基隆長庚醫院 外科部 泌尿科
Case report –penile metastasis of prostate adenocarcinoma with priapism as the initial presentation
Hung-Yi Chen, Chun-Te Wu, Wen-Hsiang Chen, Cheng-chia Lin, Shian-Shiang Huang, Cheng-Feng Lin
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung
A 95-year-old male has underlying disease of severe prostate hyperplasia, abnormal serum prostate-specific antigen(PSA: 18.41ng/dl) and hardness digital rectal examination were noted. Because of multiple comorbidities and bed ridden status, further prostate malignancy survey cannot be performed. Patient has long-term Foley catheteration for difficult urinary voiding treatment. He hospitalized for antibiotic treatment under the impression of urinary tract infection with initial present by gross hematuria and pyuria. However, painful priapism with adequate glans circulation noted for one week . Bedside cavernosal aspiration revealed no blood content but only debris. No evidence of sickle cell anemia via hematological study. Dorsal slit with cavernosal biopsy was performed for symptoms relief and differential diagnosis under local anesthesia. The priapism and pain improved after the shunting procedure was done.
The following pathological report of biopsy tissue showed poorly differentiated adenocarcinoma. Metastatic prostate adenocarcinoma was proved by the immunohistochemical(IHC) stain which disclosed P504S positive. Further bone scan revealed no obvious bony metastasis, patient cannot complete pelvic magnetic resonance imaging(MRI) study because of poor general conditions. This patient died of another episode of pneumonia related sepsis progression l month later.
Prostate adenocarcinoma metastasis by pelvic lymphovascular route with the presentation of lymph edema. Gross hematuria and urine retention are also common in the advanced disease. We reported an uncommon case of non-ischemic priapism by prostate cancer penile metastasis.