Abstract
The mechanism of bone metastases in patients with carcinoma of the prostate remains controversial. It is recognized that bone metastases may occur by arterial spread, retrograde venous spread or direct involvement from contiguous structures. The bone is devoid of lymphatics and therefore this vascular pathway is not a likely mechanism for the development of metastatic foci. Two theories predominate related to the mechanism of spread to bone from carcinoma of the prostate. Tumor emboli are believed to be randomly distributed throughout the body and sites of successful metastases are related to “seed-in-fertile soil.” Skeletal metastases occur primarily in areas containing hematopoietically active red bone marrow and it is this framework on which metastases form. Based on these principles it is believed that tumor cells enter the lymphatic drainage of the prostate, pass through the thoracic duct and enter into the general circulation. They pass through the lungs and heart and become distributed randomly throughout the body in this manner. Because they are more prone to grow in bone marrow active foci become evident in these areas. Proponents of this theory base their arguments on the similar distribution of bony metastases of lung and breast carcinoma. The other predominant theory related to the spread of carcinoma of the prostate is based on the anatomical findings of Batson’s paravertebral venous plexus. This valveless plexus of veins anastomoses with pelvic, intercostal and head and neck and intracranial veins and ascends the vertebral column. Increases in intrathoracic pressure directs blood flow into this system from the caval and azygous venous system and accounts for the increased distribution of axial skeletal metastases in patients with carcinoma of the prostate. Tumor cells would therefore not pass through the lungs or liver. Experimental evidence supports this form of metastases as well.
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Resnick, M.I. (1992). Hemodynamics Of Prostate Bone Metastases. In: Karr, J.P., Yamanaka, H. (eds) Prostate Cancer and Bone Metastasis. Advances in Experimental Medicine and Biology, vol 324. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3398-6_7
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DOI: https://doi.org/10.1007/978-1-4615-3398-6_7
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