Solitary prostatic cancer metastasis to the testis: A case report and lessons to learn

  • Asmaa Ismail Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
  • Hazem Elmansy Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
  • Walid Shahrour Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
  • Owen Prowse Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
  • Ahmed Kotb | drahmedfali@gmail.com Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.

Abstract

Prostate cancer (Pca) is a complex disease. Several case series and reports have described the spread of Pca to unusual organs, like esophagus, eye and periureteric fat causing ureteropelvic junction obstruction. Spread of Pca to the testis has been reported in few case reports, however Pca was always firstly diagnosed in all published cases and testicular spread of cancer has been diagnosed during follow up of the patients. This case is unique in that, the patient initially presented with a testicular mass and histologic examination after orchiectomy allowed to diagnose prostatic cancer. This patient was 81 years old and he never had PSA screening by his family doctor. PSA was not even done initially by us considering his age and the presentation with testicular mass. This case may impact clinical practice in several ways: 1) considering Pca always in the differential diagnosis of any disease of an adult man, regardless of its presentation because we did not do that at initial patient evaluation and PSA was only measured after orchiectomy when pathology demonstrated metastatic Pca; 2) suggesting standard orchiectomy with epididemectomy for surgical castration instead of the current surgical technique of subcapsular/subepididymal orchiectomy, because our patient had cancer involving his epididymis as well; 3) suggesting to include PSMA as a part of preoperative staging for high risk Pca patients, in consideration that PSMA is proving to be a promising new imaging technique that can help diagnosing metastatic Pca in unusual locations.

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Published
2020-01-14
Info
Issue
Section
Case Reports
Keywords:
Prostate cancer, testicular metastasis, PSMA, Orchiectomy
Statistics
  • Abstract views: 253

  • PDF: 110
How to Cite
Ismail, A., Elmansy, H., Shahrour, W., Prowse, O., & Kotb, A. (2020). Solitary prostatic cancer metastasis to the testis: A case report and lessons to learn. Archivio Italiano Di Urologia E Andrologia, 91(4), 265-266. https://doi.org/10.4081/aiua.2019.4.265