Objectives: Together with the aging population the incidence of prostate cancer (Pca) is still increasing. For the detection of Pca the PSA blood test, digital rectal examination (DRE), and transrectal ultrasound (TRUS) are frequently used methods. TRUS has an important role in diagnosing Pca. However, the low specificity and sensitivity of conventional grayscale TRUS have made it into a volume measuring and biopsy-guiding tool. Methods: A Medline literature search on transrectal ultrasound was performed and relevant articles were reviewed. Results: New ultrasound techniques were introduced to overcome the limitations of conventional grayscale TRUS. In this paper, an overview of developments in TRUS with 3D, Doppler, contrast, intermittent, harmonic, and pulse inversion techniques along with possibilities for future development are discussed. Conclusions: The underlying principles and methods are discussed briefly and clinical results published in recent literature are presented.