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Life sciences · Journal article
Cancer Urology · September 29, 2026
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Metastasis of prostate cancer to the epididymis is exceptionally rare, with only 23 cases reported. This case highlights diagnostic challenges and underscores the role of advanced imaging in detecting atypical metastases. Aim. To present a case of acinar adenocarcinoma metastatic to the left epididymis, analyzing pathogenesis, diagnostic approaches, and management strategies. A 67-year-old male with prostate cancer (initial cT2cN0M0, Gleason 8) underwent laparoscopic radical prostatectomy with pelvic lymphadenectomy (21.09.2023). Histopathology revealed pT3bN1 (3/24 nodes), Gleason 9 (4 + 5), positive surgical margin (R1). Adjuvant radiotherapy (total dose 70.8 Gy) and androgen deprivation therapy (goserelin) were administered. Upon biochemical recurrence (prostate-specific antigen (PSA) 2 ng/mL), positron emission tomography combined with computed tomography, with prostate-specific membrane antigen (PSMA-PET/CT) detected lesions in the left epididymis, lung, and bones. Bilateral orchiectomy was performed. Histological examination included morphology and immunohistochemical study (PSA, PSMA, NKX3.1). PSMA-PET/CT showed intense uptake in the left epididymis (standardized uptake value maximum 12.7), left lung (6 mm nodule), and bones. Orchiectomy confirmed metastatic adenocarcinoma in the epididymis with vascular/perineural invasion, morphologically identical to primary prostate cancer. IHC: PSA (+++), PSMA (+++), PLAP (−), OCT3/4 (−), excluding germ cell tumor. HRR gene testing revealed no mutations. Enzalutamide (160 mg/day) was initiated due to progression. Epididymal metastases from prostate cancer are anecdotal (0.01 %), requiring differentiation from primary testicular tumors. PSMA-PET/CT is pivotal for detecting atypical recurrences (sensitivity 85–92 % at PSA 0.5 ng/mL). Aggressive features (Gleason 9, R1, early recurrence) predict multifocal progression, including rare sites. Orchiectomy serves dual diagnostic and therapeutic purposes (androgen deprivation). Reporting such cases is crucial for optimizing management algorithms.