Metastasis to the Glans Penis: An Unusual Site of Rectal Cancer Recurrence

Abstract

RESUMOA doença secundária do pénis é uma situação clínica frequentemente associada a doença disseminada e as localizações mais comuns são os órgãos genito-urinários. O prognóstico é mau e as opções de tratamento incluem: penectomia; excisão local; radioterapia; quimioterapia; terapêutica de suporte. Apesar das várias terapêuticas existentes, nenhuma na literatura é apontada como superior às restantes. Os autores documentam o caso de um doente de 66 anos com metástase da glande peniana em contexto de adenocarcinoma do recto, diagnosticada dois anos após o tratamento da doença primária. O doente foi submetido a tratamento paliativo com radio-quimioterapia e permanece assintomático e livre de doença após um ano de seguimento. O follow-up apertado dos doentes com neoplasia do recto é mandatório. A radio-quimioterapia é uma abordagem válida, com bom controlo da doença e melhoria sintomática. Palavras-chave: Metástases; Neoplasias do Pénis/secundária; Neoplasias do Recto; Radioterapia. ABSTRACTSecondary malignancy of the penis is a rare clinical condition, often associated with disseminated genitourinary malignancies. The prognosis is poor and the treatment options include penectomy, local surgical excision, radiation therapy, chemotherapy and supportive therapy. Neither of these therapeutic options lead to superior treatment outcomes in the literature. The authors report the case of a 66 year-old man with a metastasis to the glans penis from a rectal adenocarcinoma, diagnosed two years after radical treatment for primary disease. The patient underwent palliative treatment with radiotherapy and chemotherapy, remaining asymptomatic and disease-free at one year follow-up. Close follow-up of patients with history of rectal adenocarcinoma is very important. Radiochemotherapy is a feasible and effective therapeutic option for penile metastasis, addressing both disease control and symptomatic improvement.

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

“…Local symptom control was achieved by administering 35Gy in 14 fractions using the 3D conformal technique [ 12 ] to the penis in one case and 40Gy in the other report (fractionation and technique were not described) [ 13 ]. 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 ].…”

Radiotherapy is effective in the management of rare penile metastases: Two case reports

“…More recently, a 3DCRT treatment for a total dose of 30 Gy in 10 fractions was used in association with capecitabine in a penile localization from rectal cancer, with a complete response consisting in a resolution of the penile lesion [10]. In another experience from 2015, a radiotherapy course of 30 Gy in 10 fractions was delivered with adjuvant intent after circumcision and modified glansectomy to prevent local recurrence in rectal adenocarcinoma histology proven metastasis: despite patient poor outcome because of overall burden of disease, six months after palliative treatment no local recurrence was noted [11]. Masbridge et al reported the early detection of a case of penile metastasis from prostate cancer thanks to the use of PSMA-PET/CT [12].…”

An overview of the diagnoses and treatments for penile cancer

“…It is, however, important to be aware that, although the appearance of penile cancer is clear in the majority of cases, there are some rare alternative presentations. Penile metastasis has been reported from sites such as bladder (Valsero et al, 2013), prostate (Sánchez et al, 2011) and rectum (Nunes et al, 2015). Additionally, inflammatory lesions can occasionally mimic the appearance of a penile cancer (Alnajjar et al, 2016).…”