Current Role of PET CT in Staging and Management of Penile Cancers

Abstract

Penile cancer (PeCa) is a rare urological malignancy characterized by significant geographical variations in both incidence and mortality rates. Due to its rarity and the consequent lack of randomized trials, current management is based on retrospective studies and small prospective trials. In addition, both the diagnostic pathways and treatment strategies exhibit substantial heterogeneity, differing significantly between less-developed and well-developed countries. The prognosis of PeCas is determined by the presence and extent of regional lymph node (LN) involvement. Therefore, the early detection and treatment of LN metastasis is paramount to ensure better outcomes. In recent decades, overall survival of PeCas has increased, mainly due to advancements in imaging techniques and risk stratification. We aim to provide an overview of the current role of PET CT imaging in the management of patients with PeCa.

Keywords: PET CT; lymph nodes; penile cancer; sentinel node biopsy.

Figure 1

Flowchart of paper selection process.

Figure 2

(A). A 37-year-old man with stage T2 penile squamous cell carcinoma. Imaging with 18FDG PET/CT shows one 12 mm, SUV_mean 2 suspect left inguinal lymph node (Arrow). Histology revealed a metastasis of PeCa without extracapsular extension. (B). A 61-year-old man with stage T1 penile squamous cell carcinoma. Imaging with 18FDG-PET/MR shows one 40 × 26 mm SUVmax 7 positive left inguinal lymph node. Histology revealed a metastasis of PeCa without extracapsular extension.

Figure 3

A 71-year-old man with stage pT1 pN1 penile squamous cell carcinoma shows no evidence of positive pelvic lymph nodes (A) or inguinal lymph nodes (B) during follow-up.