Malignant Priapism in a Patient with Metastatic Prostate Adenocarcinoma

Abstract

Metastases to the penis due to a primary carcinoma ofthe prostate are rare. In approximately half of the patients, malignant priapism is the main symptom. This study reports on a case of malignant priapism, caused by a direct and metastatic infiltration of the corpora cavernosa by a prostatic adenocarcinoma. Sonography gave hints, the magnetic resonance imaging verified the infiltration and aspiration cytology verified the carcinoma. Hemodynamics, evaluated by Doppler sonography, and intracavemosal blood gas analysis demonstrated a mixed high-low priapism without need of therapy.

Malignant priapism secondary to adenocarcinoma of the prostate

“…Other routes of malignant spread to the penis include retrograde lymphatic flow, arterial spread, direct extension from aggressive low-lying rectal cancers and implantation secondary to surgical instrumentation 6 9. The corpora cavernosa are the most frequently reported sites of penile metastasis 5…”

“…Penile metastasis most commonly presents as multiple infiltrative lesions, indurated nodules (60%) or in episodes of priapism (40%) 4–6 9…”

Successful treatment of primary malignant lymphoma of the penis by organ-preserving rituximab-containing chemotherapy

“…In addition, the priapism of the penis seemed to occur because of tumor invasion to the corpora cavernosa. The pathogenesis of the priapism is thought to be secondary to tumor infiltration of the corpora cavernosa which causes stasis or thrombosis of the venous system and consequent irritation of the neural pathways and an erect penis [6]. The tumor cells infiltrate to the corpora cavernosa through retrograde venous and lymphatic routes, as arterial embolism, or by direct invasion.…”

Penile Metastasis from Other Malignancies

“…Then, several investigators described the possible routes by which tumor spreads to the penis, which is still controversial and can be summarized as follows: local direct extension, arterial embolism, retrograde venous, lymphatic or instrumental spread [1][2][3][4][5][6][7]9] . Without doubt, more than one route of dissemination may occur in a single case.…”