Fascia of prostate

The fascia of the prostate (Prostatic fascia) is a multilayered fibrovascular connective tissue sheath that covers the anterolateral surface of the prostate gland. It is distinct from the prostate's own fibromuscular stroma (historically and inaccurately termed the prostatic "capsule") and forms part of the broader fascial system that suspends and stabilizes the prostate within the pelvis.

Anatomical Description

Three principal fascial layers surround the prostate:

• Prostatic fascia (PF): Covers the medial and anterolateral aspects of the prostate. Histologically, it is a multifascial layer of fibrovascular tissue containing smooth muscle, nerves, and blood vessels, but it is negative for prostate-specific antigen, confirming it is not prostatic tissue itself.

• Endopelvic fascia (EF): The parietal layer that covers the levator ani muscle and partially engulfs the prostate laterally. The prostatic fascia merges with the endopelvic fascia along the lateral prostate surface.

• Denonvilliers' fascia (DF): A single fibromuscular structure covering the posterior aspect of the prostate and surrounding the seminal vesicles, forming the boundary between the prostate and the rectum. It has multiple fused layers and is continuous with the prostatic stroma medially.

Relationship to Neurovascular Structures

The neurovascular bundles (NVBs) critical for erectile function are situated in a triangular space formed between the prostatic fascia, endopelvic fascia, and Denonvilliers' fascia in the posterolateral region of the prostate. The NVBs are composed of numerous nerve fibers superimposed on a scaffold of veins, arteries, and variable amounts of adipose tissue. The prostatic fascia itself is rich in neural tissue, though never exceeding the amount found in the NVB proper.