A hidden ureteral metastasis that originated from prostate cancer: a case report and literature review

Metastasis from primary prostate cancer (PCa) to the ureter is extremely rare. This study reports a 61-year-old male presenting with right flank pain and fever. Computed tomography urography (CTU) and magnetic resonance hydrography (MRH) showed right hydroureteronephrosis obstructed by soft tissue in the right ureter, retroperitoneal and left iliac vascular area lymphadenectasis. In addition, transitional cell carcinoma (TCC) was highly suspected. Ureteroscopy was performed, but nothing was found. Radical nephroureterectomy (RNU) with bladder cuff removal was finally applied as a thorough treatment based on its malignant intra-operative frozen result. Pathological examination revealed right ureteral carcinoma in the form of metastatic PCa. The Gleason score was 9 (5+4), grade V. We determined that RNU with bladder cuff removal was the best treatment for him and hematogenous metastasis was the most possible metastatic pathway from the prostate to the right ureter.