Ureteral metastasis after radical prostatectomy: A case report worthy of vigilance
Background: Radical prostatectomy is one of the main treatment methods for localized prostate cancer, and the cases of postoperative ureteral metastasis are very rare. Herein, we report an extremely rare case involving a patient with ureteral metastasis after radical prostatectomy.
Case presentation: A 70-year-old man has confirmed the diagnosis of prostate cancer with a Gleason score 3+4=7 by his preoperative pathology. Therefore, a radical prostatectomy was performed in our hospital on March 2, 2018, and the postoperative pathological results confirmed the diagnosis as prostate adenocarcinoma with a Gleason score 3+4=7. After the operation, the patient was ordered to follow up regularly, and the next treatment plan was determined based on the results of the follow-up, but the patient did not follow up regularly in our hospital. On December 20, 2018 and March 14, 2019, PSA re-examinations in another hospital showed biochemical recurrence (MRI showed no obvious recurrence and abnormal signals in the prostate area), and he did not return to our hospital for regular endocrine therapy. In October 2019, PET-CT in another hospital showed that: left lower ureteral calculi and left hydronephrosis. In November 2019, the patient returned to our hospital for re-examination of PSA (indicating biochemical recurrence) and urinary CT plain scan + enhanced indicated: the soft tissue density of the left ureter and bladder entrance area with mild enhancement, and left ureteral hydrops. Afterwards, the ureteroscopy was performed: the neoplasm and stenosis were found in the lower segment of the ureter. The endoscopic body dilated through this segment, and the ureteral dilation was visible. The slightly larger stones were removed, and the neoplasm were biopsy. In the end, the postoperative pathological results suggested: ureteral metastasis after radical prostatectomy.
Conclusion: Regular follow-up after radical prostatectomy is very important. Postoperative biochemical recurrence requires regular endocrine therapy, and the possibility of distant metastasis should be vigilant. In addition, there is a possibility of false negative in PET-CT, which suggests that patients with hydroureter should be alert to the occurrence of ureteral metastasis of prostate cancer.