Extended Periprostatic Nerve Distributions on The Prostate Surface Confirmed using Diffusion Tensor Imaging (DTI).

OBJECTIVE: To perform descriptive microscopic study of prostatectomy specimens from 19 patients which anatomically characterizes distributions of periprostatic nerves qualities and visualize them using diffusion tensor imaging (DTI).

METHODS AND MATERIALS: Serial whole-mounted sections were stained for cholinergic(nNOS), adrenergic(TH), and sensory(CGRP) nerves. Extracapsular stained nerves were counted by prostate surface sector and classified by diameter. Stain-related relative density was calculated and distribution patterns were evaluated. To better visualize the reported neuronal structures and independently confirm our findings, nerve concordance in five male volunteers was investigated using a 3-Tesla-MRI-DTI system.

RESULTS: At the base, cholinergic nerves were distributed from the anterolateral to posterior sectors, continuing posterolaterally (midsection) into the posterolateral-posterior sector toward the apex. Adrenergic nerves were distributed across the anterolateral-posterior sectors at the base, with the course narrowing to the posterolateral-posterior sectors at the mid and apical levels. Sensory fibers were found posterolaterally-posteriorly at the base, continuing posterolaterally over the mid and apical levels. Although it was not possible to determine the different nerve qualities, DTI confirmed histologic findings from the base to the apex.

CONCLUSION: Different types of nerve fibers demonstrate distribution variations. When linked to possible functional aspects of the different nerve types, this morphologic evidence may be of importance to further protect function after radical prostatectomy. To our knowledge this is the first time that DTI confirmed reported histological findings in nerve sparing radical prostatectomies. DTI could be used as an important tool to correlate nerves-to-tumor for better pre-operative planning and incorporate imaging into the treatment. This article is protected by copyright. All rights reserved.