A 70-year old man, who was in excellent health, noticed pain in the back. This pain did not respond to usual pain-killer medication and he decided to see a doctor. Relevant clinical findings included: a rock-hard, enlarged prostate palpated on rectal examination, an osteoblastic tumor involving the lumbar vertebral bodies, elevated prostatic acid phosphatase and alkaline phosphatase in the serum. He had a prostatic biopsy, which revealed a poorly differentiated adenocarcinoma. Bilateral orchidectomy was performed and chemotherapy was instituted, but he died 5 months later.

Gross appearance of the urinary bladder and the prostate. Could one make the definitive diagnosis of prostatic carcinoma and distinguish this from benign prostatic hyperplasia?

In this case, the tumor has invaded into the urinary bladder. Where else does prostatic carcinoma usually spread?

Common metastatic sites of prostatic carcinoma.

Question for Class Discussion