Question

A patient presents with prostate carcinoma, which has now spread to the vertebra. What is the route of spread to the lumbar vertebra?

• A. Prostatic venous plexus
• B. Transcoelomic spread
• C. Inferior vesical vein
• D. Internal iliac vein

Answer 1

The Correct Option is A

The spread of prostate carcinoma to the vertebrae occurs predominantly through the venous system, specifically via the prostatic venous plexus. This plexus is part of the valveless Batson's venous plexus or vertebral venous plexus, which facilitates the hematogenous spread of cancer cells.

Explanation:

1. Anatomy Review: The prostate is surrounded by a network of veins known as the prostatic venous plexus. This plexus connects to the internal vertebral venous plexus (Batson’s plexus).

2. Route of Spread: Cancerous cells from the prostate can enter this venous plexus and move against gravity to reach the vertebral column, particularly the lumbar vertebrae, without passing through the lungs.

3. Pathophysiology: The lack of valves in Batson's plexus allows for bidirectional blood flow, enhancing the likelihood of cancer spread from the prostate to the vertebrae.

Thus, among the provided options, the correct route of spread is through the prostatic venous plexus.