- Case report
- Open Access
Penile metastasis of prostatic adenocarcinoma: Report of two cases and review of literature
© Philip and Mathew; licensee BioMed Central Ltd. 2003
Received: 27 July 2003
Accepted: 14 September 2003
Published: 14 September 2003
Carcinoma of the prostate metastasising to the penis is rare. These patients have a poor prognosis receiving various treatment modalities.
Two such patients are discussed here having received differing therapeutic regimes, pointing out the necessity for standardised palliative treatment rather than radical therapy.
Management of patients with penile metastases from carcinoma of the prostate should emphasise improving quality of life with palliative treatment rather than radical therapy
Metastasis to the penis is rare, despite rich vascularisation and complex circulation. These most commonly arise from the prostate and the bladder [1, 2]. It is a debilitating near terminal condition at presentation with a dismal prognosis. Conservative management is generally advocated with emphasis on improvement of quality of life. Therapeutic modalities used include radical penile amputation and radical radiotherapy. We discuss two patients who underwent differing treatment; the presenting features and symptomatology of all other cases reported in the literature have been reviewed.
Review of literature
Ninety-eight cases of penile metastases from prostate cancer were identified in the literature [3–10]. Patients were between 42 to 93 years (average 70 years). Urinary symptoms were noted in 28 patients, varying in severity from urethral bleeding to complete urinary retention. Priapism was reported in half the patients, ten of whom also had urinary retention. In 16 patients, the presenting symptom was penile pain; seven of whom had palpable penile nodules. Of 75 patients, metastases was restricted to the corpora cavernosa in 32 patients, glans penis in 12, urethra in four, skin/prepuce in four and corpus spongiosum in three and 20 having multiple involved areas. Biopsy was the mainstay of diagnosis in all the patients with three having additional cystoscopies. 33 patients underwent surgery such as penile amputation, cystostomy and bilateral orchidectomy. Fifteen patients each received radiation and hormonal treatment. These patients had a poor prognosis with survival documented at between 10 days and 84 months, with an average of 6 months, from presentation.
Metastatic spread from the prostate to the penis occurs by several routes [7, 10], retrograde venous or lymphatic spread, and direct extension are the commonest mechanisms. The most reliable diagnostic modality remains the needle core biopsy; this allows for histological and immunological confirmation of metastatic spread, and evaluation of extent of invasion . Treatment options depend on the general condition of the patient, site and extent of the primary tumour, presence of metastases, and symptomatology. The treatment options available include local excision of the tumour, radiation therapy, bilateral orchidectomy, additional hormonal and/or chemotherapy and, partial or total amputation of the penis. In patients who present with urinary tract outflow obstruction, procedures such as cystostomy or suprapubic catheterisation are of palliative value . Amputation of the penis with urethrostomy formation is to be considered in patients with ulceration, irritating secretion and intractable penile pain for symptom control. In one of our cases treatment followed palliative lines but in the other, subtotal penectomy for severe intractable penile pain, resulted in immediate pain relief and marked improvement in quality of life. Emphasis should be on palliative treatment and improving quality of life in view of the poor prognosis and a 6-month mortality of 80%. Surgery could be a therapeutic option, but only in patients attended with severe intractable pain.
We would like to acknowledge the invaluable advice and assistance of Mr David Vinnell and Mrs Tracey Smyth in preparing the microphotographs in this manuscript
- Tu SM, Reyes A, Maa A, Bhowmick D, Pisters LL, Pettaway CA, Lin SH, Troncoso P, Logothetis CJ: Prostate carcinoma with testicular or penile metastases. Clinical, pathologic, and immunohistochemical features. Cancer. 2002, 94: 2610-2617. 10.1002/cncr.10546.View ArticlePubMedGoogle Scholar
- Haddad FS, Manne RK: Prostatic tumors with penile secondaries: review of the literature with a case report. Urol Int. 1986, 41: 465-470.View ArticlePubMedGoogle Scholar
- Senkul T, Karademir K, Silit E, Iseri C, Erden D, Baloglu H: Penile metastasis of prostate adenocarcinoma. Int J Urol. 2002, 9: 597-598. 10.1046/j.1442-2042.2002.00518.x.View ArticlePubMedGoogle Scholar
- Geetha G, Nagarajan V, Tulasi NR, Nagarajan M: Carcinoma prostate with penile metastases. A case report. Indian J Cancer. 2002, 39: 73-74.PubMedGoogle Scholar
- Chan PT, Begin LR, Arnold D, Jacobson SA, Corcos J, Brock GB: Priapism secondary to penile metastasis: A report of two cases and a review of literature. J Surg Oncol. 1998, 68: 51-59. 10.1002/(SICI)1096-9098(199805)68:1<51::AID-JSO11>3.0.CO;2-U.View ArticlePubMedGoogle Scholar
- Buchholz NP, Moch H, Feichter GE, Schmid HP, Mihatsch MJ: Clinical and pathological features of highly malignant prostatic carcinomas with metastases to the penis. Urol Int. 1994, 53: 135-138.View ArticlePubMedGoogle Scholar
- Osther PJ, Lontoft E: Metastasis to the penis: case reports and review of the literature. Int Urol Nephrol. 1991, 23: 161-167.View ArticlePubMedGoogle Scholar
- Savion M, Livne PM, Mor C, Servadio C: Mixed carcinoma of the prostate with penile metastases and priapism. Eur Urol. 1987, 13: 351-352.PubMedGoogle Scholar
- Patel NP, Ward JN: Cancer of the prostate metastatic to prepuce and glans. Urology. 1978, 11: 269-270.View ArticlePubMedGoogle Scholar
- Hamm FC, Weinberg SR: Secondary malignant infiltration of the penis: report of four cases, two with surgical treatment for palliation. J Urol. 1955, 73: 349-354.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.