Patient with penile metastasis from prostate cancer and survival over 5 years: A case report with longitudinal evaluation using computed tomography and magnetic resonance imaging

Unusual Presentation of Solitary Penile Metastasis of Prostate Cancer on 68 Ga-PSMA PET/CT

ABSTRACT

A 75-year-old patient was referred with biochemical recurrence for prostate cancer. The patient underwent 68 Ga-PSMA (prostate-specific membrane antigen) PET/CT scan, which revealed a focal PSMA activity in the proximal left lateral penile margin. Although a subsequent ultrasound did not identify the abnormality, MRI pelvis revealed a 10-mm lesion in the left proximal corpus cavernosum. This lesion was consistent with metastatic acinar adenocarcinoma of the prostate on postresection histopathology. This unusual presentation of asymptomatic, histopathology-proven, penile solitary metastases was documented 3 years after robotic-assisted laparoscopic prostatectomy and pelvic external beam radiotherapy.

68 Ga-PSMA-11 PET/CT and 64 CuCl 2 PET/CT Help in Identifying Rare Metastatic Site of Penile Shaft in a Patient of Carcinoma Prostate

ABSTRACT

A 71-year-old man, presenting with complaints of burning sensation and pain during urination, finally diagnosed with prostate carcinoma. Ultrasonography of the abdomen and pelvis revealed prostatomegaly. Serum PSA level was elevated, and TRUS-guided biopsy demonstrated acinar adenocarcinoma (Gleason score: 5 + 4 = 9). 68 Ga-PSMA-11 PET/CT for initial staging showed PSMA-avid enlarged prostate, pelvic lymphadenopathy, and focal PSMA uptake in the left side of the shaft of the penis. The patient also underwent a 64 CuCl 2 PET/CT, which demonstrated similar findings of enlarged prostate and adenopathy with focally increased tracer uptake in the shaft of the penis coinciding with the lesion observed on 68 Ga-PSMA-11 PET/CT, thereby detecting a rare metastatic site from carcinoma prostate.

Penile metastasis from prostate cancer misdiagnosed as Peyronie disease: a case report

Introduction

Penile metastases from prostate cancer are rare, and patients’ prognosis and survival rates are low. Conservative treatment is usually recommended for such patients with an emphasis on improving their quality of life.

Aims

The aims were to raise awareness of penile metastasis from prostate cancer and Peyronie disease among physicians and other health care professionals, as well as to provide a useful experience for future diagnosis and treatment.

Methods

The current case report is based on patient self-report and a literature review. Written informed consent was obtained from the patient.

Results

We report the case of a 68-year-old man who was admitted with a complaint of urinary retention. Preoperative examination and ancillary tests showed a 2.0-cm-long hard nodule palpable on the dorsal aspect of the penile root, which was misdiagnosed as Peyronie disease. However, a biopsy of the penile scleroma was performed, and the final pathology finding confirmed the diagnosis of penile metastasis from prostate cancer. The patient opted for continuous androgen deprivation therapy (abiraterone) and systemic chemotherapy (docetaxel and cisplatin). He was treated for 2 cycles and had no specific discomfort during chemotherapy, except for significant gastrointestinal reactions, hypocellularity, and hair loss symptoms.

Conclusion

This report describes a rare case of penile metastasis from prostate cancer, which was initially misdiagnosed as Peyronie disease, indicating that clinicians need to improve their understanding and discrimination of this disease.

Isolated, PSMA-negative penile metastasis from castration resistant prostate adenocarcinoma, identified by FDG-PET

Penile metastases are a rare entity and are associated with widespread metastatic disease. It is associated with significant morbidity with a poor prognosis. There have been few case reports about metastatic prostate adenocarcinoma to the penis. Diagnosis is often clinical, however, the use of PSMA PET has a high sensitivity. We report the first case of metastatic castration resistant prostate cancer with an isolated penile metastatic site. This was not identified on conventional staging or PSMA PET, but using FDG PET. A radical penectomy was performed with ongoing survival.

Case Report: 18F-PSMA-1007 PET/CT Avid Solitary Penile Metastasis of Castration-Resistant Prostate Cancer With a PSA of 0.072 ng/ml

Penile metastasis of prostate cancer is rare, with a poor prognosis, and only a limited number of relevant cases have been reported so far. With the application of ¹⁸F-PSMA-1007 PET/CT, the biochemical recurrence of prostate cancer can be detected at an early stage for providing important evidence, facilitating clinical decision-making. Here, we have reported a case of solitary penile metastatic recurrence in the context of mild PSA progression (PSA: 0.072 ng/ml). This case highlights the preferable sensitivity of ¹⁸F-PSMA-1007 PET/CT imaging in prostate cancer.

Atypical Metastases in the Abdomen and Pelvis From Biochemically Recurrent Prostate Cancer: 11C-Choline PET/CT Imaging With Multimodality Correlation

PET imaging with targeted radiotracers has become integral for mapping the location and burden of recurrent disease in patients with biochemical recurrence (BCR) of prostate cancer (PCa). PET with 11C-choline is part of the National Comprehensive Cancer Network and European Association of Urology guidelines for evaluation of BCR. With advances in PET technology, increasing use of targeted radiotracers, and improved survival of patients with BCR due to novel therapeutics, atypical sites of metastases are being increasingly encountered, challenging the conventional view that PCa rarely metastasizes beyond bones or lymph nodes. We describe such atypical metastases in the abdomen and pelvis on 11C-choline PET (including in the liver, pancreas, genital tract, urinary tract, peritoneum, and abdominal wall, as well as perineural spread), presenting multimodality imaging features and relevant imaging pitfalls. Given atypical metastases' inconsistent relationship with serum PSA and non-specific presenting symptoms, they are often first detected on imaging. Awareness of their imaging features is important as their detection impacts clinical management, patient counseling, prognosis, and clinical trial eligibility. Such awareness is particularly critical as the role of radiologists in the imaging and management of BCR will continue to increase given the expanding regulatory approvals of other targeted and theranostic radiotracers.