Alexander Otsetov, Kalin Kalchev, Natasha Takova and Alexander Hinev
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.