Solitary Penile Metastasis from Prostate Cancer on 18F-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography

Varun Singh Dhull; Pankaj Kshirsagar; Manoranjan Chowhan; Swapnil Chandrakant Patil

doi:10.4103/ijnm.ijnm_123_22

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37 (

); 402-403

doi:

10.4103/ijnm.ijnm_123_22

Solitary Penile Metastasis from Prostate Cancer on ¹⁸F-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography

Varun Singh Dhull^1,, Pankaj Kshirsagar², Manoranjan Chowhan¹, Swapnil Chandrakant Patil¹

Department of Nuclear Medicine, Aditya Birla Memorial Hospital, Pune, Maharashtra, India

1Department of Surgical Oncology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India

Address for correspondence: Dr. Varun Singh Dhull, Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune - 411 033, Maharashtra, India. E-mail: drvarundhull@gmail.com

Received: 2022-07-21, Accepted: 2022-08-08, Published: 2022-12

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Abstract

We report a case of a 66-year-old man with prostate cancer who underwent ¹⁸F-prostate-specific membrane antigen positron emission tomography/computed tomography for baseline staging that revealed primary lesion in prostate gland along with a solitary metastatic deposit in the penile shaft. Penile metastasis is rare and usually associated with widespread metastatic disease. Solitary penile metastasis is even rarer and can present as a unifocal, multifocal, or diffuse lesion. Early detection is important in guiding treatment and preventing complications.

Keywords

Penile metastasis

prostate cancer

prostate-specific membrane antigen positron emission tomography/computed tomography

solitary

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A 66-year-old male with prostate cancer (Gleason score 4 + 4) was sent for ¹⁸F-Prostate-specific membrane antigen (¹⁸F-PSMA) positron emission tomography/computed tomography (PET/CT) for baseline staging (serum prostate-specific antigen level – 93.16 ng/ml; normal levels: <4 ng/ml). The patient had difficulty in micturition and was catheterized. PSMA-PET/CT revealed soft-tissue density lesion epicentered along the right lobe of prostate gland with contiguous extension and involvement of the right seminal vesicle (maximum standardized uptake value [SUV_max] - 14.40). Fat planes with urinary bladder and rectum were not well defined (a-d, thin white arrows; g, thin black arrow). Interestingly, there was a solitary metastatic deposit (measuring ~ 2.2 cm × 2.9 cm; AP × TR) in the penile shaft as well (SUV_max - 13.7) (e and f, thick white arrow; g, thick black arrow). There was no significant PSMA avid or enlarged locoregional lymphadenopathy or PSMA avid lesion elsewhere in the body (g) [Figure 1]. Prostate cancer usually metastasizes to bones or locoregional lymph nodes and less commonly to lung and liver.[1] Penile metastasis is rare and usually associated with widespread metastatic disease with most common primaries originating in urinary bladder, prostate, and rectosigmoid colon.[2 3 4] Solitary penile metastasis is even rarer with only handful of cases described in the literature.[5 6 7] It can present as a unifocal, multifocal, or diffuse lesion with commonly seen signs and symptoms being penile pain, ulceration, priapism, urinary retention, dysuria, hematuria, and nodules. Early detection is important in management and preventing complications and thus may result in better treatment outcome.[4 7 8 9]

CT images (a, c, e), corresponding PSMA PET/CT images (b, d, f) and maximum intensity projection (MIP) image (g) revealed PSMA avid lesion epicentered along the right lobe of prostate gland (SUVmax- 14.40) (a-d, thin white arrows; g, thin black arrow). Also, there was a solitary metastatic deposit in the penile shaft (SUVmax- 13.7) (e, f, thick white arrow; g, thick black arrow)

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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Declaration of patient consent

Financial support and sponsorship

Conflicts of interest

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[1] Kotake Y, Gohji K, Suzuki T, Watsuji T, Kusaka M, Takahara K, . Metastases to the penis from carcinoma of the prostate. Int J Urol. 2001;8:83-6.
[Google Scholar]

[2] Zhang K, Da J, Yao HJ, Zheng DC, Cai ZK, Jiang YQ, . Metastatic tumors of the penis: A report of 8 cases and review of the literature. Medicine (Baltimore). 2015;94:e132.
[Google Scholar]

[3] Mearini L, Colella R, Zucchi A, Nunzi E, Porrozzi C, Porena M. A review of penile metastasis. Oncol Rev. 2012;6:e10.
[Google Scholar]

[4] Tatkovic A, McBean R, Schoeman J, Wong D. Prostate penile metastasis: Incidence and imaging pattern on ⁶⁸ Ga-PSMA PET/CT. J Med Imaging Radiat Oncol. 2020;64:499-504.
[Google Scholar]

[5] Salavati A, Schik AN, Koksel Y, Gencturk M, Froelich JW. Solitary penile metastasis of prostate cancer on 18F-fluciclovine PET/CT imaging in a patient with PSA of 1 ng/mL. Clin Nucl Med. 2020;45:389-91.
[Google Scholar]

[6] Bianchi D, Rizzo A, Bonacina M, Zaniboni A, Savelli G. Penile metastasis from prostate cancer detected by 18F-fluorocholine PET/CT. Clin Nucl Med. 2021;46:e38-9.
[Google Scholar]

[7] Wong HL, Shi H, Koh LT. Solitary metastasis to the penis from prostate adenocarcinoma - A case report. J Radiol Case Rep. 2019;13:20-8.
[Google Scholar]

[8] De Luca F, Zacharakis E, Shabbir M, Maurizi A, Manzi E, Zanghì A, . Malignant priapism due to penile metastases: Case series and literature review. Arch Ital Urol Androl. 2016;88:150-2.
[Google Scholar]

[9] Fan J, Liang H, Zhang X, Chen X, Duan X, Li L, . Case report: ¹⁸F-PSMA PET/CT may improve the clinical management of penile metastases from prostate cancer. Front Oncol. 2021;11:683343.
[Google Scholar]