Malignant Priapism, an Ominous Sign With Dismal Prognosis: A Case Report

Malignant priapism is a rare and serious manifestation that results from advanced malignancy. It is caused by the infiltration of tumour cells into the penile tissue. Genitourinary cancers are the most common cause, especially prostatic adenocarcinoma. It indicates widespread metastatic disease and is associated with a poorer prognosis. It presents as a prolonged, painful erection that is not related to sexual activity and is often refractory to conventional treatments. It is rare and usually diagnosed late in the disease course. We report a 70-year-old male who underwent transurethral resection of the prostate (TURP) and bilateral orchidectomy for locally advanced prostatic adenocarcinoma and lost to follow-up. He presented six months later with painful priapism, multiple penile nodules, and acute urinary retention. Imaging studies, including high-resolution penile ultrasound and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scan, confirmed multiple penile metastatic deposits. Despite initial pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, his refractory symptoms necessitated a total penectomy with perineal urethrostomy. Histopathological examination confirmed infiltrating carcinomatous deposits. Unfortunately, despite aggressive management, the patient eventually succumbed to the disease. This report emphasizes the aggressive character of penile metastases from prostate cancer, the challenges in diagnosis and treatment, and the need for a multidisciplinary approach. Early recognition and palliative strategies are essential for maximizing the quality of life.