Blackwell Science, LtdOxford, UK IJU International Journal of Urology 0919-81722002 Blackwell Science Asia Pty Ltd 910October 2002 518 Penile metastasis of prostatic adenocarcinoma T aenkul et al. 10.1046/j.0919-8172.2002.00518.x Case Report597598BEES SGML
International Journal of Urology (2002) 9, 597–598
Case Report
Penile metastasis of prostatic adenocarcinoma . 1 . . . . . . TEMUÇIN S¸ENKUL,1 KENAN KARADEMI R, EMIR S¸ILIT,2 CÜNEYT IS¸ERI,1 . DOG˘AN ERDEN1 AND HÜSEYIN BALOG˘LU3 Departments of 1Urology, 2Radiology and 3Pathology, GATA Haydarpas¸a Training Hospital, Istanbul, Turkey Abstract
Prostatic carcinoma metastasizing to the penis is rare. A case of adenocarcinoma of the prostate with metastases to the penile shaft and glans penis is presented.
Key words
penile metastasis, prostatic adenocarcinoma.
Introduction Penile metastases are rare, despite the rich and complex vascularity of this organ. Such a metastasis is almost always a poor prognostic sign. We report an unusual presentation of metastatic prostatic carcinoma.
Case report A 76-year-old man was referred to a dermatology clinic complaining of a painful solitary lesion on his glans penis, which appeared about two weeks ago (Fig. 1). The patient had been in follow-up for his prostatic adenocarcinoma for 10 years. In 1991, he presented for low back pain, which was found to be due to multiple bone metastases. Digital rectal examination revealed a firm prostate and his serum prostate specific antigen (PSA) was 35 ng/mL. In his transrectal ultrasonograhy guided sextant biopsies, all of the cores contained Gleason 4 + 3 prostatic adenocarcinoma. The patient was orchidectomized and the PSA decreased to less than 4 ng/mL. The PSA levels remained in the normal limits for 2 years, then the patient did not follow his check-ups, until the appearance of his penile lesions. The patient referred to the urology clinic, and the PSA level was found to be higher than 70 ng/mL. The biopsy of his lesion revealed
Correspondence: Temuçin S¸enkul MD, GATA Haydarpas¸a Training Hospital, Department of Urology, 81327 Üsküdar/ . Istanbul, Turkey. Email:
[email protected] Received 25 September 2001; accepted 8 April 2002.
a poorly differentiated carcinoma, whose origin was proven to be prostate according to the immunohistochemical staining for PSA (Fig. 2). Irregular nodules were palpated on both corpus cavernosum and spongiosum, and the same findings were displayed on magnetic resonance imaging (Fig. 3). Having been diagnosed as metastatic prostatic carcinoma, the patient was treated with estramustine phosphate (280 mg, three times a day). The glanular lesion disappeared by the 30th day of the treatment, when the PSA level decreased to 29 ng/ mL. The corporal nodules persisted as also shown by penile ultrasonography. The follow-ups are not remarkable.
Discussion Widespread use of the PSA enables the detection of the prostatic adenocarcinoma in early stages. Unfortunately, prostatic carcinoma progresses to advanced disease in many patients despite various treatment options. Prostatic carcinoma generally metastases to regional lymph nodes and bones. Metastasis to corporal bodies and glans penis are exceptional and may present with palpable nodules in the penile shaft, but the chief complaints of the patients are reported to be the penile tumor, pain at erection and dysuria.1,2 According to the largest series in the literature, 69% of 110 metastatic penile tumors originated from a genitourinary cancer, and prostate cancer was the primary in 25 of these metastases.1 It is of interest that the patient presented with painful nodular lesions on the glans penis and that he was referred to a dermatology clinic because of the similarity of glanular lesions to a chancre.
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Fig. 1 Chancroid lesion on glans penis.
Fig. 3 Extension of prostatic adenocarcinoma to penis on magnetic resonance imaging (arrows indicate the lesions on corpus cavernosum and spongiosum).
successfully used for management of penile metastasis.4 The patient was administered oral estramustine phosphate. Then the PSA level dramatically decreased and the glanular lesions disappeared. Treatment was concluded as successful but penile ultrasonography detected persistent lesions. However, the follow-up is not long enough for any interpretation, but it is known that survival of patients with metastatic penile cancer from prostatic cancer is very poor. In the evaluation of 25 patients with penile metastasis from prostatic cancer in Japan, 11 patients (41%) died of cancer within 6 months of the diagnosis.1 In conclusion, metastatic prostatic cancer presents with various signs and symptoms and one should keep in mind the possibility of the glans site for metastasis. Fig. 2 Histopathologic appearance of the lesion on glans penis.
References Abeshouse had reported the possible mechanisms of metastasis to the penis from prostatic cancer: direct invasion, implantation, dissemination through the blood stream and dissemination through the lymphatic duct.3 In the present case, prostate cancer may have followed any of the pathways cited above. In a recent and large Japanese study, the principal treatments for metastatic penile cancer are reported as chemotherapy, radiation therapy and total partial penectomy.1 Mitomycin or estramustine phosphate has been
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Kotake Y, Gohji K, Suzuki T et al. Metastases to the penis from carcinoma of the prostate. Int. J. Urol. 2001; 8: 83–6. Mehta SS, Lee JA, Chapple CR. Urethral metastasis after transurethral resection of a malignant prostate. BJU Int. 2001; 87 (1): 6–8. Abeshouse BS, Abeshouse GA. Metastatic tumors of the penis: a review of the literature and a report of two cases. J. Urol. 1961; 86: 99–112. Powell FC, Venencie PC, Winkelmann RK. Metastatic prostate carcinoma manifesting as penile nodules. Arch. Dermatol. 1984; 120: 1604–6.
