What is the primary blood supply to the prostate gland?

Blood Supply of the Prostate Gland

The primary blood supply to the prostate gland comes from the prostatic arteries, which are branches of the internal pudendal artery that originates from the internal iliac artery. 1

Arterial Supply of the Prostate

The prostate has a dual vascular arterial supply pattern:

1. Cranial or Vesico-Prostatic Artery (VPA):

   • Also known as the anterior-lateral prostatic pedicle
   • Supplies most of the central gland and benign prostatic hyperplasia (BPH) nodules
   • Frequently arises from the superior vesical artery when there are two independent prostatic arteries
   • This is the preferred artery targeted during prostatic arterial embolization procedures 1

2. Caudal Prostatic Artery (PA):

   • Also known as the posterior-lateral prostatic pedicle
   • Has an inferior or distal origin
   • Vascularizes most of the peripheral and caudal gland
   • May have close relationships with rectal or anal branches 1

Anatomical Variations

• In approximately 60% of cases, both prostatic pedicles arise from a single prostatic artery 1
• In the remaining 40% of cases, the two pedicles arise independently from separate arteries 1
• The internal pudendal artery (the main source of blood supply to the prostate) originates:
  • Independently from the anterior trunk of internal iliac artery in 50% of cases
  • By a common trunk with the lower gluteal artery in 36% of cases
  • With both upper and lower gluteal arteries in 4% of cases
  • With upper gluteal artery in 8% of cases
  • With obturator artery in 2% of cases 2

Functional Differentiation

The prostatic arterial supply can be functionally differentiated into:

• Urethral branches
• Capsular branches 3

Venous Drainage

The venous drainage of the prostate occurs through:

• Prostatic venous plexus
• This plexus typically drains into the internal iliac vein via multiple veins (usually 2-5 veins)
• One vein always drains the prostatic plexus specifically 4

Clinical Significance

Understanding the blood supply of the prostate is crucial for:

1. Imaging Interpretation:

   • Computed tomography angiography and digital subtraction angiography can accurately depict male pelvic arterial anatomy 1
   • Vascular patterns may help differentiate between benign and malignant prostatic conditions 3

2. Interventional Procedures:

   • Prostatic arterial embolization for BPH requires precise identification of prostatic arteries 1
   • Awareness of anastomoses between prostatic branches and surrounding arteries (present in up to 60% of cases) is essential to avoid untargeted ischemia to adjacent structures like the bladder, rectum, anus, or corpus cavernosum 1

3. Surgical Considerations:

   • During radical prostatectomy, understanding vascular anatomy helps minimize blood loss, which is typically less than 300mL in experienced centers 5
   • Blood transfusion rates during prostatectomy range from 4% to 10% 5

Understanding the prostatic blood supply is essential for diagnostic imaging, interventional procedures, and surgical management of prostatic conditions.