Review ArticlesAnatomy of the Anterior Prostate and Extraprostatic Space: A Contemporary Surgical Pathology AnalysisFine, Samson W. MD*; Al-Ahmadie, Hikmat A. MD*; Gopalan, Anuradha MD*; Tickoo, Satish K. MD*; Scardino, Peter T. MD†; Reuter, Victor E. MD*Author Information Departments of *Pathology †Urology, Memorial Sloan Kettering Cancer Center, New York, NY Funded in part by NIH/NCI SPORE in Prostate Cancer (2 P50 CA92629-06). Presented in part at the United States and Canadian Academy of Pathology Annual Meeting; San Diego, CA March 24–30, 2007. Reprints: Samson W. Fine, MD, Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C505, New York, NY 10021 (e-mail: [email protected]). Advances in Anatomic Pathology: November 2007 - Volume 14 - Issue 6 - p 401-407 doi: 10.1097/PAP.0b013e3181597a9c Buy Metrics Abstract Over 25 years ago, McNeal described a model of prostatic zonal anatomy based on autopsy dissections in various planes. As opposed to the cone-shaped organ seen in vivo, radical prostatectomy specimens are typically spherical, owing to tissue contraction at surgical removal and subsequent processing. Sectioning from apex to base yields topography at the Surgical Pathology “sign-out” that may vary from McNeal's descriptions. There are no in depth studies of anterior prostatic anatomic variability, including the periurethral region, peripheral (PZ) and transition (TZ) zones, anterior fibromuscular stroma (AFMS), and anterior extraprostatic space (EPS) using modern prosecting techniques. Detailed analysis of 197 entirely submitted, whole-mounted radical prostatectomy specimens focused on differences in zonal anatomy from apex through base, the relationship of AFMS to PZ and TZ, and the nature of the anterior EPS revealed features that may have significant impact on determination of zonal origin and pathologic staging of anteriorly situated prostate cancer. Among these observations are the predominant nature of the anterior PZ at the apex and the potential for its broad contact with the AFMS at this location, the differing volumes and location of the TZ in prostates with and without benign prostatic hyperplasia, and the composition of the anterior EPS, including adipose tissue, blood vessels, and skeletal muscle at the apex varying to include medium to large smooth muscle bundles at the base. © 2007 Lippincott Williams & Wilkins, Inc.