In recent years, with the development of anatomy and improvement of surgical techniques, especially the widespread use of laparoscopy, people’s understanding of the anatomy related to radical prostate cancer (RP) has changed greatly; I. Dorsal vasculature complex (DVC) Previously, it was thought that the DVC mainly consisted of the dorsal vein and its branches draining the penis and urethra, which was called the dorsal vein complex (DVC). Dorsal vein complex (DVC), but it is now believed that about 15% of DVCs contain branches from the inferior cystic artery or the collateral pubic artery, whose function may be related to the innervation of the urethral sphincter and penile erection of the penile corpus cavernosum [1]. Proper management of the DVC is also clinically important in relation to the recovery of postoperative urinary control. It is usually considered necessary to suture the DVC during RP to reduce bleeding, but suturing may damage the urethral sphincter fibers and lead to delayed recovery of postoperative urinary control [2]. For large prostate size, pelvic stenosis and difficult DVC suturing, it is also possible to cut the DVC first and then selectively suture the bleeding artery, which can not only accurately stop bleeding but also avoid damaging the sphincter stump and help improve early urinary control [3,4]. 244 cases in one group compared cutting first and then suturing (126 cases) with suturing first and then cutting the DVC (118 cases), and the results showed that both the bleeding volume, the positive cutting edge rate and postoperative incontinence rate were not significantly different. However, from a technical point of view, posterior suture ligation can be more favorable for dissection of the prostate apical region [5]. Some studies even suggest that laparoscopic radical prostate cancer can be performed without ligating the DVC and that hemostasis can be achieved by increasing pneumoperitoneal pressure and using venous retraction, while small arterial bleeding in it can be stopped by electrocoagulation. Although intraoperative bleeding may be increased, it allows for more precise dissection of the prostatic apices and complete preservation of the external urethral sphincter [6]. The anterior prostate and urethral surface are mainly covered by anterior fibromuscular stroma (AFMS) tissue that extends from the distal bladder neck. The DA is thickest at the midline of the bladder neck and fuses laterally with fibrous tissue to form the intrapelvic fascial tendon arch, with superficial longitudinal muscle fiber bundles in the DA entering the pubococcygeal muscle and converging downward on the pubococcygeal ligament or directly behind the pubic bone. The posterior DA is composed mainly of smooth muscle and fibrofatty tissue between the posterior wall of the bladder neck and the seminal vesicle, which is more suitable than Diaphragm for the fixation of the MDFR, a key structure associated with the reconstruction of the posterior wall.The MDFR is located posterior to the urethra and is a wide myofascial plate-like structure, which is mostly severed when transecting the posterior wall of the urethra and is easily confused with Diaphragm The MDFR is located posteriorly to the urethral wall in a wide myofascial plate-like structure, and the MDFR structure is mostly cut and easily confused with the Diaphragm when transecting the posterior urethral wall [8]. Understanding the DA structure helps to improve the anatomical skills of the prostatic apical region, in fact there is an avascular zone between the DVC and the prostatic envelope that separates the DA and the pubic bladder ligament from the anterior surface of the prostate, thus maximizing the preservation of the urethral sphincter supporting tissue and maintaining the physiological anatomical position of the urethra, using this technique does not require further periurethral tissue suspension and facilitates the recovery of urinary control[9] . . Third, the pubovesical complex (PVC) has been suggested that the pubic bladder ligament, DA, DVC and urethral sphincter may be involved in urinary control as a functional complex [10]. It was previously thought that the pubic prostatic ligament ends at the surface of the prostate and is called the pubic prostatic ligament, but in fact this ligament is connected to the anterior wall of the bladder through the pubovesical ligament to the pubic bone, and the DVC connects the urethral sphincter to the bladder and DA through fibromuscular tissue, whereas the pubic prostatic ligament as commonly spoken of is only a part of the pubic bladder ligament. The PVC is usually preserved intact during radical transepubic prostatectomy, but it is mostly destroyed during radical treatment of retropubic prostate cancer. Physiologically, complete preservation of these structures can serve to maintain the normal anatomical position of the external urethral sphincter and urethra, while reconstructive procedures such as urethral suspension are no longer needed to increase the stability of the urethral sphincter, and maximum preservation of the PVC is beneficial for early postoperative restoration of urinary control [9]. Walsh et al. found through anatomical studies that the so-called “Neurovascular bundle (NVB)” exists in the posterior lateral aspect of the prostate, and suggested that this is the key nerve for preserving erectile function. This was thought to be the key nerve for preserving erectile function. However, recent microdissection has revealed that, in addition to the posterior lateral aspect, a large number of nerve fibers exist ventral and peripheral to the prostate, and these nerves are located outside the NVB in a reticular pattern [11]. It has been divided into three regions based on innervation, the proximal nerve network, the nerve bundles and the distal nerve network. At the level of the prostate tip and urethra, the nerve fibers can be further divided into 2 branches, where the cavernous nerve formed by the continuation of the anterior and anterolateral prostate fibers enters the penile corpus cavernosum, while the urethral cavernous nerve formed by the continuation of the posterior lateral prostate nerve fibers enters the urethral corpus cavernosum [12]. Although histology confirms the existence of a periprostatic nerve network, functional studies of nerves outside the NVB are still lacking.Yasuhiro et al. used electrical stimulation of the periprostatic tissue and found that stimulation of the postero-lateral, anterior and lateral prostate caused an increase in penile cavernosal pressure, with the greatest change in neurocavernosal pressure at stimulation points 4-5 and a gradual decrease in pressure from postero-lateral to 12 points, which suggests that all periprostatic nerve networks may be involved in erection [13]. The incidence of erectile dysfunction after RP with preserved NVB is still high, mainly due to the large variability in the distribution of cavernous nerves and their anatomical relationship with the prostate and urethra, and the number of periprostatic nerves, especially the cavernous nerves, cannot be accurately detected yet. It also eliminates the need for contrast agents and may be used clinically in the future [14]. V. Accessory pudendal artery (APA) APA is defined as any artery that originates from a branch of the inferior inferior abdominal artery and is located above or parallel to the anal raphe and enters the penis. Different studies have reported APA positivity rates of 4-70% in men [15]. Depending on the location of the APA in relation to the prostate it can be divided into lateral and apical types, where the apical type is located at the tip of the prostate and crosses the anal raphe fibers originating from the pubic artery or associated with a pubic artery variant, which is often encircled by the DVC vein and from which the main arterial blood supply to the urethral sphincter sometimes originates. In contrast, the lateral type is often located lateral to the prostate and branches mostly from the terminal branch of the internal iliac artery, which often adheres to the prostatic fascia and can easily be misinjured during surgical separation and lead to bleeding [16]. Since the APA is highly variable and may originate from the internal iliac artery, external iliac artery, or occluded artery, and may be the only artery supplying the penile corpus cavernosum, this artery should be preserved as much as possible during radical prostate cancer surgery, and cutting these arteries may affect postoperative erection [17], but some studies have concluded that preserving the APA or not does not affect sexual function [18]. VI. Rectourethralis muscle The rectourethralis muscle is located behind the tip of the prostate and between the medial edges of the puborectalis muscle, and is Y-shaped, consisting mainly of the anterior bundle of longitudinal smooth muscle fiber groups in the lower part of the anterior rectal wall, extending horizontally forward to attach to the membranous and bulbous parts of the urethra, and the transverse urethral sphincter is closely attached to the apical and ventral parts of the rectus urethralis muscle. The dorsal aspect of the membranous urethra is mainly composed of the transverse urethralis muscle, Diaphragm, rectus longitudinalis and rectus urethralis muscle, Diaphragm ends at the urethrorectus muscle, while the rectus urethralis muscle is an important tissue structure of the urethral sphincter complex, whose main role is to support the posterior wall of the urethral sphincter and to enhance the stability of the membranous urethra and is related to urinary control [19]. The deep transverse perineal muscle is closely related to the rectus urethralis and the transverse urethralis muscle, but the results are still controversial in different studies due to the variability of its morphology and location [20]. The deeper location of the rectus urethralis muscle does not usually appear in the operative field during radical treatment of retropubic prostate cancer, but during radical treatment of perineal prostate cancer, the rectus urethralis muscle must be incised to reveal the posterior wall of the prostate. It has been found that a large number of cavernous nerve fibers travel between the rectus urethra and anal raphe or penetrate the rectus urethra muscle; therefore, the rectus urethra muscle should be protected during radical prostate cancer treatment, especially trans-perineal treatment, including reconstruction of the myofascial layer of the posterior urethral wall with sutures, to reduce postoperative erectile dysfunction [21]. VII. Prostatic anterior fat pad (PAFP) Generally, the surface of the prostate is covered with fat pad-like tissue, and intraoperative excision of this fat facilitates full exposure of the prostate tip and and bladder neck. It has been found that the thickness and density of these adipose tissues correlate with tumor aggressiveness by stimulating tumor cell proliferation and promoting angiogenesis, and that obesity increases this activity [22,23]. Currently, some studies have suggested that resection of PAFP has the effect of lymphatic clearance, and a group of 356 radical prostate cancer specimens were examined and found that 19 cases (5.5%) had metastatic lymph nodes in PAFP, among which 3 cases had pelvic lymph node dissection but no lymph node metastasis was found, which indicates that lymph nodes in PAFP are not related to lymph nodes in other sites, so for accurate lymph node staging, routine resection should be performed and check for lymph node metastasis in PAFP [24]. A retrospective analysis of 4261 radical prostate cancer specimens from a multicenter showed that the probability of finding lymph nodes in PAFP was 11.9%, with a lymph node metastasis rate of 0.94%. The anatomical basis of this lymph node metastasis is unknown, and analysis of the lymphatic distribution results in PAFP showed that 89% of the lymphatic tissue was located in the middle of PAFP. The majority (92.5%) of PAFP patients with lymph node metastases are at high or intermediate risk, and 67.5% of patients with PAFP lymph node metastases have negative pelvic lymph nodes or no pelvic lymph node dissection, for which there is no standard treatment protocol. Local radiotherapy or short-term anti-androgen therapy may benefit some patients [25]. Lymphadenectomy of these sites may prolong biochemical recurrence and reduce local recurrence in some patients, therefore it is recommended that preprostatic adipose tissue should be routinely removed during RP [26], but its impact on long-term prognosis still needs further study. In conclusion, there are many anatomical variations among different individuals in the male pelvis, and radical prostate cancer surgery requires a profound knowledge of the periprostatic anatomy, and a full understanding of the anatomical features of these important sites can help to reduce complications and obtain better surgical results.