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

From: Common primary tumours of the abdomen and pelvis and their patterns of tumour spread as seen on multi-detector computed tomography

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