Abstract

PIP: A 70-year old man presenting with an adenocarcinoma of the prostatic remnant 5 years after retropubic prostatectomy and bilateral vasectomy were performed (for benign prostatic hypertrophy) was treated by bilateral orchidectomy. The operation revealed a hard discrete white nodule adhering to the right epididymis and cord about 2.5 cm. distal to the cut end. The adenocarcinoma found in the nodule had an appearance similar to that of the prostatic biopsy and had spread to the wall of the epididymis and the vas deferens; no tumor was observed in the lumina of the vas, epididymis, lymphatic and blood vessels. Perineural involvement within the tumor was observed but was not seen in the proximal cord at the level of transection. Wachtel and Mehan (1970) reported that carcinoma of the prostate rarely spreads to the epididymis. In this case, spread through the interstitial tissue of the perineurium and epineurium within the tumor must have taken place after the development of the metastasis as it was not found at the level of transection. Although the section examined does not provide evidence, the most likely mode of spread is by arterial, venous or lymphatic embolisation from occult metastatic carcinoma elsewhere in the body.