Oligorecurrent prostate cancer presenting as isolated testicular metastasis: a rare case report

Testicular metastasis from prostate cancer is extremely rare, and on conventional radiological imaging, features can be non-specific, making diagnosis challenging. We report a case of a 63-year-old man with locally advanced prostate adenocarcinoma initially treated with radiotherapy and a 3-year course of androgen deprivation therapy. During follow-up, a rising PSA level prompted further evaluation. Conventional imaging revealed a heterogeneous lesion in the left testis. The patient underwent a left radical orchiectomy. Histological and immunohistochemical analysis confirmed a high-grade metastatic prostate adenocarcinoma. Postoperatively, the PSA level decreased to 0.04 ng/ml and remained stable for at least 2 years under active surveillance with PSA monitoring. This case demonstrates the potential of radical orchiectomy as a metastasis-directed approach for isolated testicular metastasis from castration-sensitive prostate cancer, delaying the need for systemic treatment. Further studies are needed to clarify its place in clinical practice.