Prof. Dr. Emel Akoğlu
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Urology Diagnostics
Transrectal ultrasound (trus)
What a transrectal ultrasound (TRUS) scan is, what it can and cannot show about the prostate, bladder neck and nearby structures, how to prepare, what the examination feels like, how it compares with MRI and abdominal ultrasound, approximate costs in Turkey against the UK, US and Germany, and how to choose a clinic.
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Prof. Dr. Zerrin Biçik Bahçebaşı
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What is a transrectal ultrasound (TRUS) scan?
A transrectal ultrasound (TRUS) is an imaging test in which a slim, lubricated ultrasound probe, about the width of a finger, is placed a few centimetres into the rectum. Because the rectum lies directly behind the prostate, sound waves reach it without passing through bowel gas, fat or the pelvic bones, and the picture is far sharper than one taken through the abdomen. The scan shows the prostate, the seminal vesicles, the base of the bladder and the tissue between them, and it lets the doctor measure the gland in three dimensions. It involves no radiation, no contrast injection and no needle, and takes about 10 to 20 minutes.
This guide explains what TRUS is used for, what it can and cannot show, how to prepare, how it compares with MRI, and what it costs in Turkey against the UK, US and Germany. More tests are listed in our urology diagnostics section.
Why is a transrectal ultrasound (TRUS) done?
A urologist usually requests the scan to answer a specific question. The main reasons are:
- Measuring prostate volume in men with an enlarged prostate, which helps choose between tablets and an operation such as TUIP.
- Looking at an area that felt hard on examination, or at a raised PSA result.
- Guiding a needle during a prostate biopsy (see the next section).
- Looking for cysts, stones or calcification in the prostate, and for dilated seminal vesicles or ejaculatory duct blockage in men with fertility problems or painful ejaculation.
- Assessing the gland before or after treatments, for example checking residual volume or an abscess.
It is therefore a tool for looking and measuring, not a treatment, and it rarely gives a diagnosis by itself.
What can a TRUS scan show, and what can it not?
TRUS shows the size and shape of the prostate, its internal zones (the transition zone that enlarges with age and the outer peripheral zone where most cancers start), cysts, calcifications and the seminal vesicles. It can also show how far an enlarged median lobe protrudes into the bladder. What it cannot do well is separate cancer from benign tissue: many tumours look the same as normal tissue on grey-scale ultrasound, and the test cannot grade a tumour. That is why a normal TRUS does not exclude cancer and an abnormal one does not prove it. Current European and UK guidance uses multiparametric MRI, not TRUS alone, to look for suspicious lesions, and a biopsy to confirm. Ask the clinic what question the scan is meant to answer, because that decides whether TRUS is the right test.
TRUS, MRI or abdominal ultrasound: which one?
The three methods give different information, and many men need more than one.
| Test | Best suited to | Typical limits |
|---|---|---|
| Transrectal ultrasound (TRUS) | Measuring prostate volume, guiding a needle, examining the seminal vesicles | Poor at separating cancer from normal tissue; needs a rectal probe |
| Prostate MRI | Finding and scoring suspicious areas before a biopsy | More expensive; needs a scanner slot and a radiologist skilled in prostate imaging |
| Abdominal (suprapubic) ultrasound | Bladder emptying, kidneys, rough prostate size | Less detail; bowel gas and body shape limit the picture |
When the question is cancer, TRUS is often combined with a needle test: our guide to transrectal ultrasound guided prostate biopsy explains how the probe guides sampling, and fusion biopsy joins the ultrasound picture to an MRI.
How do you prepare for a TRUS examination?
Preparation is simple. For a scan on its own you are usually asked to have an empty bowel, sometimes with a small enema about an hour before, and a comfortably full bladder if the doctor also wants to measure how well you empty. Tell the team about blood-thinning tablets, allergies (particularly to latex, as the probe cover can contain it) and any anal or rectal condition such as painful fissures or haemorrhoids. If the scan is a first step towards a biopsy, you will receive separate instructions about antibiotics and stopping certain medicines. Do not stop any prescribed medicine without checking with your doctor.
What does the TRUS examination involve and does it hurt?
You lie on your left side with your knees bent, and a brief gloved rectal examination comes first. The covered, gel-coated probe is then inserted gently and moved to image the gland in several planes; the doctor may ask you to breathe slowly or hold still for a few seconds. Most men describe pressure or fullness and a feeling of needing to open the bowels, rather than pain. The scan is shorter and more comfortable than a biopsy, and no anaesthetic is normally needed for the scan itself. If you have a painful anal condition, tell the team beforehand so that they can use extra gel or decide whether another test is more suitable. A report with measurements, usually in millilitres of prostate volume, is written afterwards.
Transrectal ultrasound (TRUS) cost in Turkey compared with the UK, US and Germany
These figures are approximate ranges for a diagnostic TRUS scan with a specialist report, not hospital quotes. Prices change with the clinic, the equipment (colour Doppler and 3D probes cost more), the doctor who reports and whether it is combined with a consultation.
| Country | Approximate cost range |
|---|---|
| Turkey | €60 – €300 |
| United Kingdom | €150 – €450 |
| United States | €250 – €900 |
| Germany | €100 – €350 |
A scan on its own is a small cost, so travelling only for it rarely makes sense; it makes more sense as part of a wider urology work-up with a consultation, blood tests, an MRI or a biopsy. If TRUS is combined with a needle biopsy, the cost rises accordingly. Ask whether the doctor's consultation, the written report and the images on disc are included, and request a free quote if you want written figures.
Is a transrectal ultrasound safe, and what are the risks?
TRUS is considered a low-risk test because it uses sound waves, not radiation, and no needle is involved when it is done alone. Some men notice mild discomfort, a small amount of rectal bleeding if they have haemorrhoids, or a short-lived urge to pass stool. Allergic reactions to latex probe covers are rare and avoidable if you mention an allergy. Infection is a recognised concern when a biopsy follows the scan, but the diagnostic scan alone carries a very low risk. See the NHS and the European Association of Urology patient information for current advice. Seek medical help for heavy bleeding, fever or severe pain.
Recovery and your trip to Turkey
There is effectively no recovery period after a diagnostic TRUS. You can drive, eat and return to work straight away, apart from mild rectal awareness for an hour or so. For travellers the practical timeline looks like this:
- Day 1: consultation, blood tests and the scan, often on the same day.
- Day 1 to 2: the doctor reports the measurements and discusses next steps, for example an MRI.
- If a biopsy follows: allow two to three nights, because pathology and any infection signs take a few days.
A short stay of one to two nights is typical for a scan-only visit. Bring recent PSA results, previous scans and a list of medicines so that the urologist can interpret the findings in context.
How to read the TRUS report and what comes next
The report will usually quote prostate volume in millilitres (a normal adult gland is roughly 20 to 30 ml, and enlargement is common over 40), describe any hypoechoic (darker) areas, cysts and calcifications, and mention the seminal vesicles. A finding such as a darker area is a reason for further tests, not a diagnosis. Possible next steps include repeating the PSA, an MRI, medication for an enlarged prostate, a biopsy, or for symptoms from enlargement a minimally invasive procedure such as TUMT. Ask the doctor to explain each finding in plain language and to say which one, if any, needs action.
How to choose a clinic, and questions to ask
Choose a urology department with a doctor who reports prostate imaging regularly, up-to-date ultrasound equipment, and a clear plan for what happens after the scan. Warning signs include a clinic that promises a cancer diagnosis from ultrasound alone, a package that adds a biopsy or treatment before any result, and no written report. See how our process works, then ask the clinic:
- What question is this scan meant to answer, and would MRI be better?
- Who performs and reports the scan, and do I receive the images and a written report?
- Is a consultation included, and is a biopsy only suggested if needed?
- What preparation is needed, and is a latex-free probe cover available?
- Can the report be shared with my doctor at home?
Hospitals with Urology in Turkey
Frequently asked questions
It is a scan using a slim ultrasound probe placed in the rectum to produce a close picture of the prostate and seminal vesicles. It uses sound waves, not radiation, and usually takes 10 to 20 minutes.
Most men feel pressure or fullness and an urge to open their bowels rather than pain. Tell the team if you have haemorrhoids or an anal fissure, as they can make the probe more uncomfortable.
Not reliably. Many tumours look like normal tissue on ultrasound, so a normal scan does not exclude cancer and an abnormal area does not prove it. MRI and a needle biopsy are used for that question.
Approximate ranges are €60 to €300 in Turkey against about €150 to €450 in the UK. Prices vary with the equipment, the reporting doctor and whether a consultation is included. A written quote gives exact figures.
You may need an enema about an hour before and a comfortably full bladder. Mention blood thinners, latex allergy and any rectal problems. Do not stop prescribed medicine unless your doctor tells you to.
No real recovery is needed for a scan alone. You can eat, drive and work straight away, although you may feel mild rectal awareness for an hour or so.
TRUS is good for measuring the gland and guiding needles, while MRI is better at finding and scoring suspicious areas before a biopsy. Many men have both.
It is generally low risk, as it uses sound waves and no needle when performed alone. Mild bleeding is possible with haemorrhoids, and latex allergy can be avoided with a different probe cover.
A young adult gland is roughly 20 to 30 ml, and many men have a larger prostate with age. Volume matters most for choosing treatment, and your urologist should interpret it alongside symptoms.
One to two nights are enough for a consultation and a scan on its own. If a biopsy follows, allow two to three nights so that any infection signs appear while you are still near the team.
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