Management of obstructive uropathy patients with advanced prostate cancer - a systematic review

The optimal management of malignant ureteral obstruction in prostate cancer patients remains under debate and there exist no evidence-based recommendations to assist clinicians in advising patients.

Four databases were searched for the best available evidence for the treatment of ureteral obstruction and subsequent obstructive uropathy in prostate cancer regarding efficacy, overall survival and side effects. Treatment options considered were percutaneous nephrostomy (PCN), retrograde stenting and androgen deprivation (AD). The retrieved publications were screened for inclusion and exclusion criteria and assessed for methodological quality.

Of 987 identified publications, 13 were included in the review. The identified evidence consists of 3 cohort studies and 10 case series. More data and higher rates of successful decompression are published for PCN than for internal stenting. The results show inferior overall survival in patients pretreated with AD and high response rates for hormone-naive patients when treated with AD. There are no consistent results regarding the influence of unilateral or bilateral obstruction on overall survival.

Various methodological flaws reduce the validity and generalisability of these results. There is currently no scientific evidence allowing for a reliable answer to the optimal management of malignant ureteral obstruction in prostate cancer patients.