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 |