Prostate Cancer Recurrence Due to Isolated Testicular Metastases Detected by PSMA PET/CT

This is the authors' abstract. We don't add key points for this paper.

Prostate cancer is the most common solid malignancy to metastasize to the testicles, although testicular metastases remain rare and are often discovered only postmortem. Methods: Retrospective analysis of 95 ⁶⁸Ga-prostate-specific membrane antigen (PSMA) PET/CT reports from September 2016 to July 2024 using scrotal region search terms identified 30 patients with indeterminate findings and 6 patients with pathology-confirmed testicular metastases. Data on imaging, pathology, clinical outcomes, and prostate-specific antigen values were reviewed. Results:⁶⁸Ga-PSMA PET/CT detected isolated testicular metastases in 6 patients with M0 castrate-sensitive prostate cancer after maximal pelvic therapy who were imaged because of rising prostate-specific antigen levels. Three of the 6 patients did not have ultrasound abnormalities. Five of the 6 patients were treated with orchiectomy and had durable responses (median follow-up, 33 mo; range, 10–58 mo). Conclusion: Including the testes in field of view of the PSMA PET scan may avoid false-negative results. ⁶⁸Ga-PSMA–avid testicular and peritesticular lesions may indicate metastasis even with a negative ultrasound. Orchiectomy can result in durable remissions for these patients.