Abstract
BackgroundProstatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases.Case presentationA 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence.ConclusionSince it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.
Highlights
Prostatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide
Since it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy
We present the case of an elderly man who we found to have had bilateral testicular, epididymal and spermatic cords metastases from prostatic adenocarcinoma
Summary
Carcinoma of the prostate gland is one of the leading cancers in men worldwide, and the incidence and mortality still appear to be on the rise [1]. A prostate biopsy obtained through a digitally guided transrectal procedure revealed an infiltrating adenocarcinoma of the prostate (Gleason score 5 + 5 = 10), on histopathological examination He subsequently had a therapeutic bilateral total orchidectomy carried out; the right testis and epididymis was removed via a trans-scrotal incision, while the left testis and spermatic cord was excised via a groin incision. A diagnosis of metastatic carcinoma of the testes, epididymides and spermatic cords from the prostatic adenocarcinoma was made He was subsequently placed on yearly zoledronic acid 5 mg given over 15 min, ketoconazole 200 mg twice daily for the bone metastasis, bicalutamide 50 mg daily to ensure maximal androgen blockade, and tamsulosin 0.4 mg daily to improve urine flow.
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