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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 94-96

Cancer prostate metastasis to testis: A rare encounter


Department of Urology, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Kshitij Raghuvanshi
Department of Urology, Bharati Vidyapeeth Medical College and Hospital, Pune 411043, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCO.JCO_16_18

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  Abstract 

Carcinoma of prostate rarely metastasizes to the testis. It is the most common primary cancers among all the solid malignancies contributing the majority of testicular metastases. Here, we report such type of rare case in a 64-year-old man who presented with a history of severe lower urinary tract symptoms and progressively increasing swelling of the right testis. The case was subsequently diagnosed as a prostate cancer with testicular metastasis.

Keywords: Carcinoma of prostate, orchiectomy, testicular metastasis


How to cite this article:
Raghuvanshi K, Deshmukh H, Raval A, Jain DK. Cancer prostate metastasis to testis: A rare encounter. J Curr Oncol 2018;1:94-6

How to cite this URL:
Raghuvanshi K, Deshmukh H, Raval A, Jain DK. Cancer prostate metastasis to testis: A rare encounter. J Curr Oncol [serial online] 2018 [cited 2019 Mar 20];1:94-6. Available from: http://www.journalofcurrentoncology.org/text.asp?2018/1/2/94/249055


  Introduction Top


Prostatic adenocarcinoma is one of the most common tumors in male population and most commonly metastasizes to pelvic lymph nodes, bones, and lungs, followed by other organs such as liver, brain, and bladder.[1],[2]Prostate is one of the commonest primary malignancy, after leukemia and lymphoma, for testicular metastases and are detected incidentally following orchiectomy performed for advanced disease.[3]Here, we report a case of advanced prostate cancer with testicular metastasis.


  Case Report Top


A 64-year-old man presented in October 2016 with a history of severe lower urinary tract symptoms (International Prostate Symptom Score, IPSS-32) for 8 months with a right-sided progressively increasing painless testicular mass and mild discomfort in the right testis for 4 months. On examination, the right testis measured 12×6 × 5cm and was found to be smooth non-tender with no testicular sensation. The left testis was normal. Digital rectal examination revealed grade II hard and nodular prostate. Systemic examination was normal. Serum prostate-specific antigen (PSA) level was 209.4ng/dL.

The ultrasonography (USG) of kidney, ureter, and bladder showed well distended and thickened urinary bladder wall with a pre-void of 575cm3 and a post-void of 320cm3. Prostate measured 9.1×7.8×6.7cm with a weight of 250g. The USG of scrotum showed a heterogeneous mass in the scrotum on the right side measuring 10.1×5.3×4.7cm but the right epididymis and testis could not be identified separately. A 4×3cm cystic area was observed within the mass suggestive of necrosis. No abnormality was found with the left testis.

The patient underwent transrectal ultrasound–guided biopsy of the prostate, which revealed adenocarcinoma of the prostate (clinical stage: T4, N0, M1) with Gleason score of 8 (4+4). Bone scan was not performed as the patient could not afford the cost. He underwent bilateral orchiectomy (high inguinal on the right side and scrotal on the left) [Figure 1]. Postoperative recovery was uneventful. Histopathological examination of the testis showed a metastatic adenocarcinoma with neuroendocrine features [Figure 2]. The patient was doing well until the last follow-up (November 2017) with the PSA level at 1ng/dL.
Figure 1: Grossly enlarged right testis (operated as high orchiectomy) and small left testis (operated as low orchiectomy)

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,
Figure 2: Histopathology of the testis. (A) Normal testis. (B) Tumor on 10× magnification. (C) Tumor on 40× magnification. (D) Tumor on 40× showing pseudo rosette. (E) Tumor with trabecular pattern

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  Discussion Top


Testicular metastasis is a rare entity and comprises 0.9% of all the testicular tumors. Prostate followed by lung, skin, and kidney are the common possible solid primaries for testicular metastases constituting 35%, 18%, 11%, and 9%, respectively.[4],[5]In a previous report, Pienkos and Jablokow[6] reviewed 24,000 autopsies and reported a 0.06% incidence of testicular metastasis.

To the best of our knowledge, metastasis of prostate cancer to the testis is very less common than other metastatic sites including pelvic lymph nodes, bone, lung, liver, and brain. The retrograde vein spreading or embolism, arterial embolism, lymphatic extension, or endocanalicular spreading possibly contribute to the metastasis of prostate cancer to the testis.[3] In addition, the involvement of the prostatic urethra could also increase the risk of testicular metastasis.[7] However, the precise factors for the prognosis of testicular metastasis from prostate cancer are unknown, possibly because of the rare occurrence.

In 1938, Semans[8] reported the first case of prostate carcinoma metastasizing to the testis, and since then several reports have been published. [Table 1] summarizes few cases of prostate carcinomas, which were metastasized to the testis. Generally, testicular metastasis is not diagnosed clinically but found after autopsy or orchiectomy in the patients with advanced prostate cancer; however, in our case, the patient visited hospital for testicular mass leading to investigations confirming prostate cancer with testicular metastases. Though the diagnosis was confirmed after orchiectomy, the clinical presentation was unusual. Secondary testicular tumors generally occur in fifth or sixth decade of life and generally involve only one testis, consistent with our case. Unilateral testicular swelling with or without pain is the common presentation in testicular metastasis.
Table 1: Summary of prostate carcinoma cases that metastasized to the testis

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In a previous case, a 77-year-old man visiting for the treatment of urolithiasis was noted to have scrotal swelling.[9] This patient underwent biopsy of the prostate and bilateral orchiectomy, which confirmed prostatic carcinoma and metastatic adenocarcinoma of the bilateral testis. Another 72-year-old man, who was previously diagnosed with prostate cancer (6 years back), presented with painless right testicular swelling of 3 months duration and was subsequently confirmed to have metastatic adenocarcinoma of the testis.[2] In another case, a 54-year-old patient was diagnosed with testicular metastasis secondary to prostatic cancer after 7 years of hormonotherapy and chemotherapy.[16] All these cases show varied nature of this rare testicular occurrence.

In our case, though there was a possibility of bone metastasis, the bone scan was not performed as it was not affordable to the patient. Fortunately, he did not report any other manifestation and was doing well until the last follow-up.

In conclusion, the testicular mass must be evaluated for malignancy and correlated clinically with other urogenital symptoms. Prompt diagnosis and intervention can prevent further spread of the disease.

Financial support and sponsorship

Nil.

Conflicts of interests

There are no conflicts of interest.

 
  References Top

1.
Mittal J, Dorairajan LN, Manikandan R, Bade BA, Mishra A. Testicular and epididymal metastasis from prostate carcinoma: A rare manifestation of common disease. J Clin Diagn Res 2017;11:PD01-2.  Back to cited text no. 1
    
2.
Kwok D, Spernat D, Kooner R. Testicular mass in the presence of prostate cancer—A rare site of metastasis. Int J Urol 2010;8:1-3.  Back to cited text no. 2
    
3.
Kusaka A, Koie T, Yamamoto H, Hamano I, Yoneyama T, Hashimoto Y, et al. Testicular metastasis of prostate cancer: A case report. Case Rep Oncol 2014;7:643-7.  Back to cited text no. 3
    
4.
Samanta DR, Senapati SN, Avinash A, Mohanty SN. Synchronous bilateral testicular metastasis in gastric carcinoma: A rare case report. Oncol J India 2018;2:10-2.  Back to cited text no. 4
  [Full text]  
5.
Li B, Cai H, Kang ZC, Wu H, Hou JG, Ma LY. Testicular metastasis from gastric carcinoma: A case report. World J Gastroenterol 2015;21:6764-8.  Back to cited text no. 5
    
6.
Pienkos EJ, Jablokow VR. Secondary testicular tumors. Cancer 1972;30:481-5.  Back to cited text no. 6
    
7.
Campara Z, Simic D, Aleksic P, Spasic A, Milicevic S. Metastasis of prostate adenocarcinoma to the testis. Med Arch 2016;70:318-20.  Back to cited text no. 7
    
8.
Semans JH. Carcinoma of the prostate with metastases to the testes. J Urol 1938;40:524-9.  Back to cited text no. 8
    
9.
Gao Q, Chen J, Dai Y. Prostate cancer involving bilateral seminal vesicles along with bone and testicular metastases: A case report. J Med Case Rep 2018;12:72.  Back to cited text no. 9
    
10.
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:TD03-5.  Back to cited text no. 10
    
11.
Zhang J, Dong M, Hu X, Liu L, Li S, Li C, et al. Prostatic adenocarcinoma presenting with metastases to the testis and epididymis: A case report. Oncol Lett 2016;11:792-4.  Back to cited text no. 11
    
12.
Mortensen MA, Engvad B, Geertsen L, Svolgaard N, Lund L. Metastasis in testis from prostate cancer. Ugeskr Laeger 2014;176:V10130632. [Article in Danish].  Back to cited text no. 12
    
13.
Manikandan R, Nathaniel C, Reeve N, Brough RJ. Bilateral testicular metastases from prostatic carcinoma. Int J Urol 2006;13:476-7.  Back to cited text no. 13
    
14.
Baydar DE, Kosemehmetoglu K, Akdogan B, Ozen H. Prostatic adenosquamous carcinoma metastasizing to testis. ScientificWorldJournal 2006;6:2491-4.  Back to cited text no. 14
    
15.
Inaba Y, Okamoto M, Harada M, Sakaue M, Maeda S. [Prostatic carcinoma with bilateral testicular metastasis: A case report]. Hinyokika Kiyo 1994;40:249-52.  Back to cited text no. 15
    
16.
Gunlusoy B, Arslan M, Selek E, Cetinel M, Ayder AR, Cicek S. A case report: Prostatic carcinoma with metastasis to the testicle. Int Urol Nephrol 2004;36:63-4.  Back to cited text no. 16
    


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