Testicular metastases: a poor prognostic factor in patients with advanced prostate cancer

Korkes, Fernando; Gasperini, Renato; Korkes, Karen Levy; Neto, Deusdedit Cortez Vieira Silva; Castro, Marí­lia Germanos de

doi:10.1007/s00345-008-0322-8

Cited by 19 publications

(21 citation statements)

References 8 publications

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“…In the reports in literature which were incidental findings after orchidectomy, as a part of primary treatment, no further treatments are proposed with the patients noticed to do well [1,2]. For the cases with metastasis to the testis detected long after initiation of treatment for the prostate cancer, androgen deprivation had been continued even though they had the potential to be aggressive [5].…”

Section: Discussionmentioning

confidence: 99%

“…[1] Most reports are incidental findings after bilateral orchidectomy for androgen deprivation therapy with the majority of the patients aged above 60 years [1,2]. Considering tumors of solid organs, prostate cancer has been noted to be the most common cause of metastases to the testis.…”

Section: Introductionmentioning

confidence: 99%

“…Considering tumors of solid organs, prostate cancer has been noted to be the most common cause of metastases to the testis. [3] The mechanism for metastasis of prostate cancer to the testis has been proposed to include retrograde venous extension or embolism, arterial embolization, lymphatic extension and endocanalicular spread [2,4]. The overall prognosis is poor as the patients have high Gleason score of 8 or 9, exhibiting atypical neoplasm behavior becoming hormone refractory 6 to 8 months following diagnosis resulting in survival of between 6 to 12 months after diagnosis [2].…”

Section: Introductionmentioning

confidence: 99%

“…[3] The mechanism for metastasis of prostate cancer to the testis has been proposed to include retrograde venous extension or embolism, arterial embolization, lymphatic extension and endocanalicular spread [2,4]. The overall prognosis is poor as the patients have high Gleason score of 8 or 9, exhibiting atypical neoplasm behavior becoming hormone refractory 6 to 8 months following diagnosis resulting in survival of between 6 to 12 months after diagnosis [2]. A challenge in diagnosis is encountered when the patient is relatively young and there is a need to rule out a primary testicular tumor as the cause of the testicular enlargement in a resource poor setting.…”

Section: Introductionmentioning

confidence: 99%

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Metastatic prostate cancer to the testis as an initial presentation: Management review and outcome

Kyei¹,

Vanderpuye²,

Edusei³

et al. 2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Metastatic prostate cancer to the testis as an initial presentation is a rare condition. Though it has been noted to be associated with poor prognosis, no treatment guideline is currently available aimed at improving the outcome. This report reviews the management of a case and its outcome. Case Report: A 47-year-old male presented with a painless swelling of the left testis and rectal discomfort of three weeks duration. He had a strong family history of prostate cancer. Examination of the scrotum revealed a left non-tender testicular mass 7x5 cm that was hard with irregular surface. A digital rectal examination revealed an enlarged and nodular prostate and seminal vesicle involvement. A histological and immunohistochemical analysis of the prostatic biopsy and specimen from an inguinal orchidectomy of the left testis confirmed a metastatic prostate cancer to the testis. After three months of combined androgen deprivation therapy, he developed progressive obstructive urinary symptoms, severe pain in the anus, and a rapid increase in size of the prostate gland being castrate resistant. He underwent three dimensional conformal radiotherapy to the whole pelvis followed by seven cycles of docetaxel based chemotherapy. Nineteen months following diagnosis, his PSA was 1.86 ng/ml. Despite normal tPSA levels, there was clinical failure with development of bilateral lower limb swelling from para-aortic lymphadenopathy at two years. The patient died after two additional cycles of docetaxel chemotherapy. IJCRI publishes Conclusion:In a young patient with prostate cancer presenting initially with testicular metastasis, aggressive management strategies as pertains for castrate resistant cases need to be initiated early to improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Metastatic prostate cancer to the testis as an initial presentation: Management review and outcome

Kyei¹,

Vanderpuye²,

Edusei³

et al. 2016

IJCRI

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“…4 Although there is a large range varying from 5 to 78 months of reported survival for these cases, metastasis to the testis has been commonly accepted as a sign of advanced disease since they tend to be accompanied by metastasis to other organs. 3,4,10 This case, however, is an illustration of oligometastatic disease that may be amenable to standard treatments despite the presence of distant metastasis. The oligometastatic state is defined as metastatic cancer limited in number and organ sites that may indicate a more indolent biology and progression, and one review of retrospective studies defined oligometastatic prostate cancer as including up to five sites of extrapelvic lesions.…”

Section: Cuaj -Case Series Cho Et Al: Testicular Oligometastasis Frommentioning

confidence: 99%

Case: Testicular oligometastasis from prostate cancer — Report of rare isolated recurrence after radiotherapy and intermittent androgen-deprivation therapy

Cho

Sigurdson

Davidson

et al. 2017

CUAJ

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Testicular oligometastasis secondary to prostate cancer is rare. We present a case where a patient with locally advanced prostate cancer was treated with high-dose external beam radiotherapy and two years of androgen-deprivation therapy, followed by intermittent androgen suppression. Three and a half years after initial diagnosis, he was found to have a painless testicular mass. Orchiectomy was performed and histopathology demonstrated metastatic prostatic adenocarcinoma. He remains in clinical remission on intermittent androgen suppression eight years following initial treatment, and over four years after presentation with testicular metastasis. CaseA 61-year-old Caucasian male presented to his family physician for urinary frequency and nocturia in 2008. He denied gross hematuria, dysuria, or any changes in stool or bowel function. Serum prostate-specific antigen (PSA) level was 20.3 ng/mL, which led to a prostate biopsy. Histopathology showed adenocarcinoma with a Gleason score of 4+5 (9/ 10) involving 80% of the tissue submitted. There was no extraprostatic, perineural, lymphatic, or vascular spread. A computed tomography (CT) scan of the abdomen and pelvis was performed for staging and showed left obturator lymphadenopathy, without evidence of distant metastasis. Excisional biopsy confirmed the presence of metastatic prostate carcinoma in this obturator node. On examination, he had a markedly enlarged prostate in keeping with a T3a lesion. Therefore, his prostate cancer was staged as T3a N1 M0.He commenced androgen deprivation therapy (ADT) with an anti-androgen agent followed by luteinizing hormone-releasing hormone (LHRH) agonist in 2008, followed by a course of external beam radiation therapy delivered with a dose of 7000 cGy in 35 fractions. His PSA nadir in 2009 was 0.1 ng/mL. After 2 years of ADT, he opted for intermittent androgen

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Preperitoneal vas deferens infiltration in high‐risk prostate cancer

Gözen,

Koudonas,

Senel

et al. 2023

BJUI Compass

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ObjectivesThe objective of this study is to evaluate the prevalence and the importance of preperitoneal vas deferens (VD) infiltration in high‐risk prostate cancer (PCa).Patients and MethodsIn this prospectively designed study, we included 332 high‐risk PCa patients with a Briganti score >5%, who were treated by robot‐assisted radical prostatectomy between July 2017 and February 2022 at the Urology Department, SLK Kliniken Heilbronn. In addition to the standard histological analysis of the distal VD, which was attached to the prostate specimen, we analysed the infiltration status of preperitoneal VD in this cohort. The preperitoneal VD, which represents the middle part of ductus deferens and extends between the internal inguinal ring and obturator fossa, was resected during extended pelvic lymphadenectomy. Distal and preperitoneal VD status was registered together with preoperative and postoperative disease characteristics. Descriptive analysis methods and logistic regression analysis were used.ResultsBriganti score of the target cohort had a median value of 19%, while 235 patients (70.8%) of the group demonstrated a locally advanced disease. The Grade Group at prostatectomy specimen was at least 3 for 286 patients (86.1%). Distal VD infiltration was found in 20 patients (6%) and preperitoneal VD infiltration in two patients (0.6%). Distal VD infiltration was not associated with an increased possibility for positive surgical margins or nodal status among pT3b patients, while both patients with preperitoneal VD infiltration were characterized by highly aggressive disease in locally advanced stage and bilateral distal VD infiltration.ConclusionsPCa extension along VD may reach a more proximal point of VD than the reported from the existing data infiltration of VD adjacent to seminal vesicles. This rare manifestation of PCa local extension may be the intermediate step to the rare cases of recurrence in the testicles. However, more robust data are needed to confirm the aforementioned hypothesis. Distal VD infiltration seems to have no additional prognostic value among patients with infiltrated seminal vesicles.

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Testicular metastases: a poor prognostic factor in patients with advanced prostate cancer

Abstract: In conclusion, testicular metastases from prostate cancer are a rare event, observed in 1.8 per 1,000 cases. As other visceral metastases, testicular metastases might also be considered as an unusual additional factor of poor prognosis.

Cited by 19 publications

References 8 publications

Metastatic prostate cancer to the testis as an initial presentation: Management review and outcome

Metastatic prostate cancer to the testis as an initial presentation: Management review and outcome

Case: Testicular oligometastasis from prostate cancer — Report of rare isolated recurrence after radiotherapy and intermittent androgen-deprivation therapy

Preperitoneal vas deferens infiltration in high‐risk prostate cancer

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