Early penile metastasis from primary bladder cancer as the first systemic manifestation: a case report

Abstract

Metastatic involement of penis is an exceptionally rare condition. 77% of the metastases are originated from the pelvic region; prostate and bladder are the most frequent primary locations. Retrograde venous route, retrograde lymphatic route, arterial spread, direct extension, implantation and secondary to instrumentation are the mechanisms of metastasis. Approximately two thirds of all penile metastasis are detected at a mean time of 18 months after the detection of the primary tumor and the remaining one third is presented at the same time with primary tumor. Diagnosis is usually made by biopsy and also non invasive methods as MRI or colour-coded duplex ultrasonography. Treatment options in these patients are local excision, partial or complete penectomy, external beam radiation therapy and chemotheraphy. Despite these alternatives prognosis is usually poor.We present a case of urethelial carcinoma of the bladder and coincidental prostate adenocarcinoma with penile metastasis which is presented with priapism 6 months after radical cystectomy as the first systemic manifestation. We performed biopsy initially for staging and the patient underwent MRI showing the extension of the disease. The patient underwent radiotherapy of 56 gy and priapism partially resolved after the treatment. Chemotheraphy was also planned but the patient died 3 months following radiotheraphy.

Successful Treatment of Malignant Priapism by Radiotherapy: Report of a Case, Review of the Literature, and Treatment Recommendations

“…Similarly, it has been reported that complete relief pain and priapism can be achieved by locally administering 30Gy in 10 fractions in metastatic bladder urothelial carcinoma [21] and metastatic rectal adenocarcinoma [32] using the 3D conformal technique. On the contrary, priapism symptoms were only partially relieved in earlier case reports [20,28], even with a higher dose (56Gy) [20]. To reconcile the results, it is plausible that the modern conformal radiotherapy technique is better than the field-based technique in terms of ensuring coverage of target and avoiding hotspots or high doses to the organs at risk given the palliative nature of the treatment.…”

Relevance of computed tomography and magnetic resonance imaging for penile metastasis after prostatectomy: uncommon case report and brief review of the literature

“…Primary tumor generally involved the genitourinary tract (69%) followed by gastrointestinal cancer (19%). All described cases were associated with very poor prognosis—variable survival rates from 1 to 24 months—and in all these cases, autopsy has identified multiple coexistent sites of metastasis in the patients [5] , [6] , [7] . Only 2 articles from the recent literature have described a penile metastatic localization from osteosarcoma and cholangiocarcinoma [8] , [9] .…”

Efficacy and safety of gemcitabine monotherapy in an elderly patient with penile metastasis from bladder carcinoma: a case report

“…In the present case, the patient had a nonulcerative penile nodule without any overt symptoms. Penile metastases of UC are usually diagnosed by biopsy, and non-invasive methods, such as MRI or color-coded duplex ultrasonography, may be used for disease staging [20]. The optimal treatment for penile metastases requires a multidisciplinary approach that is correlated with the disease extent.…”