Obstructive Uropathy from Locally Advanced and Metastatic Prostate Cancer: An Old Problem with New Therapies

Abstract

Despite stage migration to more organ-confined disease in the era of prostate-specific antigen, the complications of advanced prostate cancer are still relatively common. Urinary tract obstruction in advanced and metastatic prostate cancer can have a varied presentation, because it may occur in multiple anatomic locations at any point in the natural history of the disease. In all cases, management depends on the current stage of disease, technical feasibility of potential therapeutic interventions, and overall prognosis of the patient. This review highlights a practical approach to the evaluation, diagnosis, and management of obstructive uropathy from prostate cancer.

Ureteral Reimplantation or Percutaneous Nephrostomy: Which One Is Better in Management of Complete Ureteral Obstruction Due to Advanced Prostate Cancer?

“…Before the advent of prostate specific antigen (PSA), ureteral obstruction was a common presentation for prostate cancer (1). By the beneficial effect of PSA in early detection of prostate cancer, the initial presentation of this cancer has changed to organ confined disease during the past decades, and locally advanced disease has been limited to only 3% of this population (1,2).…”

“…Before the advent of prostate specific antigen (PSA), ureteral obstruction was a common presentation for prostate cancer (1). By the beneficial effect of PSA in early detection of prostate cancer, the initial presentation of this cancer has changed to organ confined disease during the past decades, and locally advanced disease has been limited to only 3% of this population (1,2). Ureteral obstruction is developed in 3% to 16 % of patients with locally advanced prostate cancer (3), Whereas prostate cancer is the most common solid organ cancer in men (4); ureteral obstruction treatment is one of the main steps in the management of advanced prostate cancer.…”

“…Ureteral obstruction can occur because of the direct compression of prostate tumor and extrinsic compression of the lymph node metastasis in retroperitoneal space (1,3,5). Obstructive uropathy is a slow process and, ultimately, leads to electrolyte imbalance, urosepsis, renal insufficiency, and death (5,6).…”

“…Many specialists refuse surgical options of ureteral obstruction because of the poor condition and reduced survival of patients with advanced cancer (1,5,7,9), and the majority of studies have focused on other options, such as ureteral stents and PCN. Despite this traditional impression, there is no documented evidence of surgical management rejection in complete ureteral obstruction.…”

“…These modalities are morbid and out of date (1). Another surgical intervention for treatment of complete ureteral obstruction is bypassing the obstruction by Ureteroneocystostomy.…”