1
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Taheri H, Ebrahimi P, Nazari P, Kefayat A, Mahdavian A. An unusual presentation of metastatic prostate cancer in a 44-year-old man: A case report and review of the literature. Clin Case Rep 2024; 12:e8447. [PMID: 38292222 PMCID: PMC10822781 DOI: 10.1002/ccr3.8447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/23/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Prostate cancer is one of the two most common non-cutaneous cancers in men. Its presentation might be with unusual symptoms and cause the wrong initial diagnosis. This case report discusses a rare neurologic manifestation of advanced metastatic cancer in a low-risk man. He had been receiving treatment for multiple sclerosis incorrectly due to unusual manifestations such as claudication and pelvic, leg, and shoulder pain. The patient underwent a whole-body bone scan and then a transrectal ultrasound-guided biopsy, which confirmed metastatic prostate cancer with a Gleason score between 7/10 and 10/10 in all samples. Following treatment with chemotherapeutic injections (docetaxel), luteinizing hormone-releasing hormone (LHRH) analogous (Zoladex), and testosterone-suppressing tablets (abiraterone), the disease has been under control and prostate-specific antigen (PSA) level has decreased significantly. The most common sites of metastasis are regional lymph nodes, bones, and lungs. However, there are reports about the spread of this type of cancer to other parts of the body. Although most patients are diagnosed when the tumor is localized to the prostate, in about 25% of patients, the disease is diagnosed when metastasis has occurred. Some markers can assist physicians in the diagnosis of this disease, such as the Prostate Health Index and the 4 K score. Key Clinical Message The diagnosis of prostate cancer should be considered in all age ranges of adult men. The long-distance metastasis might cause unusual presentations of the disease, such as neurologic, musculoskeletal, and dermatologic symptoms and signs far from the origin of the cancer, before genitourinary manifestations. It is crucial to keep the diagnosis of prostate cancer in mind for men with suggestive signs and symptoms that are not usually detected in this disease.
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Affiliation(s)
- Homa Taheri
- Cedars‐Sinai Cardiology DepartmentBeverly HillsCaliforniaUSA
| | - Pouya Ebrahimi
- Ahvaz Jundishapur University of Medical SciencesAhvazIran
| | - Pedram Nazari
- Cancer Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | | | - Abbas Mahdavian
- Urology DepartmentAhvaz Jundishapur University of Medical SciencesAhvazIran
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2
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Di Rienzo G, Tafuni A, Maestroni U, Ruffini L, Silini EM, Gasparro D, Pilato FP, Gnetti L. Testicular metastasis of prostate adenocarcinoma: the other side of orchiepididymitis. Pathologica 2024; 116:69-74. [PMID: 38482677 PMCID: PMC10938275 DOI: 10.32074/1591-951x-940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Livia Ruffini
- Nuclear Medicine Division, University Hospital of Parma, Parma, Italy
| | | | | | | | - Letizia Gnetti
- Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
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3
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Allaume P, Khene ZE, Peyronnet B, Mathieu R, Bensalah K, Rioux-Leclercq N, Kammerer-Jacquet SF. [Secondary tumors localized in testis]. Ann Pathol 2023; 43:361-372. [PMID: 36822906 DOI: 10.1016/j.annpat.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/27/2022] [Accepted: 01/12/2023] [Indexed: 02/23/2023]
Abstract
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.
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Affiliation(s)
- Pierre Allaume
- Service anatomie pathologique, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
| | - Zine-Eddine Khene
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Benoît Peyronnet
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Romain Mathieu
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Karim Bensalah
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Nathalie Rioux-Leclercq
- Service anatomie pathologique, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Solène-Florence Kammerer-Jacquet
- Service anatomie pathologique, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
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4
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Ahmed SA, Nawaz MM, masood Y, maqbool H, Mir K. Metastatic prostate tumor to testes: Sign of advance disease. Urol Case Rep 2023; 50:102410. [PMID: 37416751 PMCID: PMC10320517 DOI: 10.1016/j.eucr.2023.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 07/08/2023] Open
Abstract
Prostate cancer is the second most common cause of mortality for males in the United States. Metastases may be present, typically in the axial skeletal region. To date, few patients have presented with metastases to the testicles. We present the case of an adult male with diagnosed prostate cancer who presented and subsequently diagnosed bilateral testicular metastases. Testicular metastases secondary to diagnosed prostate cancer are very rare. Patients present with these metastases may have unfavorable prognosis. This case demonstrates that prostate cancer may metastasize to rare locations such as the testes, requiring further surgical intervention.
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5
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Mamaliga T, Obando JA, Liu Y. Testicular Metastasis From Prostate Cancer Demonstrated on PSMA PET/CT. Clin Nucl Med 2023; 48:645-646. [PMID: 37167255 DOI: 10.1097/rlu.0000000000004686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
ABSTRACT Testicular metastasis from prostate cancer is rarely reported in radiology literature. We present the case of an 84-year old man with history of prostate cancer, who obtained an 18 F-Pylarify PET/CT for biochemical recurrence, with an incidentally detected prostate-specific membrane antigen-avid large right testicular mass. The 18 F-Pylarify PET/CT showed no evidence of local prostate tumor recurrence in the prostate bed, but demonstrated small right common and external lymph node metastases in addition to the incidentally noted large right testicular mass. The patient underwent orchiectomy with subsequent histopathologic examination confirming metastasis from prostate cancer.
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Affiliation(s)
- Tatiana Mamaliga
- From the Department of Radiology, University of Louisville School of Medicine, Louisville, KY
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6
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Balagobi B, Gobishangar S, Sarma S, Brammah R, Jenil A. A young patient with prostatic carcinoma with testicular metastasis. Int J Surg Case Rep 2022; 99:107653. [PMID: 36115121 PMCID: PMC9568776 DOI: 10.1016/j.ijscr.2022.107653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/28/2022] Open
Abstract
Prostate cancer is one of the most frequent cancers in males and commonly a disease of the older population, but it is increasingly seen among older adolescents and young adults. The common sites of metastasis of prostatic carcinoma are bones and regional lymph nodes. Testicular metastasis from prostatic carcinoma is an infrequent presentation. We report a case of a young patient with prostatic carcinoma and multiple metastases, including bilateral testis. A 40-year-old male presented with lower urinary tract voiding symptoms and back pain for three months. His prostate-specific antigen level was elevated at 13.98 ng/ml. A magnetic resonance imaging of the prostate revealed two PIRADS V lesions and metastases in multiple bones and regional lymph nodes. On follow up, the patient complained of bilateral testicular swelling and ultrasound scan of the testes revealed bilateral testicular metastasis. Fine needle aspiration cytology of right-side testicular lesion revealed malignant cells compatible with metastasis from prostate cancer. Later involvement of multilevel vertebral and skull metastases was identified by magnetic resonance imaging. A T3bN1M1c staging of prostate cancer was made, androgen deprivation therapy followed by chemo and radiotherapy was instituted, following extensive discussion with the patient. Unfortunately the patient succumbed to the illness during the course of treatment. This case report is of a patient with rare presentation of bilateral testicular metastasis with prostate cancer in young age.
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7
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Chandran J, Palaniappan R, Purushotaman D. Bilateral testicular metastases from adenocarcinoma prostate: A rare case report with review of literature. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_228_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Olorunsola IS, Etonyeaku AC, Lekwa BO, Ojo OS. Bilateral secondary testicular, epididymal and spermatic cords carcinoma of prostatic origin: a case report and review of the literature. J Med Case Rep 2021; 15:222. [PMID: 33931116 PMCID: PMC8088057 DOI: 10.1186/s13256-021-02807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Ifeoluwa S. Olorunsola
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun Nigeria
| | - Amarachukwu C. Etonyeaku
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun Nigeria
- Mishmael Hospitals and Clinics, Akure, Ondo Nigeria
| | | | - Olusegun S. Ojo
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun Nigeria
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9
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McCann C, Doherty A, Flynn C, Mulholland C. Prostate cancer metastasis to the testis: an unexpected presentation of a solitary recurrence. BMJ Case Rep 2021; 14:14/3/e237853. [PMID: 33653833 PMCID: PMC7929892 DOI: 10.1136/bcr-2020-237853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Conor McCann
- Urology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, UK
| | - Anna Doherty
- Urology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, UK
| | - Ciaran Flynn
- Histopathology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, UK
| | - Colin Mulholland
- Urology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, UK
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10
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Isolated Testicular Metastasis Diagnosed More than a Decade and a Half Post Primary Treatment for Prostate Cancer. Case Rep Oncol Med 2019; 2019:4956954. [PMID: 31885973 PMCID: PMC6899263 DOI: 10.1155/2019/4956954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/19/2019] [Indexed: 12/03/2022] Open
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.
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11
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Turk A, Graff JM, Memo M. Case report of metastatic prostate cancer to testicles: An ominous sign of advanced disease. Urol Case Rep 2019; 26:100935. [PMID: 31236324 PMCID: PMC6581981 DOI: 10.1016/j.eucr.2019.100935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/01/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022] Open
Abstract
Prostate cancer is the most common cancer in men in the United States and the second leading cause of mortality in this population. Those diagnosed may undergo a variety of treatments ranging from radiation to chemotherapy to surgery. Although metastases commonly first appear in bone, it is important to consider rare locations of metastasis such as the testicles. We present the case of a 56 year old male who presented with diffusely worsening back pain along with scrotal swelling who was ultimately diagnosed with metastatic prostate cancer to the bilateral testicles.
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Affiliation(s)
- Andrew Turk
- Northeast Ohio Medical University (NEOMED), USA
| | | | - Mark Memo
- N.E.O. Urology Associates, Inc., Professor of Urology, NEOMED, USA
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12
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Su J, Aslim EJ, Aydin H, Tan PH, Ho HSS. A rare case of isolated castrate resistant bilateral testicular metastases in advanced prostate cancer. Asian J Urol 2018; 5:127-130. [PMID: 29736376 PMCID: PMC5934351 DOI: 10.1016/j.ajur.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/23/2016] [Accepted: 12/02/2016] [Indexed: 11/24/2022] Open
Abstract
Testicular metastasis is rare with the prostate being the most common site of primary cancer. We report a case of a 72-year-old man with castration-resistant prostate cancer (CRPC) and known metastases to bone and lymph nodes, who developed bilateral painful swollen testes 3 years after the initial diagnosis of prostate cancer. He had first presented with lower urinary tract symptoms (LUTS) with suspicious findings on digital rectal examination of the prostate, and an elevated serum prostate specific antigen (PSA) level of 129 ng/mL. Transrectal prostate biopsy revealed Gleason 4 + 5 adenocarcinoma. Radiological staging showed locally advanced prostate cancer with extensive metastases to bone and pelvic and retroperitoneal lymph nodes. He was given hormonal therapy for over 2 years until progression to CRPC. Six months later he developed painful bilateral testicular swellings, and serum markers for testicular germ cell cancer were normal. Bilateral orchiectomy was performed, showing metastatic prostate cancer (Gleason 4 + 5) on histology. One month postoperatively his PSA level dropped to 0.1 ng/mL from a presurgery level of 6.24 ng/mL.
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Affiliation(s)
- Jiarui Su
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Hakan Aydin
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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13
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Campara Z, Simic D, Aleksic P, Spasic A, Milicevic S. Metastasis of Prostate Adenocarcinoma to the Testis. Med Arch 2018; 70:318-320. [PMID: 27703299 PMCID: PMC5035009 DOI: 10.5455/medarh.2016.70.318-320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/15/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction: Prostate carcinoma is the most frequently diagnosed carcinoma in the male population. The most typical places of the metastases are pelvic lymphatic glands, bones and lungs, and very rarely it metastasizes into a testis. The prognostic importance of testicular metastasis of prostate cancer is not yet well-known, due to a very few published cases. According to the known facts, it is certain that a metastasis of the prostate carcinoma into a testis is a sign of an advanced disease. Case report: This work presents a 48-year-old patient, to whom an adenocarcinoma of the prostate has been proven by the pathohistological finding of transrectal biopsy, performed due to the elevated level of prostate-specific antigen (PSA). Nine years after the initial diagnosis, due to a gradual rise of PSA and tumorous enlargement of the left testis, left inguinal orchectomy and right orchectomy were performed. Metastatic dissemination of prostate adenocarcinoma into a testis was determined by a pathohistological analysis of the left testis. Conclusion: The metastasis of the prostate carcinoma into a testis, as a rare localization of the metastatic dissemination, after additionally performed orchectomy along with further oncological therapy, can provide a continuation of a good life quality as well as a control of the disease in a longer time period.
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Affiliation(s)
- Zoran Campara
- Clinic of Urology, Military Medical Academy (MMA), Belgrade, Serbia
| | - Dejan Simic
- Clinic of Urology, Military Medical Academy (MMA), Belgrade, Serbia
| | - Predrag Aleksic
- Clinic of Urology, Military Medical Academy (MMA), Belgrade, Serbia
| | | | - Snjezana Milicevic
- Clinic of Urology, Clinical Centre of Banja Luka, Banja Luka, Bosnia and Herzegovina
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14
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Early Detection of Bilateral Testicular Metastases From Prostatic Adenocarcinoma Using 68Ga-PSMA Ligand PET/CT. Clin Nucl Med 2018; 42:563-564. [PMID: 28368893 DOI: 10.1097/rlu.0000000000001659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of a 76-year-old man with biochemical relapse after primary therapy for prostate cancer. Ga prostate-specific membrane antigen (PSMA) ligand PET/CT performed for localization of recurrent disease revealed bilateral metastases to the testes. Histopathologic evaluation after bilateral orchiectomy revealed testicular metastases. Metastases to the testes are rare and usually seen in advanced stages. Ga-PSMA ligand PET/CT is a highly sensitive and specific imaging method for the detection of primary and metastatic prostate cancer and has refined diagnostic approaches. This case highlights the potential of PSMA-targeted PET/CT for detection of prostate cancer metastases, even in very unusual localizations.
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15
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Lee KA, Mayer E, Khoo V. Painful testicular metastasis from prostate adenocarcinoma. BMJ Case Rep 2017; 2017:bcr-2017-219963. [PMID: 29212868 DOI: 10.1136/bcr-2017-219963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old man presented with unilateral testicular pain and urinary frequency. His presenting prostate-specific antigen (PSA) was 100 ng/mL, and a biopsy revealed Gleason 4+4 prostate adenocarcinoma. The significance of his initial PSA was somewhat complicated by possible prostatitis and early initiation of bicalutamide. PSA rose on two occasions prior to radiotherapy but coincided with a flare of testicular pain on one of these. Whole-body staging diffusion-weighted MRI scan was negative. He was treated with 3 years of androgen deprivation therapy (ADT) and radical radiotherapy. PSA fell to undetectable levels on ADT. Twelve months following completion of ADT, PSA rose to 3.6 ng/mL. No disease recurrence was noted on restaging MRI pelvis. The patient was well, except for persistent testicular symptoms, which failed to resolve following multiple antibiotics. Testicular tumour markers were negative. Ultrasound findings were consistent with chronic epididymitis. A right orchidectomy was performed for symptomatic relief, confirming metastatic prostate adenocarcinoma.
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Affiliation(s)
- Karla A Lee
- Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Erik Mayer
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vincent Khoo
- Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK
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16
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Cho CKJ, Sigurdson S, Davidson CM, Leveridge M, Mahmud A. Case: Testicular oligometastasis from prostate cancer - Report of rare isolated recurrence after radiotherapy and intermittent androgen-deprivation therapy. Can Urol Assoc J 2017; 12:E31-E33. [PMID: 29173266 DOI: 10.5489/cuaj.4524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Testicular oligometastasis secondary to prostate cancer is rare. We present a case where a patient with locally advanced prostate cancer was treated with high-dose external beam radiotherapy and two years of androgen-deprivation therapy, followed by intermittent androgen suppression. Three and a half years after initial diagnosis, he was found to have a painless testicular mass. Orchiectomy was performed and histopathology demonstrated metastatic prostatic adenocarcinoma. He remains in clinical remission on intermittent androgen suppression eight years following initial treatment, and over four years after presentation with testicular metastasis.
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Affiliation(s)
- Chan-Kyung J Cho
- Department of Oncology, Queen's University, Kingston General Hospital; Kingston, ON, Canada.,Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
| | - Samantha Sigurdson
- Department of Oncology, Queen's University, Kingston General Hospital; Kingston, ON, Canada
| | - Christopher M Davidson
- Department of Pathology and Molecular Medicine, Queen's University, Kingston General Hospital, Kingston, ON, Canada
| | - Michael Leveridge
- Department of Urology, Queen's University, Kingston General Hospital; Kingston, ON, Canada
| | - Aamer Mahmud
- Department of Oncology, Queen's University, Kingston General Hospital; Kingston, ON, Canada.,Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
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17
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Testicular Metastasis From Prostatic Adenocarcinoma Presenting as Recurrent Epididymo-orchitis. Urology 2017; 108:e7-e9. [DOI: 10.1016/j.urology.2017.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 06/03/2017] [Accepted: 07/20/2017] [Indexed: 11/21/2022]
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18
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Bonetta A, Generali D, Corona SP, Cancarini G, Brenna SG, Pacifico C, Roviello G. Isolated Testicular Metastasis from Prostate Cancer. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:887-889. [PMID: 28804118 PMCID: PMC5567765 DOI: 10.12659/ajcr.904521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Alberto Bonetta
- Department of Radiotherapy, Cremona Social and Territorial Health Company (ASST), Cremona, Italy
| | - Daniele Generali
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Molecular Therapy and Pharmacogenomic Unit, Cremona Social and Territorial Health Company (ASST), Cremona, Italy
| | - Silvia Paola Corona
- Peter MacCallum Cancer Centre, Department of Radiation Oncology, Moorabbin Campus, East Bentleigh, Victoria, Australia
| | | | - Sarah Grazia Brenna
- Department of Radiotherapy, Cremona Social and Territorial Health Company (ASST), Cremona, Italy
| | - Chiara Pacifico
- Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, Italy
| | - Giandomenico Roviello
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Department of Oncology, Medical Oncology Unit, San Donato Hospital, Arezzo, Italy
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19
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Kamble VR, Agrawal PM. Bilateral Testicular Metastases from Occult Primary Prostate Cancer in a Young Adult: A Rare Case Report. J Clin Diagn Res 2017; 11:TD03-TD05. [PMID: 28658877 PMCID: PMC5483779 DOI: 10.7860/jcdr/2017/25292.9783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
Testicular metastases are detected incidentally in upto 4% cases after orchiectomy for Prostate Carcinoma (PCa). Most of the secondaries to testes are due to PCa, only few patients have clinically manifested metastases to bilateral testes. Metastases to bilateral testis is unusual while unilateral involvement of the testis is seen usually. We report a case of primary PCa with bilateral testicular metastases which presented with palpable mass in the right testis. A 43-year-old male patient presented with two-month history of swelling in right inguino-scrotal region. On digital rectal examination, the prostate was enlarged. The Serum Prostate-Specific Antigen (PSA) level was >100 ng/ml. Ultrasound (USG) revealed metastatic deposits in bilateral testis, however prostate was having relatively normal echo pattern. Contrast Enhanced Computed Tomography (CECT) abdomen revealed primary malignancy of prostate gland with secondary metastases in bilateral testes and metastatic lymph nodes. Transrectal biopsy from prostate and excisional biopsy of right inguinal node showed prostate gland adenocarcinoma and deposits of adenocarcinoma respectively. Patient underwent bilateral orchiectomy. Histopathology showed that bilateral testes were infiltrated by metastatic adenocarcinoma with Gleason score 8. The patient is currently on chemotherapy. This is a rare case of primary PCa with clinically manifested bilateral testicular metastases in the form of palpable mass in right testis.
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Affiliation(s)
- Vijaya Rajesh Kamble
- Associate Professor, Department of Radiology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
| | - Purva Mahesh Agrawal
- Junior Resident, Department of Radiology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
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20
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Malik M, Joseph D, Jonnadula J, Ahmed SF, Valiyaveettil D, Vaghmare R. Bilateral Testicular Metastases and Filariasis in Prostatic Adenocarcinoma. Clin Genitourin Cancer 2016; 15:e743-e745. [PMID: 28017535 DOI: 10.1016/j.clgc.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/10/2016] [Accepted: 11/20/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India.
| | - Deepa Joseph
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Jyothi Jonnadula
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Syed Fayaz Ahmed
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rama Vaghmare
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
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21
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YANG YUJIN, SEO MINJUNG, JEON HEEJEONG, NOH JINHEE, PARK SEOLHOON, CHOI YUNSUK, JO JAECHEOL, BAEK JINHO, KOH SUJIN, KIM HAWK, MIN YOUNGJOO. Metastatic prostate cancer initially presenting as chylothorax: A case report. Mol Clin Oncol 2016; 4:1009-1012. [DOI: 10.3892/mco.2016.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/23/2015] [Indexed: 11/06/2022] Open
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22
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Sampathrajan S, Garg G, Gupta S, Sahay SC, De S. Incidentally Detected Testicular Metastasis in a Case of Prostatic Adenocarcinoma. J Clin Diagn Res 2016; 9:ED03-4. [PMID: 26816900 DOI: 10.7860/jcdr/2015/15849.6884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/08/2015] [Indexed: 11/24/2022]
Abstract
Adenocarcinoma of the prostate is one of the common cancers among elderly men worldwide. However, testicular metastasis detected incidentally after orchiectomy is a rare presentation as most commonly we encounter patients presenting with bone metastasis at the time of primary diagnosis. Here, we describe a recently diagnosed case of prostatic carcinoma that had metastasis in a single testis, incidentally detected in the orchiectomy histopathological specimen, performed for surgical castration and emphasize the importance of routine microscopical examination of the testicular specimens.
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Affiliation(s)
- Sowmiya Sampathrajan
- Senior Resident, Department of Radiation Oncology, Pushpanjali Crosslay Hospital, Galaxy Cancer Institute , Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Garima Garg
- Consultant, Department of Pathology, Pushpanjali Crosslay Hospital, Galaxy Cancer Institute , Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Sweety Gupta
- Consultant, Department of Radiation Oncology, Pushpanjali Crosslay Hospital, Galaxy Cancer Institute , Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Shailesh Chandra Sahay
- Senior Consultant, Depatment of Urology, Pushpanjali Crosslay Hospital, Galaxy Cancer Institute , Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Sudarsan De
- Senior Consultant, Department of Radiation Oncology, Pushpanjali Crosslay Hospital, Galaxy Cancer Institute , Vaishali, Ghaziabad, Uttar Pradesh, India
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23
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Shinn BJ, Greenwald DW, Ahmad N. Unilateral testicular metastasis of low PSA level prostatic adenocarcinoma. BMJ Case Rep 2015; 2015:bcr-2015-209914. [PMID: 25994435 DOI: 10.1136/bcr-2015-209914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Navid Ahmad
- Department of Pathology, Wilkes Barre General Hospital, Wilkes Barre, Pennsylvania, USA
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