We report an unusual case of testicular metastasis from prostate cancer in a 71-year-old known hypertensive and diabetic Filipino male, treated with External Beam Radiation (EBRT) for prostate cancer in 2021. 3 months prior to consult He presented with left scrotal enlargement and intermittent pain, leading to a diagnosis via bilateral radical orchiectomy and histopathological analysis. The findings confirmed metastatic adenocarcinoma in the left testis, with prostate origin. The patient was discharged in good condition after four days. This case highlights the rare occurrence of testicular metastasis from prostate cancer, underscoring the importance of thorough evaluation in patients with a previous diagnosis of prostate cancer.

Prostate cancer ranks as the 5th most frequently diagnosed cancer among males in the Philippines, with an estimated 8,242 new cases annually, highlighting its status as a significant health concern for the Filipino male population [1]. Metastasis of prostate adenocarcinoma to the testicles or spermatic cord is an exceptionally uncommon occurrence, with reported incidences ranging from 0.01% to 0.5% of cases [10,12]. Historically, testicular metastases were primarily identified during post-mortem examinations or through orchidectomy procedures for surgical castration, revealing small deposits of prostate adenocarcinoma [13]. However, with the advent of pharmacological androgen deprivation therapy (ADT) in the modern era, the incidental discovery of testicular metastases during surgical castration has become less frequent. We present a case of a 71-year old male who developed testicular and spermatic cord metastasis from prostate adenocarcinoma.

In this case, epididymoorchitis was suspected initially, but due to the patient’s history of prostate cancer and worsening symptoms, testicular metastasis was considered. Imaging and surgery confirmed testicular and spermatic cord metastases—rare sites for prostate cancer spread and the first such case reported in the Philippines. Testicular metastases from prostate cancer are uncommon (0.02–2.5%), and spermatic cord involvement is even rarer (0.01%). These typically occur in older patients and often suggest advanced disease with poor prognosis. Diagnosis can be aided by immunohistochemistry.

This case highlights the necessity of monitoring in patients with a history of prostate cancer. The successful management of this patient, despite the advanced nature of the disease, illustrates the effectiveness of prompt intervention in managing metastatic prostate cancer. Solid tumors spreading to the testicles are typically quite rare. The outlook for testicular metastases originating from a primary prostate tumor is uncertain, primarily due to the infrequency of this phenomenon. Further studies and surveillance are imperative to enhance early detection and improve management outcomes for prostate cancer patients in the Philippines.