Penile Metastases In The Presence Of Normal PSA Levels And Negative Bone Scan: A Case Report

摘要

Advanced carcinoma of the prostate is usually associated with high PSA levels and bony metastases and there are case reports of cavernosal thrombosis in such patients. Here, we report a case of advanced carcinoma of the prostate with diffuse pelvic and pulmonary metastasis and cavernosal thrombosis, however with normal PSA and negative bone scan. Case Report A 65-year-old man presented with significant lower urinary tract symptoms, a PSA of 506ng/ml and a T3 prostate tumour on DRE. Following TURP (which confirmed Gleason grade 4+5 adenocarcinoma of prostate) and bilateral orchiectomy, his PSA fell to 1.6 (at 6 months). He remained well and asymptomatic following surgery with PSA levels no higher than 1.8.Sixteen months after surgery, he presented with a constant perineal pain and was found to have an indurated penis with nodules on the corona of the glans. MR scanning showed extensive pelvic secondary deposits and a large solid mass arising from prostate and cavernosal thrombosis. There were also widespread lung metastases on his chest x ray. Biopsy of one of the penile nodules revealed poorly differentiated adenocarcinoma of prostatic origin. His isotope bone scan was negative (it was not a superscan). He was commenced on dexamethasone, analgesia and mitazantrone, but he died a month after his admission, approximately 18 months following his original diagnosis.