Evaluation of the response chemotherapy for penile metastasis of bladder cancer using 18F-fluorodeoxyglucose-PET/CT

• Metachronous penile metastasis of bladder cancer occurs very rarely and the clinical management of the disease involves complex problems, and the disease is associated with a poor prognosis.
• Penile metastasis from bladder cancer is an indicator of poor prognosis.
• In the present case, penile metastasis could not be detected with CT scans. It is well-known that metastasis can occur in normal-sized lymph nodes and tissue with normal appearance.
• The importance of PET/CT has been emphasized in the follow-up of atypical metastases.

BackgroundMetachronous penile metastasis of bladder cancer occurs very rarely. The clinical management of the disease involves complex problems, and the disease is associated with a poor prognosis. The common mode of spread to the penis is by the retrograde venous route.Patients and methodsA 68-year-old patient who was diagnosed with invasive bladder cancer underwent 18F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) for staging purposes. An 18 mm intracavernosal metastatic lesion was detected in the penis with a SUVmax of 12.9.ResultsAfter the administration of gemcitabine + cisplatin-based chemotherapy, remission was observed in the metastatic penile lesion according to EORTC criteria (12 mm, SUVmax: 9), and second line chemotherapy program was planned.ConclusionPenile metastasis from bladder cancer is an indicator of poor prognosis. The patients with penile metastasis poorly respond to therapy, despite the use of effective systemic chemotherapy. The researchers of the current study achieved a partial response to chemotherapy in the current case of penile metastasis. The disease-specific life expectancy is less than one year in these patients. Radical ablative surgery does not contribute to survival; however, it offers an alternative method in symptomatic patients.