Prostatic Adenocarcinoma in a Patient With a History of Cryptorchidism-Associated Hypogonadism: A Case Report

Prostate cancer is a prevalent malignancy often associated with advancing age and high androgen levels. Hypogonadism is characterized by low testosterone levels, and as prostate growth is androgen-dependent, this links elevated testosterone to increased prostate cancer risk. This rare presentation of a middle-aged man with the development of prostate cancer, following a history of congenital cryptorchidism and subsequent hypogonadism, challenges the conventional understanding of the role of testosterone in the development of prostate cancer. A gentleman in his late 60s, with a previous unilateral orchidectomy for suspected testicular cancer and 10 years of testosterone replacement therapy for hypogonadism, presented with an elevated prostate-specific antigen (PSA) level of 5.1 ng/mL. Digital rectal examination revealed a firm lobulated prostate, and MRI indicated a 15 mm PIRAD 4 (prostate imaging-reporting and data) lesion in the left peripheral zone. A trans-perineal biopsy confirmed a diagnosis of prostatic adenocarcinoma (Gleason score 3 + 3 = 6) with bilateral disease. To our knowledge, we are not aware of any previous literature reporting prostate cancer development in patients with cryptorchidism-associated hypogonadism. This report highlights the need for ongoing assessment of the long-term effects of testosterone replacement therapy in patients with a history of cryptorchidism and hypogonadism and the initiation or development of prostate cancer.