Abstract Segmenting 3D end?ring transrectal ultrasound (TRUS) prostate images ef?ciently and accurately is of utmost importance for the planning and guiding 3D TRUS guided prostate biopsy. Poor image quality and imaging artifacts of 3D TRUS images often introduce a challenging task in computation to directly extract the 3D prostate surface. In this work, we propose a novel global optimization approach to delineate 3D prostate boundaries using its rotational resliced images around a speci?ed axis, which properly enforces the inherent rotational symmetry of prostate shapes to jointly adjust a series of 2D slicewise segmentations in the global 3D sense. We show that the introduced challenging combinatorial optimization problem can be solved globally and exactly by means of convex relaxation. In this regard, we propose a novel coupled continuous max-?ow model, which not only provides a powerful mathematical tool to analyze the proposed optimization problem but also amounts to a new and ef?cient duality-based algorithm. Extensive experiments demonstrate that the proposed method signi?cantly outperforms the state-of-art methods in terms of ef?ciency, accuracy, reliability and less user-interaction and reduces the execution time by a factor of 100.