A rare variant of prostate cancer metastasis to the epididymis: a clinical observation

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Metastasis of prostate cancer to the epididymis is exceptionally rare, with only 23 cases reported. This case highlights diagnostic challenges and underscores the role of advanced imaging in detecting atypical metastases.

Aim. To present a case of acinar adenocarcinoma metastatic to the left epididymis, analyzing pathogenesis, diagnostic approaches, and management strategies.

A 67-year-old male with prostate cancer (initial cT2cN0M0, Gleason 8) underwent laparoscopic radical prostatectomy with pelvic lymphadenectomy (21.09.2023). Histopathology revealed pT3bN1 (3/24 nodes), Gleason 9 (4 + 5), positive surgical margin (R1). Adjuvant radiotherapy (total dose 70.8 Gy) and androgen deprivation therapy (goserelin) were administered. Upon biochemical recurrence (prostate-specific antigen (PSA) >2 ng/mL), positron emission tomography combined with computed tomography, with prostate-specific membrane antigen (PSMA-PET/CT) detected lesions in the left epididymis, lung, and bones. Bilateral orchiectomy was performed. Histological examination included morphology and immunohistochemical study (PSA, PSMA, NKX3.1). PSMA-PET/CT showed intense uptake in the left epididymis (standardized uptake value maximum 12.7), left lung (6 mm nodule), and bones. Orchiectomy confirmed metastatic adenocarcinoma in the epididymis with vascular/perineural invasion, morphologically identical to primary prostate cancer. IHC: PSA (+++), PSMA (+++), PLAP (−), OCT3/4 (−), excluding germ cell tumor. HRR gene testing revealed no mutations. Enzalutamide (160 mg/day) was initiated due to progression.

Epididymal metastases from prostate cancer are anecdotal (0.01 %), requiring differentiation from primary testicular tumors. PSMA-PET/CT is pivotal for detecting atypical recurrences (sensitivity 85–92 % at PSA >0.5 ng/mL). Aggressive features (Gleason 9, R1, early recurrence) predict multifocal progression, including rare sites. Orchiectomy serves dual diagnostic and therapeutic purposes (androgen deprivation). Reporting such cases is crucial for optimizing management algorithms.

About the authors

Daniel M. Yagudaev

Central Clinical Hospital “RZD-Medicine”

Author for correspondence.
Email: y.d.m.21@mail.ru
ORCID iD: 0000-0002-5949-6915
Russian Federation, 2 Budayskaya St., Moscow 129128

V. A. Bezhenar

Central Clinical Hospital “RZD-Medicine”

Email: y.d.m.21@mail.ru
Russian Federation, 2 Budayskaya St., Moscow 129128

V. S. Ostapchuk

Central Clinical Hospital “RZD-Medicine”

Email: y.d.m.21@mail.ru
ORCID iD: 0009-0001-7079-6775
Russian Federation, 2 Budayskaya St., Moscow 129128

References

  1. Wang L., Lu B., He M. et al. Prostate cancer incidence and mortality: global status and temporal trends in 89 countries from 2000 to 2019. Front Public Health 2022;10:811044 doi: 10.3389/fpubh.2022.811044
  2. Chu F., Chen L., Guan Q. et al. Global burden of prostate cancer: age-period-cohort analysis from 1990 to 2021 and projections until 2040. World J Surg Oncol 2025;23(1):98. doi: 10.1186/s12957-025-03733-1
  3. Gomez P. Prediction of metastatic site based on somatic gene mutations in primary tumors in prostate cancer. Ann Urol Oncol 2023. doi: 10.1101/2023.12.01.23299298
  4. Serfling S., Luther A., Kosmala A. et al. Epididymal metastasis of prostate cancer detected with 68Ga-PSMA-PET/CT. Clin Nucl Med 2016;41(10):792–3. doi: 10.1097/RLU.0000000000001302
  5. Santos-Lopes S., Lobo J., Henrique R. et al. Epididymal metastasis from prostate adenocarcinoma: an unusual and challenging diagnosis suspected in gallium-68 prostate-specific membrane antigen-positron emission tomography/computed tomography and histologically confirmed. Urol Ann 2017;9(1): 89–91. doi: 10.4103/0974-7796.198886
  6. Zhang J., Dong M., Hu X. et al. Prostatic adenocarcinoma presenting with metastases to the testis and epididymis: a case report. Oncol Lett 2015;11(1):792–4. doi: 10.3892/ol.2015.3920
  7. Markovic B. Metastasis of the epididymis disclosing cancer of the prostate. Apropos of a case. Ann Urol (Paris) 1988;22(2):143–5.
  8. Mittal J., Dorairajan L.N., Manikandan R. et al. Testicular and epididymal metastasis from prostate carcinoma: a rare manifestation of common disease. J Clin Diagn Res 2017;11(9):PD01–2. doi: 10.7860/JCDR/2017/20526.10559
  9. Heman-Ackah C., Fox A.T., El-Jabbour J. Epididymal metastasis from carcinoma of the prostate. Sci World J 2004;4:262–5. doi: 10.1100/tsw.2004.61
  10. Janssen S., Bernhards J., Anastasiadis A.G. et al. Solitary testicular metastasis from prostate cancer: a rare case of isolated recurrence after radical prostatectomy. Anticancer Res 2010;30(5)1747–50.
  11. Puigvert A., Vasquez L., Santaularia, J.M. Metastasis of prostatic carcinoma in the epididymis. Eur Urol 1978;4(3):226–7. doi: 10.1159/000473955
  12. Sarma D.P., Weiner M., Weilbaecher T.G. Epididymal metastasis from prostatic cancer. J Surg Oncol 1983;24(4):323–4. doi: 10.1002/jso.2930240416
  13. Guajardo Guajardo J., Aguilo Lucia F., Serrallach Mila N., Bernat Landoni R. Metastasis to the testis and epididymis of a prostatic carcinoma: apropos of a case. Actas Urol Esp 1984;8(5):339–42.
  14. Wiebe B., Warnøe H., Klarlund M. et al. Epididymal metastasis from prostatic carcinoma. Scand J Urol Nephrol 1993;27(1):139–40. doi: 10.3109/00365599309182296
  15. Bahnson R.R., Snopek T.J., Grayhack J.T. Epididymal metastasis from prostatic carcinoma. Urology 1985;26(1):71–3. doi: 10.1016/0090-4295(85)90131-1
  16. Kovi J., Jackson A.G., Jackson M.A. et al. Solitary epididymal metastasis from carcinoma of prostate. Urology 1974;4(1):95–8. doi: 10.1016/s0090-4295(74)80269-4
  17. Thon W., Mohr W., Altwein J.E. Testicular and epididymal metastasis of prostate cancer. Urologe A 1985;24(5):270–3.
  18. Polverari G., Ceci F., Graziani T. et al. A rare case of epididymal metastasis after radical prostatectomy detected by 68Ga-PSMA PET/CT. Clin Genitourinary Cancer 2016. doi: 10.1016/j.clgc.2016.12.011
  19. Talbot R.W., McCann B.G. Secondary prostatic tumour of the spermatic cord and epididymis 5 years after prostatectomy and vasectomy. Br J Urol 1979;51(5):11. doi: 10.1111/j.1464-410x.1979.tb04246.x
  20. Addonizio J.C., Thelmo W. Epididymal metastasis from prostatic carcinoma. Urology 1981;18(1):80–1. doi: 10.1016/0090-4295(81)90299-5
  21. Anastasiadis A.G., Ebert T., Gerharz C.D. et al. Epididymal metastasis of a prostatic carcinoma. Urol Int 1998;61(1):62–4. doi: 10.1159/000030226
  22. Puigvert A., Vásquez L., Santaularia J.M. Metastasis of prostatic carcinoma to the epididymis. Arch Esp Urol 1978;31(5):469–74.
  23. Rizk C.C., Scholes J., Chen S.K. et al. Epididymal metastasis from prostatic adenocarcinoma mimicking adenomatoid tumor. Urology 1990;36(6):519–22. doi: 10.1016/0090-4295(90)80194-r
  24. Wilenius R., Seppänen J. Two unusual cases of metastasis of prostatic cancer: metastases to the spermatic cord and the epididymis. Ann Chir Gynaecol Fenn 1969;58(4):330–2.
  25. Sneiders A., Heller J.E. Epididymal metastasis from prostatic carcinoma. Br J Urol 1990;65(1):101–2. doi: 10.1111/j.1464-410x.1990.tb14941.x
  26. Gaskin D.A., Shah D. Bilateral epididymal metastases from primary adenocarcinoma of the prostate. West Indian Med J 2003;52(4):341–2.
  27. Selimoglu H., Duran C., Saraydaroglu O. et al. Prostate cancer metastasis to thyroid gland. Tumori 2007;93(2):214–6.
  28. Eichhorn J., Nelson N., Raichandani S. et al. Prostate-specific membrane antigen PET/CT detection of prostate cancer metastasis to thyroid and cricoid cartilages. Clin Nucl Med 2024; 49(5):481–3. doi: 10.1097/RLU.0000000000005111
  29. Chalker C., Yilmaz B., Trone K. et al. Use of PSMA PET/CT to detect prostate cancer metastatic to a preexisting thyroid nodule. NPJ Precis Oncol 2024;8(1):132. doi: 10.1038/s41698-024-00619-5
  30. Tomasković I., Milicić V., Tomić M. et al. Impact of positive surgical margins after radical prostatectomy on disease progression and adjuvant treatment in pathologically localized prostate cancer. Coll Antropol 2015;39(4):811–6.
  31. Venclovas Ž., Jievaltas M., Milonas D. Significance of time until PSA recurrence after radical prostatectomy without neo- or adjuvant treatment to clinical progression and cancer-related death in high-risk prostate cancer patients. Front Oncol 2019;9:1286. doi: 10.3389/fonc.2019.01286

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2026 ABV-Press

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-36986 от  21.07.2009.