What does this research mean for the field?

Testicular involvement in prostate carcinoma can occur and may be detected using PSMA PET-CT, which is crucial for guiding treatment decisions. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This report aims to highlight the rare occurrence of testicular metastasis in advanced prostate carcinoma and the importance of comprehensive staging.

February 25, 2026Cureus0 citationsOpen Access

Unanticipated Testicular Involvement in Prostate Carcinoma: A Case Report

SSSimha Swaraj SirivelaAmrita Institute of Medical Sciences and Research Centre VPVivek Dadasaheb PatilAmrita Institute of Medical Sciences and Research Centre PYPrashanth Reddy YelsaniAmrita Institute of Medical Sciences and Research Centre

Key Points

This report aims to highlight the rare occurrence of testicular metastasis in advanced prostate carcinoma and the importance of comprehensive staging.
Clinical evaluation of a 78-year-old man with prostate cancer symptoms.
Multiparametric MRI and PSA testing conducted for diagnosis.
TRUS-guided biopsy performed to confirm adenocarcinoma.
PSMA PET-CT used to detect metastases, including in the left testis.
Bilateral orchidectomy performed followed by histopathological evaluation.
PSA level at diagnosis was 11.01 ng/mL, declining to 4.63 ng/mL after treatment.
PET-CT identified PSMA-avid lesions in the testis and advanced prostatic disease.
Histopathological evaluation confirmed metastatic prostate adenocarcinoma in the left testis.
Intensified systemic therapy with abiraterone and prednisolone was initiated.

Abstract

Prostate carcinoma commonly metastasizes to distant organs; however, testicular involvement is exceedingly rare and may be overlooked in routine clinical practice. We report the case of a 78-year-old man with high-grade prostate adenocarcinoma who presented with a three-month history of painless hematuria and lower urinary tract symptoms (LUTS). Initial evaluation revealed a prostate-specific antigen (PSA) level of 11.01 ng/mL, and multiparametric MRI demonstrated locally advanced disease. A transrectal ultrasound (TRUS)-guided biopsy confirmed adenocarcinoma with a Gleason score of 10. Whole-body gallium-68 (⁶⁸Ga) prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET-CT) identified a PSMA-avid prostatic lesion with extension into the seminal vesicles and bladder, along with two focal PSMA-avid deposits in the left testis. Bilateral orchidectomy was performed, and histopathological evaluation confirmed metastatic prostate adenocarcinoma within the left testis. The confirmation of distant metastatic involvement prompted the intensification of systemic therapy with abiraterone and prednisolone, resulting in a decline in PSA to 4.63 ng/mL at four-month follow-up. This case highlights the importance of comprehensive staging in high-grade prostate cancer and demonstrates the clinical utility of PSMA PET-CT in detecting atypical metastatic sites such as the testes, thereby guiding appropriate surgical and systemic treatment decisions.

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