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August 17, 2025Open Access

Metastatic Adenocarcinoma of the Prostate Presenting as a Penile Mass in a Patient With Acute Urinary Retention: A Case Report

RKRahul KoushikKing Edward Memorial Hospital and Seth G.S. Medical College SPSujata PatwardhanKing Edward Memorial Hospital and Seth G.S. Medical College SNSupradeep NarayanaswamyKing Edward Memorial Hospital and Seth G.S. Medical College

Key Points

Metastatic prostate adenocarcinoma was identified as the cause of a penile lesion, leading to urinary retention.
The patient showed elevated serum prostate-specific antigen (PSA) at 37.8 ng/mL, indicating cancer progression.
Confirmation of malignancy was supported by immunohistochemistry and imaging methods like PSMA PET.
Androgen deprivation therapy and chemotherapy were initiated after surgery, with significant implications for treatment.

Abstract

Metastatic prostate adenocarcinoma presenting as a penile lesion is extremely rare and can mimic primary penile malignancies. A 72-year-old male presented with acute urinary retention and a painless penile lesion with phimosis. The lesion had gradually enlarged over six months with intermittent bleeding. Examination revealed a 3 cm ulcerated mass on the glans near the coronal sulcus. A wedge biopsy suggested adenosquamous carcinoma. CT showed no distant metastases. The patient underwent total penectomy with perineal urethrostomy. Histopathology revealed malignancy with clear margins. Further evaluation at a major tertiary health care centre, including immunohistochemistry, confirmed metastatic prostatic adenocarcinoma (NKX3.1, PSA positive; CK7, CK20, CDX2 negative). Serum prostate-specific antigen (PSA) was elevated (37.8 ng/mL), and prostate-specific membrane antigen positron emission tomography (PSMA PET) confirmed metastasis. The patient was treated with androgen deprivation therapy (bilateral orchidectomy), abiraterone, and docetaxel.

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