Malignant Priapism as a Result of Metastatic Thyroid Cancer: A Hard Reality

Metastasis to the penis is an extremely rare entity. Malignant priapism is defined as a persistent, nonsexual erection that is refractory to pharmacologic treatment, corporal aspiration, and surgical shunts. Furthermore, it is typically a hallmark of an advanced cancer that has metastasized, most commonly from regional organs like the prostate or bladder. We report an unusual case of malignant priapism in the setting of metastatic follicular thyroid carcinoma. To date, this is the second reported case of penile metastasis due to thyroid carcinoma and the first incidence of priapism secondary to follicular thyroid carcinoma metastasis.

Case Report: 18F-PSMA PET/CT May Improve the Clinical Management of Penile Metastases From Prostate Cancer

Metastases from prostate cancer (PCa) to the penis are extremely rare, and few case reports exist in the literature. Because most patients usually present with multiple distant metastases at diagnosis, the prognosis is very poor. With the wide application of prostate-specific membrane antigen (PSMA) PET/CT, penile metastases may be detected at an early stage. Thus, questions regarding whether early diagnosis and precise treatment will equate to a survival advantage have recently been raised. In the present study, we reported 3 cases of penile metastasis from castration-resistant PCa. Moreover, a patient with asymptomatic penile metastases was diagnosed by 18F-PSMA PET/CT followed by lesion biopsy, and the prognosis was very well, despite with an aggressive pathological feature and low treatment intensity. In addition, we performed a literature review and found 62.5% of asymptomatic penile metastases were diagnosed by PSMA PET/CT in past seven years. Thus, we believe that PSMA PET/CT may detect more asymptomatic penile metastases in future, which led to early diagnosis, treatment and survival advantage.

Early penile-only metastasis of urothelial bladder carcinoma

Penile metastasis rarely occurs as a unique and early distant recurrence of urothelial bladder carcinoma. A 77-year-old male underwent a radical cystoprostatecomy for a pT3a urothelial bladder cancer. Preoperative imaging workup concluded to a disease confined to the bladder. The patient consulted 5 months later for a penile induration. Computed tomography imaging revealed a suspicious penile nodule with no other nodal or visceral lesion. Total penectomy after a confirmatory biopsy confirmed the infiltration of the corpora cavernosa, the corpus spongiosum and the urethra by a urothelial metastasis of bladder cancer. Distant recurrences after radical surgery for locally advanced bladder cancer may occur as a unique early metastasis located to the penis.