Tại địa phương giai đoạn tiên tiến T3/T4 ung thư tuyến tiền liệt đôi khi có thể va chạm phía sau trong trực tràng để sản xuất các triệu chứng của cảm giác buốt mót, táo bón và ít phổ biến hơn, chảy máu trực tràng | AN ATLAS OF PROSTATIC DISEASES Figure 81 An adenocarcinoma can be seen extending posterolaterally beyond the gland into adipose tissue to encircle the neighboring nerves and ganglia. Perineural invasion must be considered during nervesparing surgery Figure 82 Locally advanced-stage T3 T4 prostate cancers may occasionally impinge posteriorly in the rectum to produce symptoms of tenesmus constipation and less commonly rectal bleeding 66 15 Metastatic spread of prostate cancer The most favored sites of prostate cancer metastases Figure 83 are the obturator lymph nodes and the bony skeleton especially the lumbosacral spine and pelvis. However lymph nodes elsewhere the lungs and other soft tissues may also be involved Figures 84 and 85 . The reasons for the particular proclivity of prostate cancer metastases to develop in the skeleton have recently been elucidated35 36 1 Metastatic tumor cells release humoral factors such as parathyroid hormone and interleukin-6 Figure 83 The favored sites of metastases from prostate cancer are the lymphatic nodes of the obturator fossa and the bony skeleton in particular the lumbosacral spine and bony pelvis 67 AN ATLAS OF PROSTATIC DISEASES Figure 84 These specimens are the result of metastatic spread of prostate cancer to the lymph nodes in the pelvis and abdomen a and mediastinum b and to the lung c and spinal vertebrae d .
