Testicular metastasis from prostate carcinoma three years after subcapsular orchiectomy. A case-report

Metastatic cancer to the testis is a rare phenomenon of prostate carcinoma with only 80 cases reported in the literature. Most of these secondary testicular tumors were diagnosed on routine pathohistological examination of testicular tissue after plastic orchiectomy. In none of these cases metachronous development of these metastases has been described. For the first time we report on a 75-year old patient who developed a prostate carcinoma metastatis to the right testicle three years after undergoing subcapsular orchiectomy. This case shows that the urologist has to think about a metastatic cancer when he sees a testicular tumor also after plastic orchiectomy.     

Embryonal carcinoma of the testis associated with prostate cancer in a 72-year-old man

A 72-year-old Japanese man presented with a painless swollen left scrotal mass with elevated levels of serum alpha-fetoprotein and prostate specific antigen. The patient underwent high orchiectomy under diagnosis and a final pathological examination revealed embryonal carcinoma of the left testis. A systematic needle prostate biopsy under guidance of transrectal ultrasound revealed prostate cancer (Gleason score, 8) on the left lobe (T2aN0M0). Systemic chemotherapy was given for retroperitoneal lymph node metastasis of testicular cancer and hormonal therapy (LH-RH analog) was given for prostate cancer. The patient was well with no evidence of metastasis from the testicular cancer or prostate cancer and with no elevation of serum alpha-fetoprotein or prostate specific antigen 26 months after the orchiectomy.     

肾上腺源性雄激素与前列腺癌

目的 探讨肾上腺源性雄激素与前列癌（ＰＣａ）的关系。方法 １９９８年３月～１９９９年７月,采用雄激素全方法治疗１８例Ｂ２期以上ＰＣａ,并与２３例单纯睾丸切除治疗的晚期ＰＣａ比较,雄激素全阻断法采用睾丸切除加缓退瘤或酮康唑。结果 雄 纱全阻断治疗组可迅速使患者血清睾酮、ＰＳＡ降低和前列腺体积缩小,与单纯睾丸切除组比较,血ＰＳＡ降低和前列腺体积缩小５０％的时间差别有显著性意义（Ｐ〈０．０１）。雄激素全     

Prostatic carcinoma with metastasis to the testicle: a case report

A 63-year-old man was admitted with the complaints of macrohematuria, sense of residual urine and urinary frequency. Physical examination revealed an enlarged hard prostate and left scrotal mass. The pathological diagnosis of the needle biopsy specimen of the prostate showed undifferentiated adenocarcinoma. The patient underwent bilateral orchiectomy for hormone therapy of prostatic carcinoma and treatment of suspected left testicular tumor. The histology of testicular tumor revealed metastasis from carcinoma of the prostate. Metastasis of the testis from prostatic carcinoma is rare in spite of the high incidence of the primary tumor. Clinical findings on testicular metastasis from carcinoma of the prostate obtained in 62 cases reported in available literature are reviewed and discussed in detail.     

Silent testicular metastasis from carcinoma of the prostate

Secondary testicular tumours are rare, but metastasis of prostatic carcinoma to the testis is being reported more frequently. While this may not reflect a true increased incidence, more cases are detected by bilateral orchiectomy. Of 916 patients with carcinoma of the prostate diagnosed and treated over a period of 10 years, 124 underwent bilateral orchiectomy. Three patients were found to have testicular metastasis, 1 being bilateral. The route of spread seems to be through the lumen and/or lymphatics of the vas deferens. Although it is a sign of advanced disease, the prognostic significance is undetermined.     

Testicular and epididymal metastasis of prostate cancer

Metastatic testicular carcinoma is unusual. A case of carcinoma of the prostate with metastases to the testis and epididymis is reported. Routes of metastatic spread of neoplasm to the testis are discussed. Easily removable cancer may remain in the scrotum when using the socalled subcapsular orchiectomy without complete removal of the scrotal contents.     

原发性前列腺印戒细胞癌(附二例报告及文献复习)

目的：探讨原发性前列腺印戒细胞癌的临床特点。方法：分析2例原发性前列腺印戒细胞癌患者的临床资料，结合文献得以讨论。结果：2例患者年龄分别为64岁和73岁，临床表现为排尿困难、膀胱刺激症及会阴不适。组织学：印戒状癌细胞呈圆形，胞质丰富透明，胞核呈新月状位于细胞一侧，核分裂像多见。免疫组化染色PCA（ ）、PAP( )、AR( )、低分子CK( )，CEA（-）、AB/PAS（-）。1例D期患者行双侧睾丸切除及氟他胺治疗，术后6个月死于广泛转移；1例B2期患者行根治性前列腺切除、双侧睾丸切除、内分泌和局部放射治疗，随访25个月未见复发和转移。结论：原发性前列腺印戒细胞癌是一种罕见、高度恶性的肿瘤，确诊需依赖组织病理学及免疫组织化学检查。     

Hormone/Antihormone Withdrawal and Dexamethasone for Hormone-Refractory Prostate Cancer

Background Flutamide withdrawal has been reported to benefit patients with hormone-refractory prostate cancer. Several studies have also demonstrated that a combination of corticosteroids and testicular androgen ablation lowers serum androgen levels and improves clinical response. The purpose of this study was to examine the effect of withdrawal of oral hormonal agents and administration of dexamethasone in stage D3 prostate cancer patients.
Methods Sixteen patients with hormone-refractory prostate cancer were enrolled in the study. All patients had osseous metastasis and elevated serum prostate-specific antigen. Nine had been treated with chlormadinone acetate, 4 with estramustine phosphate, and 3 with flutamide as first-line hormonal therapy. All patients had also been treated either with bilateral orchiectomy (13 cases) or a luteinizing hormone-releasing hormone (LH-RH) agonist (3 cases). Seven patients whose disease progressed following hormone withdrawal were treated with oral dexamethasone (initially 1.5mg/day, then tapered to 0.5 mg/day).
Results Eight patients demonstrated a decrease in prostate-specific antigen of greater than 50% following hormone withdrawal. The time to cancer progression for these 8 patients was 2 to 15 months (mean, 4 months). Among the patients receiving dexamethasone, 4 showed a greater than 90% decrease in prostate-specific antigen after 3 months' treatment. The time to disease progression for these 4 patients was 3 to 11 months.
Conclusion In treating hormone-refractory advanced prostate cancer, the first pharmacologic manipulation should be withdrawal of the oral component of combined hormonal therapy. Patients whose disease progresses after hormone withdrawal should then be treated with glucocorticoids such as dexamethasone.     

Serum follicle stimulating hormone--predictor of cancer in the remaining testis in patients with unilateral testicular cancer

In 10 of 13 patients with unilateral testicular cancer and subsequent invasive cancer or carcinoma in situ in the remaining testis, the follicle stimulating hormone (FSH) level was elevated after the first orchiectomy and before further treatment. In only 4 of 26 comparable control patients was the FSH level raised. This may be because elevated serum FSH often reflects disturbances in spermatogenesis and fertility, the latter being a known risk factor for testicular cancer. An elevated FSH level that occurs after orchiectomy for unilateral testicular cancer and before further treatment identifies patients at high risk of developing a tumour in the remaining testis.     

Intralbugineous testicular prosthesis a new technique summary of 30 implants

A study of 16 patients who underwent intralbugineous testicular implants during the practice of orchiectomy is presented. In 14 cases of prostatic carcinoma, after bilateral subcapsular orchiectomy intralbugineous prostheses were implanted and in 2 other cases of testicular torsion unilateral prosthesis was implanted. With this new, easily executed technique the size, mobility and testicular sensibility are maintained.     

A case of testicular metastasis from carcinoma of the prostate

Authors report a rare case of testicular metastasis from carcinoma of the prostate in a patient treated with anti-androgen therapy. The report of this kind of testicular metastasis was more frequent in the past years, when the neoplasm was often treated with bilateral orchiectomy. Metastatic carcinoma of the prostate to the testis is commonly accepted as a sign of advanced disease and it is usually accompanied by multiple metastases to other organs. The prognostic significance of testicular localization is still unknown.     

Testicular carcinoma in patients positive and at risk for human immunodeficiency virus

Patients with the acquired immunodeficiency syndrome are at increased risk for certain malignancies. Because acquired immunodeficiency syndrome and testicular cancer affect primarily young men, the potential complications that acquired immunodeficiency syndrome might impose raise significant concern. To address this question we performed a retrospective review of all cases of testicular cancer during an 11-year period. Of 140 patients 6 had human immunodeficiency virus infection and 7 were from human immunodeficiency virus risk groups. All cases were either stage I or II disease with seminoma in 8, teratocarcinoma in 3, embryonal cell carcinoma in 1 and teratoma in 1. The clinical presentations of these patients were comparable to those of patients without human immunodeficiency virus risk factors. The majority of the patients received standard therapy, including orchiectomy followed by lymphadenectomy, radiation therapy or chemotherapy depending on stage and pathological subtype. Patients tolerated therapy well with only 1 course of radiation therapy complicated by Pneumocystis carinii pneumonia. All patients achieved complete remission and none died of testicular cancer. Since treatment of these patients may worsen the immunosuppression, surveillance is recommended after orchiectomy for acquired immunodeficiency syndrome patients with stage I disease. However, the majority of patients with human immunodeficiency virus infection should receive standard therapy.     

Impact of the length of time between diagnosis and surgical removal of urologic neoplasms on survival

Objective

Our aim was to assess the effect of surgical wait time on the survival of patients with urological neoplasms, including prostate, bladder, penile, and testicular cancers and upper tract tumours (UTUC).

Materials and methods

Current, relevant studies were identified from the literature. Keywords used for article retrieval were as follows: delay; surgery; prostate cancer; urothelial carcinoma; renal cell carcinoma; testicular cancer; bladder; renal pelvis; ureter; and survival.

Results

Regarding the length of surgical wait time, it does not matter in cases of incidental T1a renal cell carcinomas. In other cases of renal cell carcinomas, surgery should be considered within <1 month; it is of crucial importance in bladder cancer and should be <1 month for a TURBT in cases of non-muscle-invasive bladder cancer and <1 month for a radical cystectomy in cases of muscle-invasive bladder cancer; it is important in invasive UTUC and should be <1 month for a radical nephroureterectomy; it is not crucial in cases of low-risk prostate cancer. In any other case, radical prostatectomy should be considered within <2 months; it is important in testicular cancer and should be fewer than 10 days for an orchiectomy.

Conclusion

Prolonged surgical wait times have an impact on the overall quality of life and anxiety of the patient. Extending the wait time beyond a given threshold can also have a negative impact on the patient’s clinical outcomes, but this threshold differs between urological neoplasms.     

Conservative management of small testicular tumors relative to carcinoma in situ prevalence

PURPOSE: We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for germ cell tumors smaller than 40 mm in diameter to propose an appropriate conservative approach to bilateral tumors or tumor of a solitary testis. MATERIALS AND METHODS: Of 127 patients treated with orchiectomy between 1990 and 2002, 41 who presented with a tumor of less than 40 mm in diameter were selected for histological analysis of testicular parenchyma. The morphological items assessed were CIS, spermatogenesis and Leydig cell hyperplasia. RESULTS: CIS was observed in 39 of the 41 patients (95%). CIS was evenly distributed throughout the testicular parenchyma (ie around and beyond the tumor) in all 39 cases. Spermatogenesis was observed in 12 of 41 specimens (29%), spermatogenesis without spermatozoa was noted in 14 (34%) and absent germ cells were found in 15 (37%). Leydig cell hyperplasia was observed in 24 cases (58%). CONCLUSIONS: Histological analysis of whole orchiectomy specimens showed that CIS is almost always present in testicular parenchyma adjacent to germ cell tumor. In bilateral testis cancer or cancer occurring in a solitary testis tumorectomy plus radiotherapy appears to be the appropriate treatment in patients with a small tumor and no other risk factors. In patients who wish to father a child and have preserved spermatogenesis the natural history of CIS allows the postponement of testicular radiotherapy after orchiectomy, giving the double advantage of preserving testicular endocrine function and maintaining the possibility of natural fatherhood.     

Single testicular metastasis mimicking primary testicular neoplasm: a rare manifestation of prostate cancer

The incidence of secondary testicular tumors ranges from 0.02 to 2.5% among autopsies in general. With the exception of leukemias and lymphomas, prostate cancer is the most common primary site. It is diagnosed in autopsies or incidentally, following therapeutic orchiectomies in more advanced stages of the disease. In the present report, we show a case of testicular metastasis derived from prostate neoplasm whose clinical presentation as a single metastasis was similar to a primary testicular neoplasm. The diagnosis was evidenced after orchiectomy by histological examination and immunohistochemical tests.     

Testicular neoplasms in children

Six cases of testicular tumors in children are presented: 3 patients had teratoma, 1 embryonal carcinoma, 1 orchioblastoma, and 1 paratesticular rhabdomyosarcoma. Three of the 6 patients presented with hydroceles. The treatment consisted of orchiectomy alone. All patients were alive and free of disease one and one-half to eight and one-half years after orchiectomy. It is suggested that orchiectomy alone is curative in most children with testicular tumors under the age of two years.     

Testicular metastasis from carcinoma of prostate: report of two cases

Despite the high incidence of prostatic adenocarcinoma and its ability for wide dissemination, metastatic involvement of testis is rather uncommon. We report two cases (aged 76 and 55 years, respectively), where unilateral testicular metastasis was incidentally discovered after bilateral orchiectomy following detection of adenocarcinoma prostate in six-quadrant trucut specimen. Both patients had obstructive voiding symptoms, hard nodular prostate on direct rectal examination and raised serum prostate-specific antigen levels, without associated systemic or testicular symptoms. Extensive evaluation excluded any other possible primary, although axial skeletal metastasis was detected on radionucleotide bone scans, in the first case. These cases highlight the need for proper evaluation of testes and para-testicular structures, for accurate staging of these tumors and to exclude any possible metastasis.     

膀胱移行细胞癌伴前列腺癌的诊断与治疗

目的　提高膀胱移行细胞癌伴前列腺癌的诊治水平。　方法　对 8例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。　结果　 8例术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌。 7例经直肠前列腺穿刺活检确诊前列腺癌 ,1例为前列腺增生症 ,行膀胱前列腺全切术后病理证实为前列腺癌。 4例行经尿道膀胱肿瘤电切及双侧睾丸切除术 ,术后使用丝裂霉素或BCG等膀胱灌注及氟他胺内分泌治疗。 1例行膀胱前列腺全切加回肠膀胱术。 8例中 2例失访 ,3例因多发性转移 ,术后存活 <1年 ,3例行根治性膀胱前列腺全切术 ,术后随访 1.5～ 4.0年 ,经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。　结论　血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法 ,根治性膀胱前列腺切除是影响预后的重要因素     

Subcapsular orchiectomy with intracapsular testicular prosthesis for metastatic prostate carcinoma

Fifteen patients underwent subcapsular orchiectomy with placement of an intracapsular testicular prosthesis for hormonal treatment of symptomatic Stage D carcinoma of the prostate. Serum testosterone decreased to castration levels, and the intracapsular prosthesis was often indistinguishable from a normal testicle postoperatively. This new technique of castration may be considered an alternative in those patients reluctant to undergo other forms of orchiectomy.     

Testicular carcinoma in situ and nonpalpable seminoma eight years after contralateral teratocarcinoma

A thirty-five-year-old man had invasive seminoma and extensive carcinoma in situ in his remaining testicle eight years after orchiectomy and lymphadenectomy for Stage I teratocarcinoma. Beyond orchiectomy and hormone replacement, suitable treatment for such second neoplasms, which occur in at least 1 percent of patients, is not clear. More work also is needed to determine appropriate follow-up after treatment of the first cancer now that long-term survival of testicular cancer is the rule.