Physical Examination Discovered Prostate Cancer Metastasis to the Testis: A Case Report

Abstract

BACKGROUND Prostate cancer is the most common non-cutaneous cancer in men. While approximately three-quarters of all cases present as localized disease, the rate of metastatic disease has been increasing. Common sites of metastatic prostate cancer include regional lymph nodes, bones, and lungs. In this case report, we discuss a man with a history of low-risk prostate cancer who developed a testicular mass, which was ultimately diagnosed as a solitary testicular metastasis. CASE REPORT An abnormal nodule on the left apex area was identified on a digital rectal exam of an otherwise healthy 67-year-old man in February 2008. The patient underwent an ultrasound-guided transrectal biopsy of the prostate gland in April 2008. The biopsy demonstrated adenocarcinoma of the prostate, Gleason 6 (3+3), with tumor present in 3 out of 12 submitted cores in up to 20% of biopsy specimens. Following treatment, his prostate cancer remained quiescent for several years. He was also found to have a urethral bulbar stricture that required dilation; during the procedure, a nurse detected an abnormality in the right testicle while prepping the patient. A follow-up testicular ultrasound in September 2020 identified an abnormal heterogeneous area with calcifications within the right testicle. Following radical right orchiectomy, pathology revealed metastatic prostatic adenocarcinoma, acinar type, with lymphovascular invasion present at the spermatic cord margin. CONCLUSIONS Surveillance for prostate cancer following treatment, even for low-risk disease, should always be continued. Although rare, recurrence and metastasis can occur in patients with low and even absent post-treatment prostate-specific antigen levels.

Figure 1.

Right testicular ultrasound showing a 4.0 cm section of the 5.5×3.5×2.5 cm heterogeneous mass with internal calcifications.

Figure 2.

Low-power magnification shows extensive large gland cribriforming architecture with focal areas of comedo necrosis. Arrows display areas of necrosis within the cancer tissue.

Figure 3.

High-power imaging shows glandular architecture with prominent nucleoli consistent with prostate cancer, as indicated by the arrows.

Figure 4.

Positive NKX3.1. This slide shows stronger nuclear positivity, which is specific for prostate cancer. Arrows point to uptake within cancer nuclei.