Metastatic cancer to the penis: a multi-institutional comprehensive analysis of 31 patients

The metastatic spread of cancer to the penis is a very rare clinical entity generally associated with disseminated disease and poor prognosis. The aim of this paper was to show the outcomes of a series of patients treated for metastatic cancer to the penis and enhance the understanding and the management of penile metastasis in order to improve patients' care and outcomes.

We retrospectively analyzed the medical records of 31 patients diagnosed with metastatic cancer to the penis and treated at eight Ligurian urological departments between January 2014 and January 2024. Clinical characteristics, physical examination findings, diagnostic evaluations, treatment options and follow-up data were assessed.

27 (87%) patients had a prior history of malignancy with a metachronous metastasis. The most common primary site of malignancy was the genitourinary tract (71.1%) followed by the gastrointestinal tract (16.1%). The time interval from the diagnosis of the primary tumour to the detection of the penile metastasis was 36.0 months. The penile metastasis generally appeared with a mass (54.8%) and pain (29%), more rarely with priapism (6.5%), oedema (6.5%) and hematuria/urinary disorders (3.2%). The metastatic lesion required a total penectomy in 17 (54.8%) patients and a partial penectomy in 8 patients (25.8%). At a follow-up of 15.9 (1-75) months, 4 (18.2%) patients were still alive with disease.

Our data confirmed penile metastasis as a rare entity usually associated with clinical symptoms involving the penis in the context of a known primary malignancy, mainly from the neighboring pelvic organs, with a poor prognosis. The majority of our patients required a total penectomy with a negative impact on their quality of life. These aspects highlighted the importance of a penile examination and an early diagnosis of a penile metastasis during the follow-up schedule of many patients with a history of previous oncologic disease.