Penile Metastasis from Prostate Cancer: Detection on 18F-PSMA-1007 PET/CT

Hend Komber; Ayah Nawwar; Julie Searle; Iain Lyburn

doi:10.4274/mirt.galenos.2025.32815

Penile Metastasis from Prostate Cancer: Detection on ¹⁸F-PSMA-1007 PET/CT

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Penile Metastasis from Prostate Cancer: Detection on ¹⁸F-PSMA-1007 PET/CT

Mol Imaging Radionucl Ther 2025;34(3):221-223 DOI: 10.4274/mirt.galenos.2025.32815

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Abstract

A 74-year-old man with a history of prostate cancer and rising prostate-specific antigen underwent ¹⁸F-prostate specific membrane antigen (PSMA)-1007 positron emission tomography/computed tomography for investigation of oligometastatic disease. There was evidence of PSMA avid local recurrence findings with pelvic and retroperitoneal nodal metastases and skeletal deposits. Although rare and could easily be mistaken for contamination, a small penile metastasis was found. This is associated with poor prognosis and could impact further management. This case highlights the importance of a detailed review of the penis, to ensure differentiation between urinary activity and pathological uptake.

Keywords: 18F-PSMA-1007 positron emission tomography/computed tomography, prostate cancer, penile metastasis

Figure 1. A 74-year-old man presents with recurrent prostate cancer and a prostate-specific antigen (PSA) level of 10 ng/mL (A) The left anterior oblique maximal intensity projection of ¹⁸F-fluorodeoxyglucose, positron emission tomography/computed tomography (PET/CT), demonstrates prominent heterogeneous prostatic activity with intense focal activity in the right peripheral zone. A focus of uptake in the distal penile shaft was also seen (arrow). Axial, sagittal ¹⁸F-prostate-specific membrane antigen (PSMA)-1007 PET and sagittal fused PET/CT (B, C and D) demonstrate the subcentimetric focus of tracer uptake in the right side of the penile shaft (arrows), which is not due to urinary contamination. Sagittal low-dose non-contrast CT (E) does not show an appreciable soft tissue lesion. ¹⁸F-PSMA-1007 PET is fast becoming a key imaging modality in the assessment of biochemically recurrent prostate cancer (), which can occur in up to 27% of patients who are managed by radical prostatectomy, and up to 55% of those managed by radiation therapy (). A recent meta-analysis found that although the detection rate (DR) of ¹⁸F-PSMA-1007 PET is dependent on serum PSA values, there is a good DR even at low PSA levels (0.5 ng/mL) (). As expected, local relapse, regional lymph node, distant lymph node, and bone metastases are the most frequent sites of metastases (), with a significantly higher number of positive findings when compared to conventional CT (). Penile metastases are rare, usually presenting as part of advanced disease, and indicate poor prognosis, with half of the patients dying within one year of diagnosis (). The primary malignancies involved are predominantly urological (bladder and prostate cancers), but also, less commonly, gastrointestinal and lung cancers (). Awareness of the penis as a rare site of metastasis is important to avoid misdiagnosis with other non-malignant conditions (). Penile metastases can present clinically with malignant priapism and are detectable on PSMA PET/CT (). Penile metastases from prostate cancer have also been detected on ¹⁸F-choline PET (,).
To our knowledge, there has been one case report of a penile metastasis from prostate cancer detected on ¹⁸F-PSMA PET, this was a case of a solitary penile metastasis found on baseline staging in a patient with prostate cancer and PSA>90 ng/mL (). Our case describes an unexpected example of a ¹⁸F-PSMA avid penile deposit, as part of multifocal recurrence of prostate cancer in a patient with suspected recurrence due to rising PSA. This is associated with extremely poor prognosis, with an average survival of 9 months ().

Footnotes

Ethics

Informed Consent: The patient has given permission for anonymised imaging and clinical information to be used for teaching, audit, research and publications including social media.

Authorship Contributions

Surgical and Medical Practices: A.N., J.S, I.L, Concept: A.N., J.S, I.L, Design: H.K, A.N., J.S, I.L, Data Collection or Processing: H.K, A.N., J.S, I.L, Analysis or Interpretation: H.K, A.N., J.S, I.L, Literature Search: H.K., Writing: H.K, A.N., J.S, I.L.

Conflict of Interest: No conflicts of interest were declared by the authors.

Financial Disclosure: The authors declare that this study has received no financial support.

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