Testicular metastasis as isolated recurrence after radical prostatectomy. A first case

Testicular metastasis of prostate adenocarcinoma: the other side of orchiepididymitis

Background

Metastatic prostate adenocarcinoma is a rare event and there are few references to this topic. We report an unusual case of prostate cancer metastasis and review of contemporary literature. Moreover, we discuss the pathogenesis and the clinical aspects of this event.

Case presentation

A 70-year-old patient was admitted to the hospital for right scrotal pain. The ultrasound examination described an increase in testicular size, suggesting the possibility of orchiepididymitis. Past medical history reported a previous prostate adenocarcinoma. Inflammatory blood tests were normal. Importantly, PSA was 3.3 ng/ml. PET scan positivity in the scrotum raised suspicion of a relapse. Therefore, he underwent right orchiectomy.

Conclusion

Although metastatic prostate adenocarcinoma is rare, a correct diagnosis is of paramount importance because the therapy changes accordingly. Patients who complain of scrotal pain need to be examined accurately. Although the most common cause behind this symptom is infectious, the patient's past medical history should be reviewed to exclude previous malignancies.

[Secondary tumors localized in testis]

Testis tumors are uncommon in oncology, and testicular metastasis from distant solid tumors are even rarer. We present two cases encountered in our department of pathology in CHU de Rennes, France. Moreover, we collected all reported cases in the Medline/PubMed databases of non-hematopoietic secondary testis tumors in adults, excluding autopsy studies, to propose an integrative study on this topic. In total, we report 98 cases of secondary testis lesions to prostate (n=38, 38.77 %), colorectal (n=19, 19.39%), gastric (n=12, 12.24%), kidney (n=7, 7.14%), lung (n=6, 6.12%) and other primary cancers. The median age at diagnosis was 66.5 years. We identified significantly more prostate adenocarcinoma (P<0.0001) when the primary tumor was known and significantly more colorectal adenocarcinoma (P=0.035) and pancreatic adenocarcinoma (P=0.002) when the primary tumor was unknown. The age at diagnosis was older when the primary tumor was known (P=0.007). We present the challenges for the diagnosis and propose some elements for diagnosis orientation. Finally, we discuss the possible ways of metastatic dissemination from primary site to testis, as illustrated by the two cases we present.

Prostate adenocarcinoma metastasis to the testis: A new case report

Prostate cancer (PCa) in the second most common cancer in men worldwide. It commonly metastasizes to the bone, lymph nodes, liver and lungs. Synchronous or metachronous testicular metastasis is a rare finding, generally diagnosed incidentally after bilateral orchidectomy for hormonal management in patients with advanced PCa, or at autopsy. We report a case of a 55-year-old male, presenting a PCa and who developed a single testicular metastasis treated by radical orchidectomy, while he was under hormonotherapy.

Testicular recurrence of oligometastatic prostatic adenocarcinoma after 22 years of androgen deprivation therapy

Testicular metastasis of carcinoma is a rare condition. We report a rare case of right testicular metastasis of prostatic adenocarcinoma in an 84 years old patient, after more than 20 years of controlled disease under androgen deprivation therapy. Follow-up consisted in PSA monitoring, clinical examination, CT and bone scan. Biological recurrence, right testicular mass and finally right total orchiectomy allowed the diagnosis of a right testicular metastasis. PSA monitoring and clinical surveillance are important tools for diagnosing metastatic localisations.

Prostate cancer metastasis to the testis: an unexpected presentation of a solitary recurrence

A 74-year-old man with a history of prostate cancer was referred to the urology team with a new left sided testicular lump. He had a background of prostate cancer 4 years previous which had been treated with external beam radiotherapy and androgen deprivation therapy, both of which had been completed. Concurrently, he also had evidence of biochemical recurrence of prostate cancer with a rising prostate-specific antigen (PSA). He underwent a left radical orchidectomy. Following histopathological analysis, this was found to be metastatic spread from his prostate cancer. Subsequent staging showed no evidence of metastatic spread elsewhere. The patient made a good recovery following surgery and his PSA levels returned to undetectable levels. He received no further treatment for metastatic prostate cancer.

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

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.

Isolated Testicular Metastasis from Prostate Cancer

BACKGROUND Prostatic adenocarcinoma is the most frequently diagnosed carcinoma in the male population; the most common sites of secondary lesions are nodes, bones, and lungs. We report the clinical case of a 58-year-old man presenting with a single metastasis in the left testis after a radical prostatectomy/lymphadenectomy for prostate cancer. CASE REPORT This clinical report focuses on a 58-year-old man with prostate cancer who developed an uncommon single metastasis in the left testis after radical surgery and adjuvant pelvic radiation therapy. CONCLUSIONS Prostate-specific antigen (PSA) levels are important in the follow-up of prostate cancer. At the same time, physical examination of all possible sites of metastasis and proper evaluation of all signs/symptoms are indispensable in the process of identifying recurrence and for the selection of patients undergoing adjuvant therapy.

Unilateral testicular metastasis of low PSA level prostatic adenocarcinoma

A 71-year-old man presented with a firm left testicle 15 years after being diagnosed with prostatic adenocarcinoma. After the initial diagnosis, the patient underwent a radical prostatectomy. He received radiation therapy 5 years after surgery for a slightly elevated prostate-specific antigen (PSA) level and a negative metastatic workup. Eight years later, the patient's PSA rose to 3.38 ng/mL and he was started on intermittent Lupron therapy. It was then 3 years later when the patient discovered the testicular mass. At that time, his PSA level was 2.98 ng/mL. He underwent a left orchiectomy which demonstrated metastatic prostatic adenocarcinoma. Currently, the patient is doing well 3 months postorchiectomy and is now receiving continuous testosterone suppression therapy. This case report discusses the unique modes of spread from the prostate to the testicle as well as the importance of follow-up care in patients with prostate cancer, especially in the setting of low PSA levels.

Isolated Testicular Metastasis of Prostate Cancer after Radical Prostatectomy: Case Report and Literature Review

Clinical recurrence of prostate cancer manifested as a testicular mass is an extremely rare condition. We report a case of a 58-year-old patient with a testicular tumor who underwent orchiectomy 7 years after radical prostatectomy. The pathology analysis confirmed metastasis from prostate carcinoma. After one year, the patient had no signs of biochemical and clinical recurrence. This argues for considering metastasectomy in such patients.

Advances in local and ablative treatment of oligometastasis in prostate cancer

Oligometastasis is a state of limited metastatic disease that may be amenable to aggressive local therapy to achieve long-term survival. This review aims to explore the role of ablative radiotherapy and surgical management of prostate cancer (CaP) patients with oligometastasis. We performed a systematic review of the literature from November 2003 to November 2013 in the PubMed and EMBASE databases using structured search terms. From our literature search, we identified 13 cases of oligometastatic CaP managed by surgery. The longest disease-free survival documented was 12 years following pulmonary metastasectomy. We also found 12 studies using radiotherapy to treat oligometastatic CaP with median follow-up ranging from 6 to 43 months. Local control rates and overall survival at 3 years range from 66 to 90% and from 54 to 92%, respectively. Most patients did not report any significant toxicity. The limited current literature suggests oligometastatic CaP may be amenable to more aggressive local ablative therapy to achieve prolonged local control and delay to androgen deprivation therapy (ADT). There is a larger body of evidence supporting the use of radiotherapy than surgery in this disease state. However, no direct comparison with ADT is available to suggest an improvement in overall survival. Further studies are required to determine the role of aggressive-targeted local therapy in oligometastatic CaP.

[Rare locations of metastases from prostate cancer]

The bone tissue is the most frequent site for prostate carcinoma metastasis. Nevertheless many other areas have also been described. Using Pubmed and Cochrane the most exhaustive research possible has been carried out to list these secondary prostate carcinoma lesions.