Prostate Bed - Definition and its Importance in Prostate Cancer

Anatomy and Issues With the Prostate Bed in Prostate Cancer

What is the prostate bed and why is it important?. Istockphoto.com/Stock Photo©decade3d

Definition:  Prostate Bed

The prostate bed is a depression beneath the bladder where the prostate gland is located, or the region left behind where the prostate gland once was before prostate cancer surgery.

Anatomy

The prostate bed is defined as the area where the prostate gland sits in the male pelvis beneath the bladder.

Prostate Bed After Prostate Cancer Surgery

The term prostate bed is most often used in the setting of men who have have surgery to remove completely an early stage prostate cancer - radical prostatectomy.

  When this is the case, the prostate bed refers to the depression - or fossa - where the prostate gland once was.

Importance of the Prostate Bed

The prostate bed is important for a few reasons. 

  • Remaining tumor - After surgery to remove the prostate, the prostate bed is a common area in which cancerous tissue could still remain.  Radiation therapy - either external beam radiation, or brachytherapy may be used to attempt to destroy any residual tumor in this area.
  • Recurrence - For men who do not have any evidence of remaining tumor in the prostate bed after surgery, the prostate bed in a common area in which prostate cancer recurs.  This is important in follow-up after surgery.  If your doctor notes that your PSA levels are rising he will want to do imaging to carefully examine your prostate bed for any evidence of a recurrence.

Radiation Therapy

For men who have a recurrence of prostate cancer in the region of the prostate bed, but no evidence of metastatic disease, radiation therapy is often chosen to treat this area.

  Even if the recurrence in this region is fairly extensive (but not metastatic) it's been found that "salvage radiation therapy" may result in good PSA control.  Salvage radiation means that radiation is given to decrease the volume of a cancer but is unlikely to cure the cancer.

Treatment Issues

With radiation therapy it is important for radiation oncologists to be able to direct the radiation to a precise location.

  A concern has been that - since the prostate bed is essentially the absence of something in being a fossa - with movement between radiation visits, for example walking, the location of your prostate bed could vary from treatment to treatment.  Movement in this area could result in parts of the region receiving inadequate radiation, or in contrast, too much radiation.  Thus far studies have not shown that the area moves in a way that could significantly interfere with treatment.

Sources:

Barkati, M., Simard, D., Taussky, D., and G. Delouya. Magnetic resonance imaging for prostate bed radiotherapy planning: An inter- and intra-observer variability study. Journal of Medical Imaging and Radiation Oncology. 2015 Nov 16. (Epub ahead of print).

Kumar, A., Smith, K., Reddy, C., Stephans, K., Klein, E., and J. Ciezki. Safety and efficacy of salvage low-dose-rate brachytherapy for prostate bed recurrences following radical prostatectomy. Journal of Contemporary Brachytherapy. 2015. 7(4):241-6.

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