Prostate Bed in Prostate Cancer Treatment

Structure adjacent to the gland vulnerable to cancer spread

Doctor explaining urological problems
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The prostate bed is a structure in the male pelvis situated just beneath the bladder where the prostate gland rests. The term is most often used in the context of a surgical procedure known as a radical .prostatectomy in which the prostate gland is removed in men diagnosed with prostate cancer.

Due to its adjacent position, the prostate bed is especially vulnerable to the spread of cancer. Because of this, the prostate bed (also known as the prostatic fossa) is often the focus of secondary cancer treatment.

When a Radical Prostatectomy Is Indicated

Surgery is commonly used to cure prostate cancer if it hasn't spread (metastasized) beyond the prostate gland itself. The radical prostatectomy is the main type of surgery performed. It involves the removal of the entire prostate gland and surrounding tissue, including the seminal vesicles (the organs which secrete fluids that make up semen). Nearby lymph nodes may also be removed.

In a radical prostatectomy, the prostate gland can be accessed in a number of different ways:

  • Through an incision in the lower abdomen (retropubic)
  • Through an incision between the anus and scrotum (perineal)
  • Through a keyhole incision using a thin, lighted surgical instrument called a laparoscope (laparoscopic)

The choice of surgery depends largely on the treatment goals. A retropubic prostatectomy is more commonly used if doctors believe that the cancer has spread to the lymph nodes.

A laparoscopic prostatectomy is far less invasive but required a skilled surgeon (and may not be offered in all clinics).

Of the three, the perineal prostatectomy is less commonly used because it is more likely to cause nerve damage resulting in erection problems.

The Prostate Bed in Cancer Treatment

The prostate bed is a key area of focus in men undergoing a prostatectomy.

It is where cancerous cells are most often found after the gland has been removed. It is also the site where cancer commonly recurs in persons previously treated for a malignancy.

For these reasons, adjuvant (secondary) radiation therapy may be used to ensure that all cancer cells have been eradicated. Meanwhile, any suggestion of recurrence will typically include an investigation of the prostate bed and surrounding tissues.

Adjuvant Radiation Therapy and the Prostate Bed

After a radical prostatectomy has been performed, the doctor will want to regularly monitor your condition with a blood test called a prostate-specific antigen (PSA) assay. The PSA is used to detect inflammation of the prostate gland. After the gland has been removed, the PSA should drop to an undetectable level within a month or so.

However, if the PSA begins to rise, your doctor may suggest a procedure called external beam radiation therapy. This delivers targeted radiation directly to the prostate bed and surrounding tissue. It is sometimes performed in conjunction with hormone therapy to improve cure rates.

Adjuvant radiation therapy may be also be recommended in men considered to be at higher risk of recurrence. The procedure is performed soon after the prostatectomy to better ensure all traces of cancer are killed.

As many as 60 percent of men undergoing a radical prostatectomy are likely to have a recurrence.

For men who experience a recurrence in the area of the prostate bed, but with no metastasis, salvage radiation therapy may be prescribed. The goal of salvage therapy is to control (rather than cure) the cancer and to prevent it from metastasizing beyond the immediate area. It is not appropriate for metastatic disease.

Side effects from radiation therapy can vary s based on how localized or extensively distributed the cancer is. Be sure to discuss with your doctor what you can reasonably expect before deciding on a course of radiation therapy.

Sources:

Barkati, M.; Simard, D.; Taussky, D. et al. "Magnetic resonance imaging for prostate bed radiotherapy planning: An inter- and intra-observer variability study." Journal of Medical Imaging and Radiation Oncology. 2015; Epub ahead of print).

Herrera, F. and Berthold, D. "Radiation Therapy after Radical Prostatectomy: Implications for Clinicians." Frontiers in Oncology. 2016; 6:117.

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