Initially, prostate cancer grows locally in the gland followed by infiltration through the gland capsule, out into the fat tissue, and into surrounding structures (seminal vesicles, urethra and bladder neck). Metastasis can occur in all T-stages. This happens lymphatically to regional lymph nodes and further to distant organs. Distant metastasis can also occur hematogenously.
At what time the disease is infiltrating or metastasize depends on the aggressiveness of the tumor (predicted by Gleason grade and score and other prognostic factors such as DNA Ploidy).
Distant metastases are often localized to the skeleton. These are osteosclerotic and primarily localized to red hematopoetic bone marrow (spine), flat bones (pelvis, ribs, sternum, skull), humerus, and femur. Metastases distal to elbows and knees are very rare.