Isolated Testicular Metastasis Diagnosed More than a Decade and a Half Post Primary Treatment for Prostate Cancer

Abstract

Prostate cancer is the most common visceral malignancy among men. It rarely metastasizes to the testicles. We herein present the case of a male patient who underwent a radical prostatectomy for a grade group 3 Gleason score 7 (4 + 3) prostate adenocarcinoma followed by adjuvant radiation therapy and continuous androgen deprivation therapy after his first biochemical recurrence. Despite optimal management, prostate-specific antigen (PSA) levels rose back up, upon which a PET/CT 68Gallium scan demonstrated an isolated left testicular lesion that turned out to be of prostatic origin following orchiectomy. Testicular metastases from prostate cancer are of unknown prognosis, and the current treatment modality favors an orchiectomy.

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

“…The majority of cases of prostate carcinoma with testicular metastasis have advanced disease with metastasis to other parts of the body, as our patient did [7,8]. However, only few cases of isolated testicular metastasis have been reported in the literature [6,16,17]. While many of these cases are usually incidental findings, few may present with a lump or a nodule, like our patient did [8].…”

“…While many of these cases are usually incidental findings, few may present with a lump or a nodule, like our patient did [8]. They are also usually associated with high Gleason histological score [16,17]. Our patient had a Gleason score of 5 + 5 = 10.…”

Physical Examination Discovered Prostate Cancer Metastasis to the Testis: A Case Report

“…According to a recent meta-analysis, there are no other reported cases of prostatic adenocarcinoma with a Gleason score of 6 and PSA level <1 at diagnosis of testicular metastasis [ 10 ]. Prostate cancer recurrence despite low concomitant PSA levels may be explained by a clonal shift in the original tumor, which could lead to the proliferation of dedifferentiated prostate cancer cell lines that have lost the ability to produce PSA.…”

Oligometastasis to testis in prostate cancer: Role of gallium-68 prostate-specific membrane antigen positron-emission tomography computed tomography

“…[ 3 ] Even in prostate cancer, a preference toward left testicular metastasis has been reported in literature. [ 4 ] This favoritism may be attributed to the location of the primary tumor in the prostate or may be just by chance or attributed to an unidentified reason. In paradox to that, in our three cases, two were involving the right testis.…”

“…On literature search, we identified four cases of testicular oligometastasis reported on 68 Ga-PSMA PET/CT scan. [ 4 5 6 7 ] All these cases identified testicular metastasis following biochemical relapse. In one of our cases, testicular metastasis was also diagnosed at staging workup.…”