LONG-STANDING URETERAL METASTASIS SECONDARY TO ADENOCARCINOMA OF THE PROSTATE AFTER BILATERAL ORCHIECTOMY

Abstract

A 64-year-old man presented with gross hematuria 1 day in duration in June 1999. He also had obstructive urinary symptoms 1 year in duration. History was remarkable for transurethral prostatic resection and orchiectomy for carcinoma of the prostate (clinical stage T3cN1M1b) 4 years earlier. According to the previous medical records, excretory urography had revealed marked hydronephrosis on the right side. Computerized tomography had shown diffuse seminal vesicle invasion, external iliac lymphadenopathy greater than 2 cm. and hydroureter on the right side. Bone scan had been normal. One month after bilateral orchiectomy prostate specific antigen (PSA) had decreased to 1.1 from 40.9 ng./ml. The patient had been lost to followup for more than 3 years. When the patient presented to us PSA had increased to 14.2 ng./ml. Excretory urography showed right hydronephrosis and an attempt at retrograde ureteral pyelography failed because the right ureteral orifice could not be identified. Transurethral prostatic resection was performed and urinary symptoms resolved. Computerized tomography revealed a hydroureter with multiple intraluminal ureteral masses. However, the seminal vesicle was normal with no lymphadenopathy. Bone scan was normal. We performed right percutaneous nephrostomy, and antegrade pyelography revealed multiple smooth marginated filling defects at the middle and lower ureter with hydroureter (fig. 1). Right nephroureterectomy with bladder cuff excision was performed. In the ureter 3 yellowish irregular elevated tumors were identified. The first mass emerged 16 cm. from the ureteropelvic junction. Microscopically, the tumor cells of the ureter were similar to those of the prostate and some