EXTRAGONADAL GERM CELL TUMOR OF THE PROSTATE

A 37-year-old man with stage I nonseminomatous germ cell tumor of the left testicle was treated with inguinal orchiectomy and close followup in 1989. In October 1998 there was no evidence of disease. In January 1999 the patient complained of dysuria, poor flow and perineal pain. When antibiotic therapy failed, he was referred to a urologist. A voluminous prostatic mass was palpable on rectal examination and confirmed on computerized tomography (CT) (fig. 1). The patient was referred to us. On physical examination a large prostatic mass was palpable and the surface was irregular. Ultrasonography and palpation of the right testis were normal. Transrectal ultrasound revealed a large, homogeneous tumor of the prostate. a-Fetoprotein (AFP) increased to 43 mg./l. (normal less than 15), while b-human chorionic gonadotropin was normal. CT of the chest was normal. Prostatic samples were obtained by transrectal sextant biopsies (fig. 2). Combined cytotoxic chemotherapy, consisting of 20 mg./ m. cisplatin, 100 mg./m. etoposide and 1.5 gm./m. ifosfamide on days 1 to 5, was given in the first course. Because of severe leukopenia and thrombocytopenia we administered 2 courses of 20 mg./m. cisplatin on days 1 to 5, 100 mg./m. etoposide on days 1 to 5 and 30 mg. bleomycin on days 1, 8 and 15. After 3 courses of chemotherapy a complete evaluation was performed. Rectal examination revealed a small normal appearing prostate. Transrectal ultrasound of the prostate showed a homogeneous normal prostate. Magnetic resonance imaging showed complete remission and prostate biopsy demonstrated no evidence of tumor. AFP was normal (4 mg./l.). At 18-month followup the patient remained disease-free.