Role of percutaneous nephrostomy in end of life prostate cancer patients: a systematic review of the literature.

Introduction: Prostate cancer is the most common cancer amongst men in the UK. Treatments for malignant ureteric obstruction consist of percutaneous nephrostomy, ureteric stent insertion, or occasionally other forms of urinary diversion. Our aim was to look at the outcomes of percutaneous nephrostomy (PCN) in patients with advanced prostate cancer and to look at the impact on patient's general health, quality of life, life expectancy and complications after PCN insertion.

Material and methods: A systematic review of the literature was done for all prospective English language articles on PCN in patients with prostate cancer using PubMed, MEDLINE, EMBASE, Scopus, CINAHL, Cochrane library, Clinicaltrials.gov, Google Scholar and individual urological journals from inception to August 2017. While studies involving prostate cancer patients were included, studies on all other mixed pelvic malignancies were excluded.

Results: Seven articles met the inclusion criteria. There were 184 patients, with a mean age of 70 years (range: 51-94 years). PCN was performed for ureteric obstruction due to advanced prostate cancer, patients underwent unilateral (n = 66) or bilateral PCN (n = 118) with conversion to an antegrade stent in 25 patients. Their post-PCN survival varied between 4-31 months and this was longer if they were hormone naïve or showed a good recovery in their renal function. Although the complication rates were low (1-3%), patients spend a high proportion of their lives in the hospital.

Conclusions: PCNs should only be pursued after thoughtful counselling regarding further treatment options and prognosis as these patients with advanced malignancies seem to have reduced survival duration and spend a significant amount of time in hospital.