We examined 34 thoracic and lumbar vertebrae in eight patients with pr
ostate cancer to elucidate the pattern of metastasis to the vertebral
column. Computed tomography of thoracic and lumbar vertebrae was perfo
rmed before treatment for the prostate cancer. Metastatic lesions were
confirmed both by the recognition of osteoblastic and/or osteolytic l
esions on CT and by histological identification at autopsy. Localized
metastatic lesions were observed mostly in the peripheral rather than
the central part of the vertebral body. There were no differences in d
istribution of lesions between the anterior and posterior parts of the
Vertebral body. There was no primary involvement of tumor in the spin
ous and transverse processes. These findings indicated that the major
metastatic pathway to the vertebral column is via the vertebral venous
system, and it appears that prostate cancer cells first metastasize t
o the vertebral body and then spread secondarily to the processes or o
ther vertebrae. (C) 1994 Wiley-Liss, Inc.