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Ureteric stricture secondary to unusual extension of prostatic adenocarcinoma

Venu Chalasani¹, Petr Macek², Gordon F. O’Neill³, Wade Barret⁴

1 Divisions of Urology and Surgical Oncology, University of Western Ontario, London, Ontario, Canada
2 Department of Urology, General University Hospital, Prague, Czech Republic
3 Department of Urology, St.Vincent’s Hospital, Sydney, NSW, Australia
4 Department of Pathology, St.Vincent’s Hospital, Sydney, NSW, Australia
Address correspondence to Dr. Venu Chalasani, University of Western Ontario & LHSC, Room A2-500, 800 Commissioners Road East, Victoria Hospital, London, Ontario N6A 5W9 Canada

Canadian Journal of Urology 2010, 17(1), 5031-5034.

Abstract

This article describes an unusual fi nding in a patient who presented with an adenocarcinoma of the prostate and right hydronephrosis. A 68-year-old male presented with right hydronephrosis and a PSA of 96. DRE was consistent with cT3 carcinoma. Cystoscopy showed an exophytic superfi cial transitional cell carcinoma (TCC) of the bladder and a transrectal biopsy of the prostate confi rmed adenocarcinoma Gleason score 4+3. Staging investigations (CT pelvis and bone scan) were negative; androgen deprivation therapy was therefore initiated for the prostatic adenocarcinoma. Upper tract imaging showed multiple fi lling defects in the proximal ureter. Ureteroscopy showed a stricture at the level of the iliac vessels. With a working diagnosis of upper tract TCC, right open nephroureterectomy was performed. Final histology showed prostatic adenocarcinoma infi ltrating the adventitia of the entire ureter up to the level of the renal pelvis.
A rare cause of ureteric stricture, contiguous spread of prostatic adenocarcinoma, should be considered in the differential diagnosis of patients presenting with upper tract obstruction and a known history of prostatic adenocarcinoma. Androgen deprivation therapy for several months did not seem to cause resolution of the tumour in the periureteric, ureteric and perihilar tissues.

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