A Rare Complication of Prostate Cancer: Penile Metastasis and Radical Penectomy
A 66-year-old man with a three-year history of prostate cancer underwent a total penectomy, a surgical removal of the penis, due to the rare complication of penile metastasis. This case, documented in the journal Urology Case Reports, highlights an exceedingly rare occurrence where prostate cancer spreads to the penis, typically resulting in a poor prognosis and short survival time. The patient initially presented with oligometastatic prostate cancer, meaning the cancer had spread to limited sites beyond the prostate. Two lesions were found in his spine and treated with radiotherapy and androgen deprivation therapy (ADT).
During a routine follow-up, the patient reported pain and hardening of the skin in his penis. These symptoms worsened over time, including difficulty retracting his foreskin. A physical examination revealed a one-centimeter mass on the tip of his penis, and further tests confirmed an enlarged prostate. Initially, doctors suspected squamous cell carcinoma (SCC), a type of skin cancer. However, a penile biopsy revealed that the prostate cancer had metastasized to the penis, affecting both the tip and the erectile tissue. Further investigation unveiled another tumor in the patient’s shinbone, also attributed to prostate cancer spread.
Prostate cancer is a common malignancy affecting one in eight men in the UK, with higher risks for those over 50, black men, and individuals with a family history of the disease. While many cases of prostate cancer are slow-growing and require no treatment, some can spread to other parts of the body. Common symptoms include urinary problems, but in this rare case, the cancer manifested as penile pain and hardening.
The patient’s prostate-specific antigen (PSA) level was within the normal range, despite the presence of the metastatic tumors. However, given the concerning findings, doctors initiated treatment with apalutamide, a hormone therapy, alongside radiation therapy. The patient initially responded well to treatment, with his PSA levels decreasing over two years. Unfortunately, following cessation of hormone therapy, the PSA levels began to rise again, accompanied by a recurrence of penile pain. Subsequent examination revealed complete hardening of the penile shaft.
After thorough discussions with the patient about treatment options and potential complications, the decision was made to perform a radical penectomy. This was followed by a perineostomy, creating a permanent opening in the perineum for urination. Remarkably, the patient tolerated the surgery well, experienced no post-operative complications, maintained continence, and demonstrated stable PSA levels with no evidence of disease progression for one year following the surgery.
This case demonstrates a stark contrast to the typical prognosis of penile metastasis from prostate cancer, where patients often succumb to the disease within a year of diagnosis, with an average survival of approximately six months. The patient’s positive outcome, both clinically and biochemically, after radical penectomy suggests that this aggressive surgical approach may offer a promising palliative option, especially when the disease is in the oligometastatic phase. It alleviated the patient’s pain and potentially delayed further disease progression.
This unique case emphasizes the importance of personalized treatment approaches in oncology. While penile metastasis from prostate cancer is exceptionally rare, it necessitates a careful evaluation of the patient’s overall condition, disease stage, and treatment goals. Open communication between the patient and the medical team is crucial for informed decision-making, particularly when considering drastic surgical interventions like radical penectomy.
The long-term benefits of radical penectomy in this context remain to be further investigated through more reported cases and long-term follow-up data. However, this case provides valuable insights into managing a rare and challenging complication of prostate cancer, offering a potential pathway for palliation and improved quality of life. The successful outcome in this case should encourage further research into the role of radical penectomy in managing penile metastasis and emphasizes the importance of considering all available treatment options for patients facing this rare and devastating complication.
The case also highlights the value of ongoing monitoring and follow-up care for cancer patients. The patient’s symptoms were initially recognized during a routine check-up, underscoring the importance of regular appointments for early detection and intervention in cancer management. The subsequent rise in PSA levels after the initial successful treatment further reinforces the need for vigilance and ongoing monitoring to promptly identify and address disease recurrence. This vigilance, coupled with a multidisciplinary approach involving urologists, oncologists, and other specialists, is essential for optimal patient care and favorable outcomes.
While this case provides a promising outlook for radical penectomy in managing penile metastasis from prostate cancer, it’s essential to remember that it represents a single case report. Larger studies with more patients and longer follow-up periods are necessary to confirm the effectiveness and establish the role of this procedure in standard clinical practice. The decision to undergo a radical penectomy should be made on a case-by-case basis after careful consideration of the patient’s specific circumstances and a detailed discussion of the potential risks and benefits.
This exceptional case adds to the scarce literature on penile metastasis from prostate cancer, offering a glimpse into a potential life-prolonging intervention for patients facing this dire complication. It emphasizes the importance of open communication between doctors and patients, personalized treatment strategies, and continuous monitoring for optimal cancer care. Further research is warranted to validate this approach and refine treatment strategies for this rare but significant clinical challenge.
