Table 6 Summary table of local, nodal and haematogenous spread in prostate cancer

Local spread

•Direct extension through the prostate capsule into the seminal vesicles and bladder base

Lymph node spread

•Order of nodal involvement: obturator, presacral, internal iliac, common iliac

Haematogenous spread

•Bone >> lung and liver;

•Spinal bone metastases are the commonest site (due to the direct communication between the presacral and periprostatic veins)

Notes

•Denonvillier’s fascia forms a relative natural barrier to rectal spread;

•Tumours at the apex of the prostate are more likely to demonstrate extracapsular extension because of relatively little capsule at this level