Prostatic adenocarcinoma (PCa) is one of the major contributors to malignancy in men worldwide and second leading cause of cancer death after lung cancer. PCa is an aggressive disease and shows a strong predilection to metastasize into the bones and pelvic lymphatic nodes. In contrast, the metastatic spreads into testicles are rare, accounting up to 4% of all prostate cancer (PCa) cases. Here we present a case from our practice of unilateral testicular metastasis, developed secondary to prostatic carcinoma and diagnosed 6 months after radical prostatectomy. A 69-year-old man presented to our outpatient department for regular follow-up 9 months after radical prostatectomy. The final pathological diagnosis demonstrated pT2b N0M0, Gleason 4+3. His preoperative PSA was 11.2 ng/ml. Preoperative imaging (CT and bone scan) was negative for distant metastases. Nine months later, he presented in our outpatient clinic with left painless testicular swelling. The metastatic work-up, including CT, was negative. However, his serum PSA levels reached 2.09 ng/ml compared with postoperative values 0.04 ng/ml. Testicular ultrasound demonstrated heterogeneous mass in left testicular parenchyma. The postoperative elevation of PSA with ultrasonographic findings suggested that it might be a metastasis, originating from the primary PCa. The left inguinal orchiectomy confirmed our primary preliminary diagnosis. We present a rare case of left testicular metastasis from prostatic adenocarcinoma nine months after radical prostatectomy.
Prostate adenocarcinoma most commonly metastases in bone, lymph nodes, lungs, liver, pleura, and adrenal glands. However, it spread into testicles is a very rare condition. In addition, metastasizedin testicles PCa can be detected as an incidental finding on autopsy studies up to 2.5%. Testicular pain and swelling, along with theelevation of serum PSA but normal levels of α-fetoprotein and human choriongonadotropin, combined with the ultrasonographic findings intesticular parenchyma, necessitate surgical exploration and the histopathological analysis will confirm the diagnosis.
It highlights the natural behaviour of prostatic carcinoma and the need for careful follow-up of patients with prostate cancer. Besides the typical sites of metastasis, every urologist should keep in mind the possibility of involvement of more rare sites, such as testicles. Therefore, the rising PSA in patients after radical prostatectomy that is accompanied with testicular swelling necessitates performing of detailed metastatic work-up, including testicles. This is important for the timely recognition of an isolated, locally curable metastatic disease, which every urologist must keep in mind before the initiation of treatment for biochemical recurrence of PCa.
Journal of Clinical chemistry and Laboratory Medicne