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PROSTATE CANCER WITH SINGLE METASTASIS IN TESTICLE: CASE REPORT
Introdução, Material, Método, Resultados, Discussão e Conclusões
Case presentation: Male, 65 years, in use of Finasteride after diagnosis of benign prostatic hyperplasia. In 2013, patient presented an increase in PSA and therefore performed prostate biopsy, which reported adenocarcinoma Gleason 9 (5 + 4) – NCCN Group "very high" (pT3pN0M0). Treatment consisted in radical prostatectomy with adjuvant radiotherapy. In January 2015, serological recurrence occurred, and blockade was initiated with LH/RH analog until August, due to the complaint of sexual impotence. In May 2016, presented ascending curve of PSA and it was reintroduced blockade with LH/RH analog, intermittently. In 2018, an isolated volume increase of the right testicle (“first symptom”) was observed and investigated by ultrasonography, which evidenced a characteristic image of a seminomatous tumor. Orchiectomy was realized in January 2019 with subsequent pathological diagnosis of undifferentiated testis neoplasm and the presence of suspected outbreaks of invasion infiltrating spermatic cord, rete testis and Tunica albuginea. In the immunohistochemistry analysis, it was demonstrated to be a prostate carcinoma metastasis compromising testicle and spermatic cord. A PET-CT was requested with PSMA for a systemic evaluation, which disclosed a negative result. After surgery, PSA returned to a descending pattern (graphic 1). Currently, there is no indication to medication.
Discussion: The patient’s characteristics exemplify a typical prostate cancer profile; elder with previous prostatic pathology. At diagnosis, presented a non-metastatic disease, with treatment aimed at curing. It evolved, years after diagnosis, with testicular disease, initially considered as primary pathology but with subsequent diagnosis of recurrence of prostate adenocarcinoma.
Final comments: Prostate cancer is the most common malignant neoplasm in men – excluding non-melanoma skin cancers. Whereas it is a disease that has an extreme clinical and biological heterogeneity, its overall survival is high; the 8:1 ratio of incidence to deathness demonstrates this variability. When metastatic, the sites are mainly located in bone (84%), lymph node (10.6%), liver (10.2%) and lung (9.1%). Metastasis to testicle is rare (0.18-0.5%) and, when it occurs, it is unilateral, without involving cutaneous testicle and epididymis. According to the location of the metastasis, the prognosis for the same disease can be variable.
Prostate cancer; Testicle cancer; Metastasis
Câncer de Próstata Metastático
Universidade Católica de Pelotas - Rio Grande do Sul - Brasil
Marcio Valério Costa, Camila Furtado Hood, Ricardo Lanzetta Haack, Laura Nunes Rotta, Luís Olímpio Dias Jordao