Skip to main content

Zonal Anatomy of Prostate on MRI

  • Chapter
  • First Online:
Prostate MRI Essentials

Abstract

Zonal anatomy of the prostate on MRI matches the distinct histological areas of the peripheral, central, and transition zones, as well as the anterior fibromuscular stroma. Understanding of the anatomical zones has an important role in detection of pathologies, such as prostate cancer, as well as morphological changes occurring with age. This chapter introduces the zonal divisions of the prostate, as well as important anatomical landmarks and sector maps that are currently used in clinical practice with an emphasis on its imaging characteristics on MRI.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Turkbey B, Huang R, Vourganti S, Trivedi H, Bernardo M, Yan P, et al. Age-related changes in prostate zonal volumes as measured by high-resolution magnetic resonance imaging (MRI): a cross-sectional study in over 500 patients. BJU Int. 2012;110(11):1642–7.

    Article  PubMed  Google Scholar 

  2. Ren J, Liu H, Wang H, Wen D, Huang X, Ren F, et al. MRI to predict prostate growth and development in children, adolescents and young adults. Eur Radiol. 2014;25:516–22.

    Article  PubMed  Google Scholar 

  3. Coakley FV, Hricak H. Radiologic anatomy of the prostate gland: a clinical approach. Radiol Clin N Am. 2000;38(1):15–30.

    Article  CAS  PubMed  Google Scholar 

  4. Aaron LT, Franco OE, Hayward SW. Review of prostate anatomy and embryology and the etiology of benign prostatic hyperplasia. Urol Clin North Am. 2016;43(3):279–88.

    Article  PubMed  PubMed Central  Google Scholar 

  5. McNeal JE. Normal histology of the prostate. Am J Surg Pathol. 1988;12(8):619–33.

    Article  CAS  PubMed  Google Scholar 

  6. Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward SH, Cerri GG. Anatomical variants in prostate artery embolization: a pictorial essay. Cardiovasc Intervent Radiol. 2017;40(9):1321–37.

    Article  PubMed  Google Scholar 

  7. Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2010;57(2):179–92. https://doi.org/10.1016/j.eururo.2009.11.009.

    Article  PubMed  Google Scholar 

  8. de Assis AM, Moreira AM, Carnevale FC. Angiographic findings during repeat prostatic artery embolization. J Vasc Interv Radiol. 2019;30(5):645–51. https://doi.org/10.1016/j.jvir.2018.12.734.

    Article  PubMed  Google Scholar 

  9. Hricak H, Dooms GC, McNeal JE, Mark AS, Marotti M, Avallone A, et al. MR imaging of the prostate gland: normal anatomy. Am J Roentgenol. 1987;148(1):51–8.

    Article  CAS  Google Scholar 

  10. Power NE, Silberstein JL, Kulkarni GS, Laudone VP. The dorsal venous complex (DVC): dorsal venous or dorsal vasculature complex? Santorini’s plexus revisited. BJU Int. 2011;108(6):930–2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Spratt DE, Lee JY, Dess RT, Narayana V, Evans C, Liss A, et al. Vessel-sparing radiotherapy for localized prostate cancer to preserve erectile function: a single-arm phase 2 trial. Eur Urol. 2017;72(4):617–24.

    Article  PubMed  Google Scholar 

  12. Kaiho Y, Nakagawa H, Saito H, Ito A, Ishidoya S, Saito S, et al. Nerves at the ventral prostatic capsule contribute to erectile function: initial electrophysiological assessment in humans. Eur Urol. 2009;55(1):148–55.

    Article  PubMed  Google Scholar 

  13. Paño B, Sebastià C, Buñesch L, Mestres J, Salvador R, Macías NG, et al. Pathways of lymphatic spread in male urogenital pelvic malignancies. Radiographics. 2011;31(1):135–60.

    Article  PubMed  Google Scholar 

  14. Yacoub JH, Verma S, Moulton JS, Eggener S, Oto A. Imaging-guided prostate biopsy: conventional and. Radiographics. 2012;32(3):819–37.

    Article  PubMed  Google Scholar 

  15. Morisawa N, Koyama T, Togashi K. Metastatic lymph nodes in urogenital cancers: contribution of imaging findings. Abdom Imaging. 2006;31(5):620–9.

    Article  CAS  PubMed  Google Scholar 

  16. Toivanen R, Shen MM. Prostate organogenesis: tissue induction, hormonal regulation and cell type specification. Development. 2017;144(8):1382–98. https://doi.org/10.1242/dev.148270.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Gupta RT, Kauffman CR, Garcia-Reyes K, Palmeri ML, Madden JF, Polascik TJ, et al. Apparent diffusion coefficient values of the benign central zone of the prostate: comparison with low- and high-grade prostate cancer. Am J Roentgenol. 2015;205(2):331–6.

    Article  Google Scholar 

  18. Vargas HA, Akin O, Franiel T, Goldman DA, Udo K, Touijer KA, et al. Normal central zone of the prostate and central zone involvement by prostate cancer: clinical and mr imaging implications. Radiology. 2012;262(3):894–902.

    Article  PubMed  PubMed Central  Google Scholar 

  19. McNeal JE. The zonal anatomy of the prostate. Prostate. 1981;2(1):35–49.

    Article  CAS  PubMed  Google Scholar 

  20. Fine SW, Reuter VE. Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer. Histopathology. 2012;60(1):142–52.

    Article  PubMed  Google Scholar 

  21. Guneyli S, Ward E, Peng Y, Yousuf AN, Trilisky I, Westin C, et al. MRI evaluation of benign prostatic hyperplasia: correlation with international prostate symptom score. J Magn Reson Imaging. 2017;45(3):917–25.

    Article  PubMed  Google Scholar 

  22. Kim E, Lipshultz L, Howards S. Male infertility. In: Gillenwater J, Grayhack J, Howards S, Mitchell M, editors. Adult and pediatric urology. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 1683–758.

    Google Scholar 

  23. Selman SH. The McNeal prostate: a review. Urology. 2011;78(6):1224–8.

    Article  PubMed  Google Scholar 

  24. Medved M, Sammet S, Yousuf A, Oto A. MR imaging of the prostate and adjacent anatomic structures before, during, and after ejaculation: qualitative and quantitative evaluation. Radiology. 2014;271(2):452–60.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Barrett T, Tanner J, Gill AB, Slough RA, Wason J, Gallagher FA. The longitudinal effect of ejaculation on seminal vesicle fluid volume and whole-prostate ADC as measured on prostate MRI. Eur Radiol. 2017;27(12):5236–43. https://doi.org/10.1007/s00330-017-4905-x.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kabakus IM, Borofsky S, Mertan FV, Greer M, Daar D, Wood BJ, et al. Does abstinence from ejaculation before prostate MRI improve evaluation of the seminal vesicles? AJR Am J Roentgenol. 2016;207(6):1205–9.

    Article  PubMed  Google Scholar 

  27. Turkbey B, Rosenkrantz A, Haider M, Padhani A, Villeirs G, Macura K, et al. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol. 2019;pii:S0302-2838(19)30180-0. https://doi.org/10.1016/j.eururo.2019.02.033. [Epub ahead of print]

    Article  Google Scholar 

  28. Hansen N, Patruno G, Wadhwa K, Gaziev G, Miano R, Barrett T, et al. Magnetic resonance and ultrasound image fusion supported Transperineal prostate biopsy using the Ginsburg protocol: technique, learning points, and biopsy results. Eur Urol. 2016;70(2):332–40.

    Article  PubMed  Google Scholar 

  29. Sommer FG, McNeal JE, Carrol CL. MR depiction of zonal anatomy of the prostate at 1.5 T. J Comput Assist Tomogr. 1986;10(6):983–9.

    Article  CAS  PubMed  Google Scholar 

  30. Greene DR, Fitzpatrick JM, Scardino PT. Anatomy of the prostate and distribution of early prostate cancer. Semin Surg Oncol. 1995;11(1):9–22.

    Article  CAS  PubMed  Google Scholar 

  31. Villers A, Steg A, Boccon-Gibod L. Anatomy of the prostate: review of the different models. Eur Urol. 1991;20(4):261–8.

    Article  CAS  PubMed  Google Scholar 

  32. Semple JE. Surgical capsule of the benign enlargement of the prostate. BMJ. 2009;1(5346):1640–3.

    Article  Google Scholar 

  33. Kitzing YX, Prando A, Varol C, Karczmar GS, Maclean F, Oto A. Benign conditions that mimic prostate carcinoma: MR imaging features with histopathologic correlation. Radiographics. 2016;36(1):162–75.

    Article  PubMed  Google Scholar 

  34. Hansford BG, Peng Y, Jiang Y, Al-Ahmadie H, Eggener S, Yousuf A, et al. Revisiting the central gland anatomy via MRI: does the central gland extend below the level of verumontanum? J Magn Reson Imaging. 2014;39(1):167–71.

    Article  PubMed  Google Scholar 

  35. Cheng L, Jones TD, Pan C-X, Barbarin A, Eble JN, Koch MO. Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens. Mod Pathol. 2005;18(8):1022–6.

    Article  PubMed  Google Scholar 

  36. Lee CH, Akin-Olugbade O, Kirschenbaum A. Overview of prostate anatomy, histology, and pathology. Endocrinol Metab Clin N Am. 2011;40(3):565–75.

    Article  CAS  Google Scholar 

  37. Mikel Hubanks J, Boorjian SA, Frank I, Gettman MT, Houston Thompson R, Rangel LJ, et al. The presence of extracapsular extension is associated with an increased risk of death from prostate cancer after radical prostatectomy for patients with seminal vesicle invasion and negative lymph nodes. Urol Oncol. 2014;32(1):26.e1-7. https://doi.org/10.1016/j.urolonc.2012.09.002.

    Article  PubMed  Google Scholar 

  38. Wheeler TM, Dillioglugil Ö, Kattan MW, Arakawa A, Soh S, Suyama K, et al. Clinical and pathological significance of the level and extent of capsular invasion in clinical stage T1-2 prostate cancer. Hum Pathol. 1998;29(8):856–62.

    Article  CAS  PubMed  Google Scholar 

  39. Feng TS, Sharif-Afshar AR, Wu J, Li Q, Luthringer D, Saouaf R, et al. Multiparametric MRI improves accuracy of clinical nomograms for predicting extracapsular extension of prostate cancer. Urology. 2015;86(2):332–7. https://doi.org/10.1016/j.urology.2015.06.003.

    Article  PubMed  Google Scholar 

  40. Augustin H, Fritz GA, Ehammer T, Auprich M, Pummer K. Accuracy of 3-tesla magnetic resonance imaging for the staging of prostate cancer in comparison to the partin tables. Acta Radiol. 2009;50(5):562–9. https://doi.org/10.1080/02841850902889846.

    Article  CAS  PubMed  Google Scholar 

  41. Kiyoshima K, Yokomizo A, Yoshida T, Tomita K, Yonemasu H, Nakamura M, et al. Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol. 2004;34(8):463–8.

    Article  PubMed  Google Scholar 

  42. Lee SB, Hong SK, Choe G, Lee SE. Periprostatic distribution of nerves in specimens from non–nerve-sparing radical retropubic prostatectomy. Urology. 2008;72(4):878–81.

    Article  PubMed  Google Scholar 

  43. Sievert KD, Hennenlotter J, Laible IA, Amend B, Nagele U, Stenzl A. The commonly performed nerve sparing total prostatectomy does not acknowledge the actual nerve courses. J Urol. 2009;181(3):1076–81. https://doi.org/10.1016/j.juro.2008.10.154.

    Article  PubMed  Google Scholar 

  44. Kasabwala K, Patel NA, Hu JC. Review of optimal techniques for robotic-assisted radical prostatectomy. Curr Opin Urol. 2018;28(2):102–7. https://doi.org/10.1097/MOU.0000000000000473.

    Article  PubMed  Google Scholar 

  45. Tewari A, Peabody JO, Fischer M, Sarle R, Vallancien G, Delmas V, et al. An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol. 2003;43(5):444–54.

    Article  PubMed  Google Scholar 

  46. McDermott VG, Meakem TJ, Stolpen AH, Schnall MD. Prostatic and periprostatic cysts: findings on MR imaging. AJR Am J Roentgenol. 1995;164(1):123–7.

    Article  CAS  PubMed  Google Scholar 

  47. Priyadarshi V, Singh JP, Mishra S, Vijay MK, Pal DK, Kundu AK. Prostatic utricle cyst: a clinical dilemma. APSP J Case Rep. 2013;4(2):16. eCollection 2013

    PubMed  PubMed Central  Google Scholar 

  48. Shebel HM, Farg HM, Kolokythas O, El-Diasty T. Cysts of the lower male genitourinary tract: embryologic and anatomic considerations. Radiographics. 2013;33(4):1125–43. https://doi.org/10.1148/rg.334125129.

    Article  PubMed  Google Scholar 

  49. Curran S, Akin O, Agildere AM, Zhang J, Hricak H, Rademaker J. Endorectal MRI of prostatic and periprostatic cystic lesions and their mimics. AJR Am J Roentgenol. 2007;188(5):1373–9.

    Article  PubMed  Google Scholar 

  50. McNeal JE. Pathology of benign prostatic hyperplasia. Insight into etiology. Urol Clin North Am. 1990;17(3):477–86.

    CAS  PubMed  Google Scholar 

  51. Oto A, Kayhan A, Jiang Y, Tretiakova M, Yang C, Antic T, et al. Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using purpose: methods: results. Radiology. 2010;257(3):715–23.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Jeong CW, Lee S, Oh JJ, Lee BK, Lee JK, Jeong SJ, et al. Quantification of median lobe protrusion and its impact on the base surgical margin status during robot-assisted laparoscopic prostatectomy. World J Urol. 2014;32(2):419–23.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joseph H. Yacoub .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Czarniecki, M.B., Yacoub, J.H. (2020). Zonal Anatomy of Prostate on MRI. In: Tirkes, T. (eds) Prostate MRI Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-45935-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-45935-2_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-45934-5

  • Online ISBN: 978-3-030-45935-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics