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INTRODUCTION: Prostate cancer is the second most prevalent tumor in the male. The most frequent places of metastasis are pelvic lymph nodes, bones, and lungs. The incidence of testicular metastases by prostate carcinoma is less than 0.5% of cases, as the clinical case presented below.
CLINICAL FINDINGS: A 66 year old male with a medical history of dyslipidemia and mitral valvulopathy with severe intervention failure of mechanical mitral prosthesis in 2005. Anticoagulated with acenocumarol. Performance status 0. In November 2005, prostate biopsy is performed by elevation of Specific Prostate Antigen (PSA) of 9 ng/ml. The anatomopathological result reports Gleason 9 (4+5) in all cylinders. Negative extension study for distance disease. It is treated by cryotherapy and subsequent radiation therapy. In their monitoring the levels of PSA are normal until 2015 that the patient ceases to attend the consultations. In March 2019 starts androgenic deprivation therapy for PSA elevation (221 ng/ml). Extension study was positive for axillary, mediastinal and retroperitoneal adenopathies. In the examination of the patient is objective left testicle induced to palpation. Testicular tumor markers in normal range. In April 2019 an intraparenquimatous hemorrhage diagnosed occupying lesion of hyperdense left parietoccipital cerebral space intraxial.
DIAGNOSIS AND TREATMENT: It is decided to perform in the same surgical act left radical orchiectomy and left parietoccipital craniotomy with resection of the intracranial lesion. The result of the brain surgery is negative for malignancy. The pathological anatomy of the testicle reports adenocarcinoma metastases compatible with prostatic origin. Patients are proposed to participate in the PROSTRATEGY clinical trial.
OUTCOMES AND FOLLOW UP: The PROSTRATEGY clinical trial is a phase II randomized with immunotherapy strategies with ipilimumab, in patients with metastatic and hormone-sensitive prostate cancer. The objective of the study is to assess whether adding immunotherapy or other therapies to standard androgen block treatment plus chemotherapy improves the overall survival of patients with high volume metastatic prostate cancer castration as well as its toxicity and viability of the new experimental arms. The described patient participates in the arm with docetaxel. Currently he has received his first cycle with good tolerance. Last PSA 27 ng/ml and testosterone in castration range.
