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

Preperitoneal vas deferens infiltration in high-risk prostate cancer

Objectives

The objective of this study is to evaluate the prevalence and the importance of preperitoneal vas deferens (VD) infiltration in high-risk prostate cancer (PCa).

Patients and Methods

In this prospectively designed study, we included 332 high-risk PCa patients with a Briganti score >5%, who were treated by robot-assisted radical prostatectomy between July 2017 and February 2022 at the Urology Department, SLK Kliniken Heilbronn. In addition to the standard histological analysis of the distal VD, which was attached to the prostate specimen, we analysed the infiltration status of preperitoneal VD in this cohort. The preperitoneal VD, which represents the middle part of ductus deferens and extends between the internal inguinal ring and obturator fossa, was resected during extended pelvic lymphadenectomy. Distal and preperitoneal VD status was registered together with preoperative and postoperative disease characteristics. Descriptive analysis methods and logistic regression analysis were used.

Results

Briganti score of the target cohort had a median value of 19%, while 235 patients (70.8%) of the group demonstrated a locally advanced disease. The Grade Group at prostatectomy specimen was at least 3 for 286 patients (86.1%). Distal VD infiltration was found in 20 patients (6%) and preperitoneal VD infiltration in two patients (0.6%). Distal VD infiltration was not associated with an increased possibility for positive surgical margins or nodal status among pT3b patients, while both patients with preperitoneal VD infiltration were characterized by highly aggressive disease in locally advanced stage and bilateral distal VD infiltration.

Conclusions

PCa extension along VD may reach a more proximal point of VD than the reported from the existing data infiltration of VD adjacent to seminal vesicles. This rare manifestation of PCa local extension may be the intermediate step to the rare cases of recurrence in the testicles. However, more robust data are needed to confirm the aforementioned hypothesis. Distal VD infiltration seems to have no additional prognostic value among patients with infiltrated seminal vesicles.

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

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.

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

Accurate staging and restaging with early detection of recurrent site is the key for planning treatment in patients of prostate cancer. Recently, gallium-68 prostate-specific membrane antigen positron-emission tomography computed tomography (⁶⁸Ga-PSMA PET/CT) has emerged as a better tool for this. Few uncommon sites of early metastasis can also be identified in addition to the other common sites. Herein, we present three cases of early metastasis to testis in prostate cancer identified on ⁶⁸Ga-PSMA PET/CT scan.

Isolated Testicular Metastasis from Prostate Cancer Detected on Ga-68 PSMA PET/CT Scan

Although prostate cancer can metastasize to any part of the body, isolated testicular metastasis is very rare and only few cases have been reported so far. Here we present a case of 65-year-old male patient, known case of prostate adenocarcinoma, referred for ⁶⁸Ga-PSMA PET/CT scan, post radiotherapy, and androgen deprivation therapy, for rising serum PSA levels. He was found to have an isolated testicular metastasis on the scan. This report highlights the importance of ⁶⁸Ga-PSMA PET-CT scan in detecting these unusual and rare sites of metastasis from prostate cancer.