A 63-year-old male presented with complaints of an enlarging left supraclavicular mass and weight loss. Computed tomography demonstrated a large retroperitoneal mass causing displacement of the adjacent organs, and moderate left hydroureteronephrosis. Multiple pulmonary nodules, lytic spinal lesions, and generalized lymphadenopathy including the left supraclavicular region were seen. Serum prostate-specific antigen level was 2064.0 ng/mL. Digital rectal exam revealed an enlarged prostate without nodularity. Biopsy of the supraclavicular node demonstrated prostatic adenocarcinoma. The diagnosis of lymphoma may be initially suggested, however, prostatic origin should be considered even when the prostate exam is not grossly abnormal.

Squamous cell carcinoma of the penis is a rare malignancy among men in North America and Europe with an incidence of <1 per 100,00 men. Of all genitourinary cancers, penile carcinoma has the potential to jeopardize sexual function the most. The treatment modalities of penile carcinoma span the gamut from organ-sparing treatments such as topical therapy, laser therapy, radiotherapy, glansectomy, widelocal excision and partial or total penectomy. There is a relative paucity of data in the medical literature describing the impact of penile cancer treatment on sexual function. The majority of available studies use retrospective data from small samples utilizing heterogeneous study tools such as patient interviews and non-validated questionnaires. The most commonly used validated instrument to evaluate sexual outcomes is the International Index of Erectile Function Questionnaire (IIEF), but is limited in that it does not assess patients who perform self-stimulation or achieve sexual stimulation by any means other than penetrative intercourse. Though advances in clinical research continue; large, well-designed comparative studies using validated instruments are elusive. The sexual outcomes after penile cancer are reviewed from the available published data to better assist the patient and the treating physician with medical decision making. With a detailed assessment of sexual outcomes, the physician is better equipped in providing patient centered care to achieve outcomes meaningful for each patient.

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INTRODUCTION AND OBJECTIVE: No large-scale studies have specifically looked at the association between traumatic brain injury (TBI) and hypogonadism in the active duty military population. This gap is important given the high prevalence of TBI among active duty military members. Since 2000, more than 380,000 incident diagnoses of TBI have been reported among US military veterans with estimated rates of 11-23% among deployed service members. Given this high prevalence it would be of significant value to further understand the downstream consequences of what has been called the "signature injury" of recent conflicts.METHODS: We conducted a population-based case-control study to estimate the association between hypogonadism and TBI. Our population consisted of active duty males in service between 2014 and 2018. Cases included all males with an incident diagnosis of hypogonadism who were also dispensed a prescription for testosterone or clomiphene citrate within one year of the diagnosis. Three controls were matched to each case and were selected from active duty males who were in the same age quinquennia as the case when the hypogonadism diagnosis was made and who had no prior diagnosis or treatment for hypogonadism. Controls were also matched to cases by military branch of service and race. Conditional logistic regression was performed to ascertain the association of TBI and hypogonadism, controlling for the possible effects of TBI severity, year of TBI, time from first TBI to diagnosis of hypogonadism, marital status, number of deployments, and military occupation.RESULTS: In total, 5,114 cases and 15,342 controls were identified. After adjusting for the effects of covariates, we found that active duty males with a history of TBI experienced more than twice the odds of developing hypogonadism than those active duty males with no prior TBI exposure (OR 2.3; 95% CI: 2.1, 2.6). When covariate interactions were included in the logistic model, a statistically significant decreasing effect of TBI was seen with increasing age (2.5, 2.1, and 1.3 for age groups <25, 25-34, and 35þ, respectively).CONCLUSIONS: In this large-scale study we found that active duty males with a history of TBI, when compared with healthy counterparts, were more than two times as likely to have been diagnosed with hypogonadism. These concerning results should prompt all clinicians, particularly those within the military, to consider hypogonadism among men with any prior TBI.