Spread

Prostatic carcinoma spreads in three ways:

• direct local invasion:
  • usually involves the seminal vesicles, base of the bladder, and urethra
  • rectal involvement is uncommon and late
    
    
• lymphatic:
  • initially to the obturator nodes, followed by perivesical, hypogastric, ilial, pre-sacral and para-aortic nodes
    
    
• haematogenous:
  • particularly to bones
  • tumour cells have ready access to the rich venous plexus contained within the fibrous sheath of the gland capsule
  • common sites for metastasis are, in descending order of frequency, lumbar spine, proximal femur, pelvis, thoracic spine, ribs and skull
  • lesions are typically osteosclerotic
  • spread may also occur to the liver and the lung