A MAN suffering from a common cancer was forced to have his entire penis amputated after it spread to his manhood, in what medics described as an “exceedingly rare” case.
The 66-year-old patient underwent the life-changing operation after experiencing pain and hardening in the skin of his penis.
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He’d been suffering from prostate cancer for three years when he began experiencing symptoms.
The prostate is a walnut-shaped gland that sits underneath the bladder and surrounds the urethra, the tube carrying pee out of the body.
In the UK, one in eight men will get prostate cancer in their lifetime.
Those over the age of 50 are more at risk, as well as black men and people with a family history of the disease.
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Some prostate cancer grows too slowly to cause any problems or affect how long you live, so many men with prostate cancer will never need any treatment.
But others may begin to experience urinary problems – one of the telltale symptoms of the disease – and some men might get cancer that grows quickly or is more likely to spread to other parts of the body.
Medics writing about the 66-year-old patient’s case in the journal Urology Case Reports said “metastasis of prostate cancer to the penis is extremely rare”.
The few cases that have been reported are typically treated with “metastasis-directed therapy, which generally results in poor prognosis and death within six to nine months”, they said.
The man had been diagnosed with prostate cancer three years prior, which doctors described as “oligometastatic” – meaning it hadn’t spread to many other places in his body.
Two metastatic lesions in the middle section of his spine had been spotted during his initial diagnosis, which were treated with radical radiotherapy and androgen deprivation therapy (ADT).
But during a routine follow-up appointment, the 66-year-old mentioned he began noticing pain in his penis as well as hardening of the skin in his penile shaft.
As his symptoms worsened over time, the man suffered increased pain and also had difficulty drawing back his foreskin.
An examination of his member revealed “a solid, one-centimetre mass” on the tip of his penis.
Further tests also showed that the patient’s prostate was “enlarged and firm”.
Doctor’s suspected the “suspicious” mass might be squamous cell carcinoma (SCC), a type of skin cancer, so they performed a penile biopsy.
This revealed that the man’s prostate cancer had in fact spread to his penis, affecting the tip as well as the erectile tissue.
What is prostate cancer?
Prostate cancer affects a small, walnut shaped gland that sits underneath the bladder and surrounds the urethra – the tube carrying pee outside the body.
It usually grows bigger as you get older.
The prostate’s main job is to help make semen – the fluid that carries sperm.
Most men with early prostate cancer don’t have any signs or symptoms – that’s why it’s important to know about your risk.
Possible symptoms include:
- Difficulty starting to urinate or emptying your bladder
- A weak flow when you urinate
- A feeling that your bladder hasn’t emptied properly
- Dribbling urine after you finish urinating
- Needing to urinate more often than usual, especially at night
- A sudden need to urinate – you may sometimes leak urine before you get to the toilet
If you do notice changes in the way you urinate, this is more likely to be a sign of an enlarged prostate, which is very common and non-cancerous.
But it’s still a good idea to get it checked out.
In the UK, about one in eight men will be diagnosed with prostate cancer in their lifetime.
Some factors may mean you’re more likely to get it.
This includes:
- Getting older – it mainly affects men aged 50 or over
- Having a family history of prostate cancer
- Being Black
If you have any of these risk factors or if you have any symptoms, speak to your GP.
They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer.
Source: Prostate Cancer UK
A follow-up bone scan identified a tumour in the man’s right shinbone, which was confirmed to be caused by prostate cancer too.
Doctors also conducted what’s known as a prostate specific antigen (PSA) test.
The normal range is between 1.0 and 1.5 ng/ml, but high levels of the antigen can be a sign of a prostate condition. The man’s PSA was recorded at 1.09 ng/mL.
As the findings were “suggestive of disease progression”, doctors began treating him with apalutamide, a type of hormone therapy used to treat prostate cancer, as well as radiation therapy.
“He tolerated the treatment well, with a decrease in PSA over the following two years,” medics wrote.
But his PSA levels began to rise again after the hormone treatment ended and the patient began experiencing penis pain once again.
Physical examination showed that his penis shaft had hardened “completely”.
After discussing treatment options thoroughly, it was decided that the man should undergo a “radical penectomy” – total removal of the penis.
He also underwent a perineostomy, where permanent opening into the urethra is created through an incision in the skin between the scrotum and anus.
“The patient tolerated the surgery well, without postoperative complications,” medics wrote.
“He remained continent, with stable PSA levels and no clinical or radiological evidence of disease progression for 12 months postoperatively.”
They concluded: “Radical penectomy, in this context, may provide a promising palliative outcome – not only by alleviating symptoms such as penile pain but also potentially delaying disease progression when performed in the oligometastatic phase.
“A final decision should be made following a thorough discussion with the patient, outlining the potential complications and benefits of radical penile surgery.
“In our case, the patient opted for radical penectomy and remained clinically and biochemically stable 12 months post-surgery.
“This outcome contrasts with existing literature, which reports that most patients with penile metastasis succumb to the disease within one year of diagnosis, with an average survival of approximately six months.”
