From the Research
Prostate cancer can indeed spread to the testicles, although this occurrence is relatively rare and typically happens in the later stages of advanced disease. Prostate cancer usually metastasizes first to nearby lymph nodes and bones, with testicular metastasis being a less common site of spread. The mechanism of spread to the testicles is thought to occur through the lymphatic system or blood vessels, rather than by direct extension 1.
Key Points to Consider
- Symptoms of testicular metastasis may include testicular pain, swelling, or the presence of a lump.
- Diagnosis typically involves physical examination, ultrasound imaging, and sometimes a biopsy to confirm cancer cells in the testicle.
- Treatment for prostate cancer that has spread to the testicles generally focuses on systemic therapy for the underlying prostate cancer, which may include hormone therapy, chemotherapy, or newer targeted therapies.
- In some cases, surgical removal of the affected testicle (orchiectomy) might be recommended, as seen in a case report where a patient underwent orchiectomy for an isolated testicular metastasis from prostate cancer and had no signs of biochemical and clinical recurrence after one year 2.
- Regular follow-up with an oncologist and urologist is essential for monitoring disease progression and adjusting treatment as needed.
Recent Evidence and Recommendations
The most recent and highest quality study on this topic is from 2019, which presents a case of isolated testicular metastasis diagnosed more than a decade and a half post-primary treatment for prostate cancer 1. This study highlights the importance of long-term follow-up and the need for a high index of suspicion for testicular metastasis in patients with a history of prostate cancer. Based on this evidence, it is recommended that patients with prostate cancer undergo regular physical examinations and imaging studies to monitor for potential metastases, including testicular metastasis. Additionally, the use of modern imaging techniques such as PSMA-PET may provide better sensitivity and specificity for detecting metastases, particularly in cases of biochemical recurrence with low values of prostate-specific antigen 3.