Ureteric stricture: an unusual presentation of metastatic prostate adenocarcinoma

Ureteral involvement by metastatic malignant disease

Ureteral metastases from other primary cancers are very rare. Treatment of these metastases is difficult and outcomes are poor. A thorough literature review was done with the aim of finding characteristics that may influence survival rates of patients with ureteral metastases. Systematic literature searches of PubMed and Web of Science were performed in Jan 2019. A total of 79 papers that included 265 patients with cancer metastases to their ureters were finally considered for evidence synthesis. Prostate, bladder, breast, gut cancer and lymphoma were the predominant primary tumors. The median interval time from primary tumor diagnosis to ureter metastasis was 28.5 months. The median survival time after diagnosis of ureter metastasis was 18 months. Risk factors of survival were analyzed. Age, sex, hydronephrosis, ureter side, and segment were not associated with survival. Interval time and treatment were associated with overall survival. Further analysis indicated that patients who underwent surgery had better outcomes.

What are the odds? Prostate metastases to ureter and peritoneum

In patients with prostate cancer, metastases mostly develop in bone, lung, liver, pleura and adrenal glands. Prostate carcinoma metastases to the ureter are very rare, and the peritoneum is an even rarer site of prostate metastases. We present two cases of ureteral metastases of prostate cancer, of which one patient also developed malignant ascites and peritoneal metastases. An overview of the literature on these metastatic sites is also provided. Both patients presented with hydronephrosis and a ureteral mass. Biopsies of the masses were taken, which showed the presence of prostate carcinoma metastases. The first patient was treated with chemotherapy but was diagnosed with progressive disease and died 3 years later. The second patient was diagnosed with pathology-confirmed peritoneal metastases 8 months later. He died 2 years after presentation with hydronephrosis.

Hydronephrosis associated with ureteral metastasis of prostate cancer: A rare case report

Prostate cancer is one of the most common male malignancies, although it rarely metastasizes to the ureter. The present case study reported a 63-year-old man who presented with asymptomatic right hydronephrosis, detected by ultrasound. Computed tomography urography demonstrated right hydronephrosis, secondary to thickening of the distal ureter. The patient's serum concentration of prostate specific antigen was 111.400 ng/ml, and a prostate needle biopsy revealed prostate adenocarcinoma, with a Gleason score of 4+5=9. Renal scintigraphy revealed poor excretion of the right kidney. A nephroureterectomy was subsequently performed, and a histological examination revealed a metastatic prostate adenocarcinoma of the ureter. Combined androgen blockage therapy with bicalutamide (50 mg, once daily) and goserelin (3.6 mg, once a month) was administered to the patient. At 3 months of follow-up, the patient's PSA levels had decreased to 0.322 ng/ml; at 6 months of follow-up, the PSA levels had further decreased to 0.136 ng/ml.

Metastatic prostate adenocarcinoma posing as urothelial carcinoma of the right ureter: a case report and literature review

This is a case report of a 67-year-old patient with distant metastasis of prostate cancer to the right ureter which caused hydronephrosis. At the beginning, both of the cytology of the morning urine and imaging findings were consistent with urothelial carcinoma. Nephroureterectomy was subsequently performed. Interestingly, the pathological examination of the excised ureter revealed that the malignancy was derived from the prostate. No skeletal metastasis was detected. However, after four months of follow-up, several abnormal signal shadows were reported in skeletal scintigraphy and the prostate specific antigen (PSA) was gradually increasing. We present such a case for its unique presentation. A review of the literature is also provided.

Unusual presentations of prostate cancer: A review and case reports

Objective

To report our institutional experience with some rare presentations of prostate cancer, as prostate cancer is a common problem and affects a large group of men during their lifetime, but a few studies report unusual presentations of metastatic prostate cancer.

Methods

All possible clinical and pathological data were collected for six relevant patients with prostate cancer and unusual metastases who were identified at our institution. PubMed was searched for unusual presentations of prostate cancer in the last 20 years (1982–2012) and all relevant publications were assessed. The authors discussed the reports and selected those articles of major clinical significance to include in a review.

Results

We identified 19 reports of major clinical significance and reviewed them. As in the cases from our institution, supraclavicular lymphadenopathy, isolated upper ureteric obstruction and severe obstructing constipation were some of the rare presentations encountered at other institutions, and reported mostly as sporadic case-reports.

Conclusion

Prostate cancer should be always considered in the differential diagnosis of elderly men presenting with supraclavicular lymphadenopathy, hydroureteronephrosis or constipation, even in the presence of a normal digital rectal examination and low serum total prostate-specific antigen (PSA) levels. PSA immunohistochemical staining should be used in doubtful cases.