case_images: PMC11757117_01
case_images: Ultrasound images of the penis: (A) clusters of calcified lesions are visible within the penile structure, and (B) fascicular blood flow signals are observed.
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case_images: However, the ultrasound image displayed clusters of calcified lesions ( Figure 1A ) and fascicular blood flow signals ( Figure 1B ). A timeline detailing PSA progression, clinical course, and treatment is available in the  Supplementary Figure S1 .
case_images: PET/CT revealed that the higher uptake of prostate gland (SUVmax 15.3) (A) and penile lesions (SUVmax 18.7) (B), indicating local recurrence and penile metastasis from prostatic cancer.
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case_images: The 18F-FDG PET/CT scan indicated significant uptake in penile lesions (SUVmax 18.7) ( Figure 2A ), an enhancing lesion in the prostate gland (SUVmax 15.3) ( Figure 2B ), as well as uptake in the liver (SUVmax 5.32) and lungs (SUVmax 12.1), alongside bone metastases.
case_images: PSMA PET/CT shows high uptake in the lungs (A) and left iliac vascular lymph nodes (B), suggesting metastasis to the lungs and left iliac vascular lymph nodes from prostatic cancer.
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case_images: PSMA PET/CT post-penectomy revealed metastases in the lungs ( Figure 3A ), left iliac vascular lymph nodes ( Figure 3B ), abdominal and pelvic nodes, and multiple bones (ilium, sacrum, coccyx, acetabulum, pubis, and ischium), as well as local recurrence of prostate cancer. Postoperative pathological analysis of penile tissue confirmed prostate adenocarcinoma with a Gleason score of 9 (4 + 5).
case_images: Pathological and immunohistochemical findings of the metastatic penile tumor: (A) prostate-specific antigen(+), (D) alpha-methylacyl-CoA racemase (P504S)(+), (B) Chromogranin A (CgA)(-), (C) alpha-Syn (Syn)(-), (E) cytokeratin 7 (CK7)(-), and (F) cytokeratin 56 (CK7)(-).
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case_images: Immunohistochemistry results ( Figure 4 ) showed negative staining for CK5/6, Syn, CgA, CK7, CD56, and Villin, with positive staining for PSA and P504S, definitively indicating penile metastasis of prostate cancer.