significant diagnostic benefits that are vital for managing your health:

• High-Resolution Imaging: TRUS provides excellent, detailed images of the prostate gland's internal structure that cannot be obtained through an external exam.
• Definitive Biopsy Guidance: It offers unparalleled real-time guidance, ensuring that biopsy needles are placed with precision in areas of concern, increasing the accuracy of the diagnosis.
• Accurate Diagnosis: The information gathered helps your doctor differentiate between various conditions, such as BPH, prostatitis, and suspected cancer, ensuring you receive the most appropriate and effective treatment plan.
• Safety: The procedure avoids the use of ionizing radiation, making it a safe method for repeated imaging if necessary.

Illnesses Diagnosed with TRUS

A Transrectal Ultrasound (TRUS) Scan is a powerful tool that helps in the diagnosis and management of several conditions affecting the prostate gland:

• Benign Prostatic Hyperplasia (BPH): The scan can definitively confirm an enlarged prostate and quantify its size, which helps guide treatment choices.
• Prostatitis: While often diagnosed by symptoms, a TRUS can show signs of inflammation, swelling, or even an abscess associated with acute or chronic prostatitis.
• Prostate Cancer: Crucially, TRUS does not diagnose cancer on its own. Instead, it is the essential tool used to guide a biopsy, which is the only way to definitively diagnose prostate cancer. It also assists in clinical staging by helping to see if the cancer appears confined to the prostate.
• Other Conditions: The scan can also identify prostate abscesses, cysts (fluid-filled sacs), and calcifications (small stones within the gland).

Proper preparation is simple but important for ensuring a smooth and effective procedure. The team at Cadabams Diagnostics will provide you with specific instructions, but general guidelines include:

• Cleansing Enema: You may be asked to self-administer a cleansing enema (such as a Fleet enema) at home one to two hours before your appointment. This empties the rectum of stool, which allows for better image quality and comfort.
• Medication Review: It is crucial to inform your doctor and our staff about all medications you are currently taking, especially blood thinners like aspirin, warfarin (Coumadin), clopidogrel (Plavix), or other anticoagulants.
• Clothing: Wear loose, comfortable clothing to your appointment. You will be asked to change into a hospital gown for the procedure.

Pre-requisites

Before you can have a TRUS scan, a few things need to be in place:

• Doctor's Referral: A referral from your urologist or general practitioner is typically required to schedule the test.
• Medication Adjustments: If a biopsy is planned, your doctor will likely instruct you to stop taking blood-thinning medications for several days before the procedure to minimize bleeding risk. Do not stop any medication without your doctor's explicit instruction.
• Prophylactic Antibiotics: To prevent infection, your doctor will usually prescribe a course of antibiotics to start before your biopsy appointment and continue for a day or two after. It is vital to take these as directed.

Best Time to Take the TRUS Scan

The effectiveness of a Transrectal Ultrasound (TRUS) Scan is not dependent on the time of day. It can be scheduled at any time that is convenient for you and aligns with the availability at our Cadabams Diagnostics center.

Eligibility

The test is performed on adult males who require evaluation of their prostate gland. Contraindications are very rare but may include conditions that would make inserting the probe extremely painful or unsafe, such as:

• Severe, painful hemorrhoids or anal fissures.
• Recent rectal or anal surgery.
• Severe narrowing (stenosis) of the rectum.

Procedure for Taking a TRUS Scan

Understanding the transrectal ultrasound procedure step-by-step can help alleviate any concerns. At Cadabams Diagnostics, our team will ensure your comfort and privacy throughout the process.

1. Preparation: You will be asked to undress from the waist down and will be given a gown to wear.
2. Positioning: You will lie on the examination table on your left side, with your knees bent up towards your chest (the fetal position).
3. Probe Insertion: The sonographer will cover the thin, sterile transducer probe with a protective sheath and a generous amount of lubricating gel. They will then gently insert the probe a short distance into your rectum. You will feel pressure, but it should not be painful.
4. Image Capture: The sonographer will slowly move the probe to capture images of your entire prostate gland and seminal vesicles from different angles. These images are viewed in real-time on the monitor. This imaging portion typically takes about 15-20 minutes.
5. Biopsy (if applicable): If a biopsy is planned, the urologist will use the live ultrasound image to guide the biopsy needle. A local anesthetic may be injected to numb the area. You may hear a 'click' and feel a brief, sharp sensation as each of the several samples is taken.
6. Completion: Once all necessary images and/or samples are collected, the probe is gently removed. The entire procedure, including a biopsy, usually takes 20-30 minutes.

Caution Before Taking the Test

For your safety and the accuracy of the test, please remember to inform the technologist or nurse before the procedure begins if you:

• Have a known allergy to latex, as this is often used for the probe cover.
• Are unsure if you took your prescribed pre-procedure medications, especially your antibiotics.
• Have any bleeding disorders, such as hemophilia.
• Have a history of fainting during medical procedures.