Bilateral secondary testicular, epididymal and spermatic cords carcinoma of prostatic origin: a case report and review of the literature

Abstract

Background Prostatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases. Case presentation A 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence. Conclusion Since it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.

Testicular metastasis of prostate adenocarcinoma: the other side of orchiepididymitis

“…The likely explanation is that scrotal temperature prevents tumor cell proliferation. The risk of metastasis might also be reduced by the presence of Sertoli cells tight junctions, which constitute the blood-testis barrier 6 , 7 .…”

“…However, testicular metastasis is often an incidental finding during specimen processing or autopsy. Both testes might be involved, but it is usually unilateral 6 , 8 . The interval between the event and the metastasis may range from six months to some years 9 .…”

“…The interval between the event and the metastasis may range from six months to some years 9 . Metastatic prostate cancer usually has a high Gleason score which matches the primitive neoplasm 6 . Table I shows literature cases of prostate adenocarcinoma metastatic to the testis.…”

A Rare Case of Castrate-Resistant Prostate Adenocarcinoma with a Unilateral Testicular Metastasis Mimicking a Primary Testicular Tumour

“…As surgical castration in the management of prostate cancer has been largely replaced by pharmacological castration, testicular metastasis from prostate adenocarcinoma has been Case Reports in Oncology reported rarely. Clinically, patients with testicular metastasis can present with testicular pain or lump [4,8]. Hence, it can mimic primary testicular germ cell tumours.…”

“…Testicular metastasis from prostate adenocarcinoma is a very rare phenomenon, reported to occur in between 0.18 and 0.5% of cases [4] . Testicular metastases were traditionally found on either post-mortem examinations or orchidectomy for surgical castration, where small deposits of prostate adenocarcinoma are seen [5] .…”