Malignant Priapism as a Result of Metastatic Thyroid Cancer: A Hard Reality

Metastasis to the penis is an extremely rare entity. Malignant priapism is defined as a persistent, nonsexual erection that is refractory to pharmacologic treatment, corporal aspiration, and surgical shunts. Furthermore, it is typically a hallmark of an advanced cancer that has metastasized, most commonly from regional organs like the prostate or bladder. We report an unusual case of malignant priapism in the setting of metastatic follicular thyroid carcinoma. To date, this is the second reported case of penile metastasis due to thyroid carcinoma and the first incidence of priapism secondary to follicular thyroid carcinoma metastasis.

Malignant priapism secondary to metastatic colon adenocarcinoma: a case report

Background and objective: Priapism is an uncommon urological emergency, and is even less commonly caused by colon adenocarcinoma metastasis. The aim of this article is to report a case of malignant priapism caused by metastatic colon adenocarcinoma. Methods and materials: Case sharing and clinical experience summary of a 61-year-old man with priapism and hematuria persisting for more than 30 days presented to our hospital in September 2019. Results: The patient did not have a history of perineal trauma, nervous system disease, or hematological system disease. Penile Doppler ultrasound showed no obvious blood flow signal, and penile arterial blood gas parameters were pH of 7.01, partial pressure of oxygen of 26 mmHg, and partial pressure of carbon dioxide of 71 mmHg, suggesting the occurrence of ischemic priapism. Abdominopelvic computed tomography enhancement images showed a localized irregular shape and high-density imaging of the root of the corpus cavernosum. Histopathology after cystoscopy confirmed the metastasis of colon adenocarcinoma. Superselective embolization of the internal pudendal artery was performed, which partially relieve the abnormal penile erection, but drug treatment did not significantly alleviate the patient's priapism. Conclusion: Priapism secondary to metastatic colon adenocarcinoma suggests systemic dissem-ination, indicative of a poor prognosis. In such cases, unnecessary surgery should be avoided. Superselective embolization could be an optional treatment for priapism secondary to cancer.

Malignant priapism: Review of the report in three decades

Introduction: Priapism is one of the few critical male urological emergencies. There are two main types of priapism, low flow/venous and high flow/arterial priapism. Malignant priapism is a rare subtype of low flow priapism usually secondary to pelvic malignancy, but other extra-pelvic primary cancers cannot be completely excluded. Aim: To assess and highlight the poor prognosis of malignant priapism, with a view to directing management towards both symptomatic relief and improving patients’ quality of life. Method: All reports of malignant priapism between 1998 and 2018 were searched and assessed focusing on the primary cancer, duration of complaint, associated symptoms, method of management and prognosis. Conclusion: Malignant priapism is a rare form of ischaemic priapism, resistant to successful therapies utilized in the management of other forms of ischaemic priapism. Urological cancers are the most common primaries implicated with the most commonly associated symptoms being pain and urinary symptoms. In the absence of any evidence based guidelines and reliably successful treatment options, clinicians should aim to employ supportive treatment strategies including adequate analgesia. Level of evidence: level4

PSMA-PET/CT-avid metastatic prostate cancer to the penis

Penile metastases from prostate cancer (PC) are rarely reported in the literature. Most commonly diagnosed due to presentation with malignant priapism and other urinary symptoms or from findings on clinical examination, prognosis has been reported to be poor. The authors outline a case of penile metastasis from advanced PC. Initially treated with neoadjuvant androgen deprivation therapy for locally advanced PC, this patient displayed upfront castrate resistance, and subsequent prostate-specific membrane antigen positron emission tomography revealed penile metastatic deposits. The patient was treated with external beam radiotherapy, and worsening urethral stricture disease resulted in the placement of a suprapubic catheter.