Penile metastasis from a T1b prostate carcinoma.
BACKGROUND
Penile metastasis from incidental prostate carcinoma has not been described to date.


METHODS
The case of a 72-year-old man affected by penile metastasis from incidental prostate carcinoma is described. In March 1998, the patient underwent prostate surgery for lower urinary tract symptoms related to benign prostatic obstruction. Histological examination revealed an incidental adenocarcinoma of the prostate. The pre-operative prostate-specific antigen (PSA) value was 3.6 ng/ml. A prostate biopsy in the peripheral prostate lobes was negative. PSA progressively rose to 8 ng/ml. The prostate biopsy was repeated and was still negative. The patient was subjected to radiotherapy, as a result of which his PSA fell to 0.7 ng/ml. 4 years after prostatectomy, the PSA rose again and the patient underwent hormonal therapy. The PSA fell to < 0.001 ng/ml. In May 2004, the patient reported a painful, erythematous nodule on his penis glans. Surgical biopsy showed a metastasis from prostate adenocarcinoma and he underwent partial penectomy. Due to disease progression, the patient underwent medical therapy. PSA and testosterone were always at minimum levels. 20 months later the patient died.


CONCLUSIONS
We underline the uncertainty of the biological behaviour and optimal management of incidentally identified prostate carcinoma. In addition, we highlight that biological and clinical progression could be the consequence of inadequate treatment recommendations.
Cai
Tommaso
T
Department of Urology, University of Florence, Italy. ktommy@libero.it
Salvadori
Adriana
A
Nesi
Gabriella
G
Detti
Beatrice
B
Tinacci
Galliano
G
Zini
Enzo
E
Bartoletti
Riccardo
R
D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D018450:Disease Progression; D006801:Humans; D033162:Incidental Findings; D008297:Male; D009367:Neoplasm Staging; D010166:Palliative Care; D010412:Penile Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D010413:Penis / Q000473:pathology; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen