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 Table of Contents     
CASE REPORT
Year : 2020  |  Volume : 35  |  Issue : 1  |  Page : 61-62  

Solitary metastasis of prostatic adenocarcinoma to the testicle detected by68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography


Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon

Date of Submission30-Sep-2019
Date of Acceptance09-Oct-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Dr. Mohamad Haidar
Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020
Lebanon
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_182_19

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   Abstract 


We present a case of a 79-year-old man with prostate cancer with biochemical recurrence after radical prostatectomy and hormonal therapy.68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) was performed to look for recurrent disease, and a solitary metastasis to the left testicle was detected. This case report highlights the importance of68Ga-PSMA PET/CT in detecting unusual metastatic lesions from prostate cancer in patients with biochemical recurrence.

Keywords: 68Ga-prostate-specific membrane antigen, positron emission tomography/computed tomography, prostate cancer, testicular metastasis


How to cite this article:
Deeb IA, Khdhir MA, Bulbul M, Haidar M. Solitary metastasis of prostatic adenocarcinoma to the testicle detected by68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography. Indian J Nucl Med 2020;35:61-2

How to cite this URL:
Deeb IA, Khdhir MA, Bulbul M, Haidar M. Solitary metastasis of prostatic adenocarcinoma to the testicle detected by68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography. Indian J Nucl Med [serial online] 2020 [cited 2020 Jan 26];35:61-2. Available from: http://www.ijnm.in/text.asp?2020/35/1/61/274374




   Introduction Top


68 Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) has proved superiority compared to other modalities; both regarding sensitivity and specificity for detecting lesions in patients with a biochemically recurrent prostate cancer,[1] this, in turn, has prompted a significant change in management of these patients.[2]


   Case Report Top


We present a case of a 79-year-old man with prostate cancer who initially presented with prostate-specific antigen (PSA) level of 7 ng/ml, suspicious digital rectal examination, and positive transrectal ultrasound biopsy. The patient underwent radical prostatectomy 17 years ago, and histopathologic evaluation showed Gleason's score 7 (4 + 3) adenocarcinoma. PSA level had dropped following surgery to 0.02 ng/mL, and the patient was maintained on hormonal therapy with triptorelin.

The patient presented with rising PSA levels from 0.47 ng/ml to 3.9 ng/ml in a span of 3 months, in keeping with biochemical recurrence.

68 Ga-PSMA PET/CT was performed and showed a single abnormal radiotracer-avid focal area localized to the left testicle with maximum standardized uptake value 9.3, and a concern for metastasis was raised [Figure 1]. This was further evaluated with ultrasound and magnetic resonance imaging examinations, confirming the presence of focal lesion [Figure 2].
Figure 1: Images demonstrating focal increased radiotracer uptake in the left testicle, no abnormality is seen on the nonenhanced computed tomography scan. (a) Positron emission tomography maximum intensity projection of the whole body, (b) axial positron emission tomography image at the level of the testicles, (c) axial nonenhanced computed tomography scan component of the positron emission tomography/computed tomography at the level of the testicles, (d) fused positron emission tomography/computed tomography image at the level of the testicle

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Figure 2:(a) Ultrasound examination with color Doppler showing a focal ill-defined lesion with calcificationsin the upper pole of the left testicle with no intralesional blood flow, (b) axial T2-weighted image at the levelof the left testicle showing a poorly defined hypointense left testicular lesion

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The patient underwent bilateral orchiectomy, and histopathologic evaluation revealed metastatic prostatic adenocarcinoma to the left testicle.


   Discussion Top


Metastatic disease to testicles from solid tumors is very rare; a retrospective autopsy study of 738 patients with solid malignant neoplasms found metastasis to testicles in 0.68% of patients.[3] Prostate cancer is the most common culprit, which was found in 35.4% of these patients as per Haupt et al.[4]

Excluding autopsy cases and incidental tumors in therapeutic orchiectomies, metastatic carcinomas to the testicles are usually solitary and unilateral, which may simulate primary neoplasms.[5]

Prolongation of the course of prostate cancer due to progressive hormonal therapies may have increased the incidence of metastatic disease to the testicles because they have more time to develop.[6]

To the best of our knowledge, there are only two cases of solitary metastatic prostate cancer to the testicle diagnosed by68 Ga-PSMA PET/CT and reported in the literature.[7],[8]

This case report highlights the importance of68 Ga-PSMA PET/CT in detecting unusual metastatic lesions from prostate cancer in patients with biochemical recurrence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG, et al. Sensitivity, specificity, and predictors of positive 68Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: A systematic review and meta-analysis. Eur Urol 2016;70:926-37.  Back to cited text no. 1
    
2.
Mattiolli AB, Santos A, Vicente A, Queiroz M, Bastos D, Herchenhorn D, et al. Impact of 68GA-PSMA PET/CT on treatment of patients with recurrent/metastatic high risk prostate cancer-A multicenter study. Int Braz J Urol 2018;44:892-9.  Back to cited text no. 2
    
3.
García-González R, Pinto J, Val-Bernal JF. Testicular metastases from solid tumors: An autopsy study. Ann Diagn Pathol 2000;4:59-64.  Back to cited text no. 3
    
4.
Haupt HM, Mann RB, Trump DL, Abeloff MD. Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasms. Cancer 1984;54:709-14.  Back to cited text no. 4
    
5.
Ulbright TM, Young RH. Metastatic carcinoma to the testis: A clinicopathologic analysis of 26 nonincidental cases with emphasis on deceptive features. Am J Surg Pathol 2008;32:1683-93.  Back to cited text no. 5
    
6.
Lieng-Yi Lu, Junne-Yih Kuo, Alex T.L. Lin, Yen-Hwa Chang, Kuang-Kuo Chen, Chin-Chen Pan, et al. Metastatic tumors involving the testes. J Urol Roc 2000;11:12-7.  Back to cited text no. 6
    
7.
Weiberg D, Radner H, Derlin T, Thon WF. Early detection of bilateral testicular metastases from prostatic adenocarcinoma using 68Ga-PSMA ligand PET/CT. Clin Nucl Med 2017;42:563-4.  Back to cited text no. 7
    
8.
da Cunha ML, de Oliveira Rodrigues C, de Araújo MPL, de Freitas Junior CH, Ferrigno R. Solitary testicular metastasis from prostate cancer. A case report diagnosed by PET/CT with PSMA. Eur J Nucl Med Mol Imaging 2018;45:888-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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