Penile metastasis of prostatic adenocarcinoma: Report of two cases and review of literature

Solitary Prostate Carcinoma Penile Metastasis on 18 F-DCFPyL PET/CT

ABSTRACT

An 83-year-old man was referred for an 18 F-DCFPyL PET scan for the evaluation of rising serum prostate-specific antigen level on the background of previous radical prostatectomy for prostate adenocarcinoma and urinary outflow tract obstruction requiring in-dwelling catheter insertion. The PET scan demonstrated focal increased activity (SUV max , 35.7) at the dorsal aspect of the mid penile shaft, with histopathological confirmation of penile metastasis from primary prostate cancer.

Symptom palliation with QUAD Shot radiation therapy to penile metastasis derived from descending colon cancer: a case report

A 54-year-old man was diagnosed with descending colon cancer with metastases in the liver, para-aortic lymph nodes, and penis, and chemotherapy was introduced after construction of a colostomy. The patient reported only mild penile pain at the time of diagnosis; however, the pain gradually worsened and interfered with his daily life. Opioids did not provide sufficient analgesia, and the patient developed dysuria and priapism. Through construction of a cystostomy, palliative radiotherapy with QUAD Shot regimen (14 Gy in 4 fractions twice-daily on 2 days repeated every 4 weeks) to the penile metastasis was started for pain relief and tumor shrinkage. The radiation rapidly improved the penile symptoms, enabling opioid reduction and cystostomy removal. The patient remained pain-free and able to urinate on his own until his death. Metastatic penile tumors are rare, especially those derived from colon cancer. Penile metastases occur mainly in the late stages of cancer and may impair the patient's quality of life. In such cases, palliative radiotherapy, especially with QUAD Shot regimen, is useful with short treatment time, durable symptom control, and little adverse effect, maintaining quality of life.

Metachronous isolated penile metastasis from sigmoid colon adenocarcinoma: A case report

BACKGROUND

Sigmoid colon adenocarcinoma has a high incidence among gastrointestinal tumors, and it very rarely metastasizes to the penis. The literature reports that the prognosis after penile metastasis is generally poor, with a median survival of about 9 mo. Metachronous isolated metastasis to the penis originating from sigmoid colon adenocarcinoma has not been reported so far. Here, we report a case of sigmoid colon adenocarcinoma with isolated penile metastasis occurring 2 years after surgery. The mass was pathologically confirmed as metastatic adenocarcinoma, and oral chemotherapy with capecitabine was given after surgery. The tumor did not recur during the 2-year follow-up period.

CASE SUMMARY

A 79-year-old man presented to the urology department with "a mass located at the root of the penis since 1 mo". Enhanced computed tomography (CT) examination suggested a 12 mm × 10 mm × 9 mm nodule at the root of the right penile corpus cavernosum. Cranial, pulmonary, and abdominal CT; and bone scan did not show any tumorigenic lesions. The carcinoembryonic antigen (CEA) level was slightly elevated (6.01 ng/mL, reference value 0-5 ng/mL). The patient had undergone laparoscopic radical sigmoidectomy for sigmoid colon cancer 2 years ago. The postoperative pathology showed moderately differentiated adenocarcinoma of the sigmoid colon, and the stage was PT2N0M0. The penile mass was removed under general anesthesia. The postoperative pathology showed adenocarcinoma, and immunohistochemistry showed CDX2(+), CK20(+), and Villin(+). Based on the medical history, he was diagnosed with penile metastasis from sigmoid colon adenocarcinoma. The CEA level returned to normal (3.34 ng/mL) 4 d after surgery. Oral chemotherapy with capecitabine was given subsequently, and tumor recurrence was not found during the 2-year follow-up period.

CONCLUSION

To our knowledge, this is a rare case of metachronous isolated penile metastasis from sigmoid colon adenocarcinoma. The penis is a potential site of metastasis of colon adenocarcinoma, and the possibility of metastasis should be considered in patients with a history of colon cancer who present with a penile mass. Solitary penile metastasis can be removed surgically, in combination with chemotherapy, and it may have good long-term outcomes.

Brachytherapy for oligometastatic prostate cancer to the penis

The origin of penile metastases is in 70% of cases from primary pelvic cancers (genitourinary and recto-sigmoid primary tumors). The prognosis is poor and it is often associated with synchronous bone metastases at the time of diagnosis. We present the case of a 61-year-old patient who developed a penile induration 7 years after radical prostatectomy followed by adjuvant external beam radiation therapy for high-risk prostatic adenocarcinoma. Biopsies confirmed the metastatic localization and a detailed assessment failed to find any further remote lesions. Faced with this penile oligometastatic prostate cancer, we proposed an ablative treatment based on interstitial multi-catheter high-dose rate brachytherapy. At the six-month follow-up, clinical examination and ⁶⁸Ga-PSMA-11-PET confirmed a complete response of the penile tumor without new lesion at a distance.

Case Report: 18F-PSMA PET/CT May Improve the Clinical Management of Penile Metastases From Prostate Cancer

Metastases from prostate cancer (PCa) to the penis are extremely rare, and few case reports exist in the literature. Because most patients usually present with multiple distant metastases at diagnosis, the prognosis is very poor. With the wide application of prostate-specific membrane antigen (PSMA) PET/CT, penile metastases may be detected at an early stage. Thus, questions regarding whether early diagnosis and precise treatment will equate to a survival advantage have recently been raised. In the present study, we reported 3 cases of penile metastasis from castration-resistant PCa. Moreover, a patient with asymptomatic penile metastases was diagnosed by ¹⁸F-PSMA PET/CT followed by lesion biopsy, and the prognosis was very well, despite with an aggressive pathological feature and low treatment intensity. In addition, we performed a literature review and found 62.5% of asymptomatic penile metastases were diagnosed by PSMA PET/CT in past seven years. Thus, we believe that PSMA PET/CT may detect more asymptomatic penile metastases in future, which led to early diagnosis, treatment and survival advantage.

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

Penile metastasis of malignant tumors is a very rare condition, often occurring as a part of systemic metastases, and is therefore associated with a poor prognosis. Although there have been reports of magnetic resonance imaging findings of penile metastasis, longitudinal imaging changes have not been presented previously. We report a case of a 80-year-old male patient with penile metastasis from prostate adenocarcinoma. First magnetic resonance imaging demonstrated multiple penile nodules in the left corpus cavernosum corpora cavernosa, and these nodules were fused and across the septum of the penis, forming an enlarged, diffusely spreading mass on the follow-up exam 5 years later. In this case, a longitudinal evaluation of magnetic resonance imaging demonstrated the course of the extension of the rare penile metastasis.

Malignant priapism: Review of the report in three decades

Introduction:

Priapism is one of the few critical male urological emergencies. There are two main types of priapism, low flow/venous and high flow/arterial priapism. Malignant priapism is a rare subtype of low flow priapism usually secondary to pelvic malignancy, but other extra-pelvic primary cancers cannot be completely excluded.

Aim:

To assess and highlight the poor prognosis of malignant priapism, with a view to directing management towards both symptomatic relief and improving patients’ quality of life.

Method:

All reports of malignant priapism between 1998 and 2018 were searched and assessed focusing on the primary cancer, duration of complaint, associated symptoms, method of management and prognosis.

Conclusion:

Malignant priapism is a rare form of ischaemic priapism, resistant to successful therapies utilized in the management of other forms of ischaemic priapism. Urological cancers are the most common primaries implicated with the most commonly associated symptoms being pain and urinary symptoms. In the absence of any evidence based guidelines and reliably successful treatment options, clinicians should aim to employ supportive treatment strategies including adequate analgesia.

Level of evidence:

level4

Prostate penile metastasis: Incidence and imaging pattern on 68 Ga-PSMA PET/CT

BACKGROUND

Prostate cancer commonly metastasises to bone and regional lymphatics and more rarely to locations such as the brain, skin and penis. Gallium-68 prostate-specific membrane antigen (⁶⁸ Ga-PSMA) positron emission tomography/computed tomography (PET/CT) has widely become the routine imaging modality for prostate cancer staging and re-staging in Australia. The aim of this study was to retrospectively review all ⁶⁸ Ga-PSMA PET/CT examinations performed to date at our institution to determine the frequency of penile metastases.

METHODS

A total of 4860 ⁶⁸ Ga-PSMA PET/CT examinations were performed between 16/07/2014 and 31/10/2019. Radiology reports for each examination were filtered to identify those with the words 'penis' or 'penile'. Once identified, relevant reports and images were individually reviewed to confirm the presence of a PSMA-avid penile lesion.

RESULTS

The incidence of penile metastasis of prostate cancer observed in this study was 0.1% with six examinations identified as having PSMA-avid penile lesions in five prostate cancer patients (age range: 71-88 years). The patients had a 1-8 year history of prostate cancer with varying severity of disease. Appearance of PSMA-avidity varied between single focal lesion, multiple focal lesions and diffuse lesion.

CONCLUSIONS

An incidence of 0.1% in our study confirms the rarity of penile metastases of prostate cancer. Although rare, identification of prostate cancer penile metastases is important for appropriate treatment management and symptom-relief.

Solitary metastasis to the penis from prostate adenocarcinoma - a case report

Penile metastasis from prostate adenocarcinoma is rare and the disease is usually disseminated at presentation. We present a case of an 83-year-old man with solitary metastasis to the penis from prostate adenocarcinoma. The clinical presentation and imaging features of penile metastasis from prostate cancer and the other primary penile tumors are discussed.

Prognosis of men with penile metastasis and malignant priapism: a systematic review

Introduction: Metastases to the penis are rare, but can have severe consequences. The aim of this study was to systematically review the literature in order to gain more information on the presentation and prognosis of this metastatic disease. We reviewed the literature relating to all case reports, series and reviews about penile metastasis, from 2003 to 2013, through a Medline search. We identified 63 articles and 69 patients. Metastases were located on the root (38.8%), the shaft (38.8%) or the glans (22.2%) of the penis. The diagnosis of penile metastasis was made after the primary cancer had been diagnosed. The most common presentation was a single small penile nodule. Ten patients reported priapism. The median survival time after diagnosis of penile metastasis was 10 months (range 6-18 months). A Kaplan-Meier analysis has shown that the patients presenting with priapism and those with metastases from non-urologic tumors have a significantly worse prognosis (age adjusted Log Rank: p=0.037 for priapism vs. no priapism and p=0.045 for urologic vs. non urologic). There are prognostic differences based on the presentation of penile metastases. Survival is substantial and treatment should therefore take into account symptoms improvement and quality of life.

Evaluation of the response chemotherapy for penile metastasis of bladder cancer using 18F-fluorodeoxyglucose-PET/CT

BACKGROUND

Metachronous penile metastasis of bladder cancer occurs very rarely. The clinical management of the disease involves complex problems, and the disease is associated with a poor prognosis. The common mode of spread to the penis is by the retrograde venous route.

PATIENTS AND METHODS

A 68-year-old patient who was diagnosed with invasive bladder cancer underwent (18)F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) for staging purposes. An 18mm intracavernosal metastatic lesion was detected in the penis with a SUVmax of 12.9.

RESULTS

After the administration of gemcitabine+cisplatin-based chemotherapy, remission was observed in the metastatic penile lesion according to EORTC criteria (12mm, SUVmax: 9), and second line chemotherapy program was planned.

CONCLUSION

Penile metastasis from bladder cancer is an indicator of poor prognosis. The patients with penile metastasis poorly respond to therapy, despite the use of effective systemic chemotherapy. The researchers of the current study achieved a partial response to chemotherapy in the current case of penile metastasis. The disease-specific life expectancy is less than one year in these patients. Radical ablative surgery does not contribute to survival; however, it offers an alternative method in symptomatic patients.

Penile Metastases of Recurrent Prostatic Adenocarcinoma without PSA Level Increase: A Case Report

We report a case of penile metastases from recurrent prostatic adenocarcinoma that was the first sign of a widespread metastatic disease in the absence of any increase in prostate-specific antigen (PSA) level. In April 2011, an 80-year-old man presented to our Radiotherapy Unit with multiple palpable hard nodules in the penis, dysuria, and moderate perineal pain, 7 years after he had received radiotherapy for prostate cancer. Nodules in the penis had appeared in February 2011. The ultrasound and magnetic resonance (MR) imaging suggested the diagnosis of multiple penile metastases. A total body computed tomography scan revealed a systemic spread of the disease, with multiple metastases in the liver, bones, and lungs. PSA level was 0.126 ng/ml. A fine needle aspiration biopsy of the liver lesion was undertaken, and the histopathologic examination revealed the prostatic origin of the metastases, so androgen deprivation therapy was started. The diagnosis of metastases should be considered in a patient with prior history of prostate malignancies presenting with solid nodules in the penis, even if the PSA level is low.

A review of penile metastasis

Penile cancer as primary disease is relatively rare in developed countries. The penis is a rare site of metastases in spite of its rich vascularization. Approximately 500 cases have been reported in the literature; almost 70% of primary lesions are of pelvic origin (from genitourinary or recto-sigmoid primary tumors). We describe a case of penile metastasis from lung cancer. The rarity of the event prompted us to also explore related reviews and discuss the incidence, physiopathology, diagnosis and therapy of penile secondary cancer.

A presentation of glandular penile metastases from prostate adenocarcinoma

Secondary tumours of the penis are rare; they most commonly arise from the prostate and the bladder. These lesions are often associated with disseminated malignancy and have a poor prognosis, with a 6-month mortality of up to 80% reported. Penile metastases have a variety of clinical manifestations including incidental penile nodules, cutaneous findings, urinary symptoms, pain and malignant priapism. Treatment options are mainly targeted at improving the patients' quality of life and are tailored to their clinical condition, but are primarily palliative. This study reports a case of a 92-year-old man with a presentation of glandular penile metastases from prostate adenocarcinoma treated conservatively.

Malignant priapism secondary to metastatic prostate cancer: a case report and review of literature

Penile metastasis of cancers from other primary sites is a rare phenomenon that infrequently manifests as malignant priapism. We outline a case of an 84-year-old patient who presented with a 3-month history of painful priapism after radiation therapy for prostate adenocarcinoma. The patient underwent surgical penile exploration and cavernosal biopsy that revealed poorly differentiated cells suggestive of prostate cancer. Postoperative imaging demonstrated extensive regional and distal metastases. A review of the literature on penile metastases returned approximately 400 published cases, with priapism being the initial presentation in 20% to 50% of cases. Regardless of site of origin or subsequent management, most cases have shown very poor prognosis.

[Rare locations of metastases from prostate cancer]

The bone tissue is the most frequent site for prostate carcinoma metastasis. Nevertheless many other areas have also been described. Using Pubmed and Cochrane the most exhaustive research possible has been carried out to list these secondary prostate carcinoma lesions.

Penile metastasis from a T1b prostate carcinoma

BACKGROUND

Penile metastasis from incidental prostate carcinoma has not been described to date.

CASE REPORT

The case of a 72-year-old man affected by penile metastasis from incidental prostate carcinoma is described. In March 1998, the patient underwent prostate surgery for lower urinary tract symptoms related to benign prostatic obstruction. Histological examination revealed an incidental adenocarcinoma of the prostate. The pre-operative prostate-specific antigen (PSA) value was 3.6 ng/ml. A prostate biopsy in the peripheral prostate lobes was negative. PSA progressively rose to 8 ng/ml. The prostate biopsy was repeated and was still negative. The patient was subjected to radiotherapy, as a result of which his PSA fell to 0.7 ng/ml. 4 years after prostatectomy, the PSA rose again and the patient underwent hormonal therapy. The PSA fell to < 0.001 ng/ml. In May 2004, the patient reported a painful, erythematous nodule on his penis glans. Surgical biopsy showed a metastasis from prostate adenocarcinoma and he underwent partial penectomy. Due to disease progression, the patient underwent medical therapy. PSA and testosterone were always at minimum levels. 20 months later the patient died.

CONCLUSION

We underline the uncertainty of the biological behaviour and optimal management of incidentally identified prostate carcinoma. In addition, we highlight that biological and clinical progression could be the consequence of inadequate treatment recommendations.

Penile metastasis of cutaneous malignant melanoma: a true hematogenous spread?: Case report and review of the literature

Penile involvement has been implicated as a metastatic site in several tumors; approximately 300 cases have been reported. Of these, only two cases showed cutaneous melanoma as the primary site. Our patient presented with a painless mass on the penile shaft together with other distant metastases. A magnetic resonance image demonstrated two sites of deposit in the subcutaneous tissue on the radix penis, and fine needle aspiration cytology of the mass confirmed the presence of melanoma cells. The patient died of systemic disease without any further treatment for penile involvement. This unusual involvement is presented with a review of the related literature.