SYSTEMATIC REVIEW OF PENILE METASTASES: ANALYSIS OF THE RESULTS OF THE LAST 10 YEARS

Background: Penile metastasis is a relatively uncommon event with about 500 cases reported in the literature from 1961 to the present. The aim of our study was to conduct a systematic literature review of the past 10 years on this particular subject. Materials and Methods: We conducted a systematic search in PubMed (http://www.ncbi.nlm.nih.gov), from January 2003 to April 2013, including the combination of the following terms: “penile/penis tumor”, “penis/penile metastasis”, “penile/penis cancer”, “malignat priapism”, limiting the search to articles in English. Embase and the Cochrane Library were also searched for the same keywords. Results: A systematic review identified 63 articles published between January 2003 and April 2013 for a total of 77 patients with an age range between 53 and 92 years and a mean follow-up of 1 year. 20 patients (26%) had metastasis of bladder origin, 19 (25.1%) prostatic, 15 (19.1%) colorectal, 7 (9.0%) pulmonary, 3 (3.9%) dermal, 3 (3.9%) esofagic, 2 (2.6%) renal, 2 (2.6%) secondary to lymphoma, 1 (1.3%) respectively from carcinoma of tongue, jaw, thyroid gland, seminal vesicles, glomangiosarcoma, leukemia myeloid lineage. In 4 cases (5.2%) penile metastasis was synchronous with the primary tumor. In the remaining 73, the average time between the onset of the primary tumor and the penile metastasis was 41 months (range: 4-60). In 35 patients (45.5%) metastasis was manifested as painful nodule in 31 (40.3%) with priapism, in 7 (9.1%) as a lump indolent, in 3 (3.8%) with hematuria, and 1 (1.3%) with ulceration. In agreement with Kendi et al. (Urol Nephrol, 2006), MRI proved to be the best diagnostic tool/stadiante. The primary therapeutic approach for the local control of the disease, has been surgical in 40 cases (51.9%), hormonal in 27 cases (35.1%), radiotherapy in 5 cases (6.5%) and chemotherapy in 5 (6.5%). The median survival after the diagnosis of penile secondariness was 10 months (range: 6-18 months). Discussion: Secondary lesions of the penis are relatively rare with a high prevalence of malignancy of bladder origin, prostate and colon/rectum. In agreement with Chaux et al. (Int J Surg Pathol 2011), penile metastasis is justified as genitourinary and colon/rectal cancers. No therapy was significantly higher from the prognostic point of view and the choice of approach should be considered by evaluating the performance status of the patient and the local extension of the lesion and systemic. Conclusion: The small number of cases, the poor prognosis and lack of targeted therapeutic choices impose a registration of cases and a constant review of the literature in order to identify shared and effective therapeutic lines.