The role of multimodal imaging in diagnosis in the diagnosis of epididymal metastasis from prostate carcinoma: A case report

Prostate cancer is a common malignancy in men, typically metastasizing to bones, lymph nodes, and visceral organs. Epididymal metastasis, however, is extremely rare, with a reported prevalence of less than 4% and usually identified incidentally. We report the case of a 72-year-old male with a history of high-risk prostate adenocarcinoma previously treated with radical prostatectomy. During follow-up, the patient presented with a painless right scrotal nodule and a concurrent rise in serum PSA levels. Scrotal ultrasound and contrast-enhanced ultrasound (CEUS) revealed a solid, hypervascularized lesion in the right epididymis. PSMA PET-CT confirmed intense radiotracer uptake at the same site, consistent with metastatic disease. No other distant metastases were detected. The patient was treated with hormonal therapy and monitored through imaging and PSA levels, showing partial response. This case underscores the importance of considering atypical metastatic sites in prostate cancer follow-up. Multimodal imaging, especially CEUS and PSMA PET-CT, plays a pivotal role in the detection and characterization of rare metastatic localizations.