Skip to main content

Diagnostic Tools in the Evaluation and Management of Penile Cancer

  • 721 Accesses

Part of the Current Clinical Urology book series (CCU)

Abstract

Resection of high-risk primary penile tumors with either partial or total penectomy can often lead to esthetically disfiguring outcomes as well as poor functional quality with regard to the ability for intercourse. Pretreatment diagnostic tools are necessary to better define those patients in whom penile-sparing approaches may achieve equivalent oncological outcomes without compromising penile length or functional ability. Additionally, due to the morbidity associated with inguinal and pelvic lymph node (LN) dissection, diagnostic tools that can accurately identify lymphatic metastases from penile carcinoma are necessary to optimize diagnosis and treatment, especially since the extent of LN involvement is the most relevant prognostic factor in penile cancer patients. These novel strategies may help avoid the unnecessary morbidity of inguinal and/or pelvic lymphadenectomy in patients that may not benefit from aggressive surgical intervention and better cater treatment for those in which it is clinically indicated. These emerging diagnostic tools may consist of imaging-based modalities, molecular-based drug delivery systems, and tissue-based biomarkers.

Keywords

  • Penile cancer
  • Squamous cell carcinoma
  • Diagnostic tools
  • Computed tomography
  • Magnetic resonance imaging
  • 18F-fluorodeoxyglucose positron emission tomography-computed tomography
  • Biomarkers

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4939-6679-0_2
  • Chapter length: 18 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   84.99
Price excludes VAT (USA)
  • ISBN: 978-1-4939-6679-0
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   109.99
Price excludes VAT (USA)
Hardcover Book
USD   109.99
Price excludes VAT (USA)
Fig. 2.1
Fig. 2.2
Fig. 2.3
Fig. 2.4
Fig. 2.5

References

  1. Pow-Sang MR, Ferreira U, Pow-Sang JM, et al. Epidemiology and natural history of penile cancer. Urology. 2010;76:S2.

    CrossRef  PubMed  Google Scholar 

  2. Bleeker MC, Heideman DA, Snijders PJ, et al. Penile cancer: epidemiology, pathogenesis and prevention. World J Urol. 2009;27:141.

    CAS  CrossRef  PubMed  Google Scholar 

  3. Daling JR, Madeleine MM, Johnson LG, et al. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer. 2005;116:606.

    CAS  CrossRef  PubMed  Google Scholar 

  4. Hakenberg OW, Comperat EM, Minhas S, et al. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2015;67:142.

    CrossRef  PubMed  Google Scholar 

  5. Tolstov Y, Hadaschik B, Pahernik S, et al. Human papillomaviruses in urological malignancies: a critical assessment. Urol Oncol. 2014;32:46.e19–27.

    Google Scholar 

  6. Bezerra AL, Lopes A, Santiago GH, et al. Human papillomavirus as a prognostic factor in carcinoma of the penis: analysis of 82 patients treated with amputation and bilateral lymphadenectomy. Cancer. 2001;91:2315.

    CAS  CrossRef  PubMed  Google Scholar 

  7. Cubilla AL. The role of pathologic prognostic factors in squamous cell carcinoma of the penis. World J Urol. 2009;27:169.

    CrossRef  PubMed  Google Scholar 

  8. Flaherty A, Kim T, Giuliano A, et al. Implications for human papillomavirus in penile cancer. Urol Oncol. 2014;32:53.e1–8.

    Google Scholar 

  9. Protzel C, Alcaraz A, Horenblas S, et al. Lymphadenectomy in the surgical management of penile cancer. Eur Urol. 2009;55:1075.

    CrossRef  PubMed  Google Scholar 

  10. Ficarra V, Akduman B, Bouchot O, et al. Prognostic factors in penile cancer. Urology. 2010;76:S66.

    CrossRef  PubMed  Google Scholar 

  11. Van Poppel H, Watkin NA, Osanto S, et al. Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi115.

    Google Scholar 

  12. Minhas S, Kayes O, Hegarty P, et al. What surgical resection margins are required to achieve oncological control in men with primary penile cancer? BJU Int. 2005;96:1040.

    CrossRef  PubMed  Google Scholar 

  13. D’Ancona CA, Botega NJ, De Moraes C, et al. Quality of life after partial penectomy for penile carcinoma. Urology. 1997;50:593.

    CrossRef  PubMed  Google Scholar 

  14. Gunia S, Koch S, Jain A, et al. Does the width of the surgical margin of safety or premalignant dermatoses at the negative surgical margin affect outcome in surgically treated penile cancer? J Clin Pathol. 2014;67:268.

    CrossRef  PubMed  Google Scholar 

  15. Hegarty PK, Eardley I, Heidenreich A, et al. Penile cancer: organ-sparing techniques. BJU Int. 2014;114:799.

    CrossRef  PubMed  Google Scholar 

  16. Pietrzak P, Corbishley C, Watkin N. Organ-sparing surgery for invasive penile cancer: early follow-up data. BJU Int. 2004;94:1253.

    CrossRef  PubMed  Google Scholar 

  17. Scardino E, Villa G, Bonomo G, et al. Magnetic resonance imaging combined with artificial erection for local staging of penile cancer. Urology. 2004;63:1158.

    CAS  CrossRef  PubMed  Google Scholar 

  18. Hanchanale V, Yeo L, Subedi N, et al. The accuracy of magnetic resonance imaging (MRI) in predicting the invasion of the tunica albuginea and the urethra during the primary staging of penile cancer. BJU Int. 2016;117:439.

    CrossRef  PubMed  Google Scholar 

  19. Kayes O, Minhas S, Allen C, et al. The role of magnetic resonance imaging in the local staging of penile cancer. Eur Urol. 2007;51:1313.

    CrossRef  PubMed  Google Scholar 

  20. Gupta S, Rajesh A. Magnetic resonance imaging of penile cancer. Magn Reson Imaging Clin N Am. 2014;22:191.

    CrossRef  PubMed  Google Scholar 

  21. Bertolotto M, Serafini G, Dogliotti L, et al. Primary and secondary malignancies of the penis: ultrasound features. Abdom Imaging. 2005;30:108.

    CAS  CrossRef  PubMed  Google Scholar 

  22. Horenblas S, Kroger R, Gallee MP, et al. Ultrasound in squamous cell carcinoma of the penis; a useful addition to clinical staging? A comparison of ultrasound with histopathology. Urology. 1994;43:702.

    CAS  CrossRef  PubMed  Google Scholar 

  23. Bozzini G, Provenzano M, Romero Otero J, et al. Role of penile Doppler US in the preoperative assessment of penile squamous cell carcinoma patients: results from a large prospective multicenter European study. Urology. 2016;90:131–5.

    CrossRef  PubMed  Google Scholar 

  24. Powles T, Murray I, Brock C, et al. Molecular positron emission tomography and PET/CT imaging in urological malignancies. Eur Urol. 2007;51:1511.

    CrossRef  PubMed  Google Scholar 

  25. Scher B, Seitz M, Reiser M, et al. 18F-FDG PET/CT for staging of penile cancer. J Nucl Med. 2005;46:1460.

    PubMed  Google Scholar 

  26. Leijte JA, Graafland NM, Valdes Olmos RA, et al. Prospective evaluation of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography in staging clinically node-negative patients with penile carcinoma. BJU Int. 2009;104:640.

    CrossRef  PubMed  Google Scholar 

  27. Graafland NM, Leijte JA, Valdes Olmos RA, et al. Scanning with 18F-FDG-PET/CT for detection of pelvic nodal involvement in inguinal node-positive penile carcinoma. Eur Urol. 2009;56:339.

    CrossRef  PubMed  Google Scholar 

  28. Souillac I, Rigaud J, Ansquer C, et al. Prospective evaluation of (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography to assess inguinal lymph node status in invasive squamous cell carcinoma of the penis. J Urol. 2012;187:493.

    CrossRef  PubMed  Google Scholar 

  29. Schlenker B, Scher B, Tiling R, et al. Detection of inguinal lymph node involvement in penile squamous cell carcinoma by 18F-fluorodeoxyglucose PET/CT: a prospective single-center study. Urol Oncol. 2012;30:55.

    CrossRef  PubMed  Google Scholar 

  30. Rosevear HM, Williams H, Collins M, et al. Utility of (1)(8)F-FDG PET/CT in identifying penile squamous cell carcinoma metastatic lymph nodes. Urol Oncol. 2012;30:723.

    CrossRef  PubMed  Google Scholar 

  31. Sadeghi R, Gholami H, Zakavi SR, et al. Accuracy of 18F-FDG PET/CT for diagnosing inguinal lymph node involvement in penile squamous cell carcinoma: systematic review and meta-analysis of the literature. Clin Nucl Med. 2012;37:436.

    CrossRef  PubMed  Google Scholar 

  32. Tabatabaei S, Harisinghani M, McDougal WS. Regional lymph node staging using lymphotropic nanoparticle enhanced magnetic resonance imaging with ferumoxtran-10 in patients with penile cancer. J Urol. 2005;174:923.

    CrossRef  PubMed  Google Scholar 

  33. Markuszewski M, Polom W, Cytawa W, et al. Comparison of real-time fluorescent indocyanine green and Tc-nanocolloid radiotracer navigation in sentinel lymph node biopsy of penile cancer. Clin Genitourin Cancer. 2015;13(6):574–80.

    CrossRef  PubMed  Google Scholar 

  34. Brouwer OR, van den Berg NS, Matheron HM, et al. A hybrid radioactive and fluorescent tracer for sentinel node biopsy in penile carcinoma as a potential replacement for blue dye. Eur Urol. 2014;65:600.

    CAS  CrossRef  PubMed  Google Scholar 

  35. Mahmoudi M, Simchi A, Imani M, et al. Optimal design and characterization of superparamagnetic iron oxide nanoparticles coated with polyvinyl alcohol for targeted delivery and imaging. J Phys Chem B. 2008;112:14470.

    CAS  CrossRef  PubMed  Google Scholar 

  36. Jo J, Aoki I, Tabata Y. Design of iron oxide nanoparticles with different sizes and surface charges for simple and efficient labeling of mesenchymal stem cells. J Control Release. 2010;142:465.

    CAS  CrossRef  PubMed  Google Scholar 

  37. Vuichoud C, Klap J, Loughlin KR. The emerging role and promise of biomarkers in penile cancer. Urol Clin North Am. 2016;43:135.

    CrossRef  PubMed  Google Scholar 

  38. Zhang J, Baran J, Cros A, et al. International Cancer Genome Consortium Data Portal—a one-stop shop for cancer genomics data. Database (Oxford). 2011;2011:bar026.

    Google Scholar 

  39. Lopes A, Bezerra AL, Pinto CA, et al. p53 as a new prognostic factor for lymph node metastasis in penile carcinoma: analysis of 82 patients treated with amputation and bilateral lymphadenectomy. J Urol. 2002;168:81.

    CrossRef  PubMed  Google Scholar 

  40. Martins AC, Faria SM, Cologna AJ, et al. Immunoexpression of p53 protein and proliferating cell nuclear antigen in penile carcinoma. J Urol. 2002;167:89.

    CAS  CrossRef  PubMed  Google Scholar 

  41. Gunia S, Kakies C, Erbersdobler A, et al. Expression of p53, p21 and cyclin D1 in penile cancer: p53 predicts poor prognosis. J Clin Pathol. 2012;65:232.

    CrossRef  PubMed  Google Scholar 

  42. Zargar-Shoshtari K, Spiess PE, Berglund AE, et al. Clinical significance of p53 and p16 status in a contemporary North American penile carcinoma cohort. Clin Genitourin Cancer. 2016;14(4):346–51.

    CrossRef  PubMed  Google Scholar 

  43. Liu JY, Li YH, Zhang ZL, et al. The risk factors for the presence of pelvic lymph node metastasis in penile squamous cell carcinoma patients with inguinal lymph node dissection. World J Urol. 2013;31:1519.

    CrossRef  PubMed  Google Scholar 

  44. Zhu Y, Zhou XY, Yao XD, et al. The prognostic significance of p53, Ki-67, epithelial cadherin and matrix metalloproteinase-9 in penile squamous cell carcinoma treated with surgery. BJU Int. 2007;100:204.

    CAS  CrossRef  PubMed  Google Scholar 

  45. Miralles-Guri C, Bruni L, Cubilla AL, et al. Human papillomavirus prevalence and type distribution in penile carcinoma. J Clin Pathol. 2009;62:870.

    CAS  CrossRef  PubMed  Google Scholar 

  46. Rubin MA, Kleter B, Zhou M, et al. Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol. 2001;159:1211.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  47. Steinestel J, Al Ghazal A, Arndt A, et al. The role of histologic subtype, p16(INK4a) expression, and presence of human papillomavirus DNA in penile squamous cell carcinoma. BMC Cancer. 2015;15:220.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  48. Bezerra SM, Chaux A, Ball MW, et al. Human papillomavirus infection and immunohistochemical p16(INK4a) expression as predictors of outcome in penile squamous cell carcinomas. Hum Pathol. 2015;46:532.

    CAS  CrossRef  PubMed  Google Scholar 

  49. Ferrandiz-Pulido C, Masferrer E, de Torres I, et al. Identification and genotyping of human papillomavirus in a Spanish cohort of penile squamous cell carcinomas: correlation with pathologic subtypes, p16(INK4a) expression, and prognosis. J Am Acad Dermatol. 2013;68:73.

    CAS  CrossRef  PubMed  Google Scholar 

  50. Tang DH, Clark PE, Giannico G, et al. Lack of P16ink4a over expression in penile squamous cell carcinoma is associated with recurrence after lymph node dissection. J Urol. 2015;193:519.

    CrossRef  PubMed  Google Scholar 

  51. Poetsch M, Hemmerich M, Kakies C, et al. Alterations in the tumor suppressor gene p16(INK4A) are associated with aggressive behavior of penile carcinomas. Virchows Arch. 2011;458:221.

    CAS  CrossRef  PubMed  Google Scholar 

  52. Hitchcock CL. Ki-67 staining as a means to simplify analysis of tumor cell proliferation. Am J Clin Pathol. 1991;96:444.

    CAS  CrossRef  PubMed  Google Scholar 

  53. Berdjis N, Meye A, Nippgen J, et al. Expression of Ki-67 in squamous cell carcinoma of the penis. BJU Int. 2005;96:146.

    CAS  CrossRef  PubMed  Google Scholar 

  54. Stankiewicz E, Ng M, Cuzick J, et al. The prognostic value of Ki-67 expression in penile squamous cell carcinoma. J Clin Pathol. 2012;65:534.

    CrossRef  PubMed  Google Scholar 

  55. May M, Burger M, Otto W, et al. Ki-67, mini-chromosome maintenance 2 protein (MCM2) and geminin have no independent prognostic relevance for cancer-specific survival in surgically treated squamous cell carcinoma of the penis. BJU Int. 2013;112:E383.

    CAS  CrossRef  PubMed  Google Scholar 

  56. Guimaraes GC, Leal ML, Campos RS, et al. Do proliferating cell nuclear antigen and MIB-1/Ki-67 have prognostic value in penile squamous cell carcinoma? Urology. 2007;70:137.

    CrossRef  PubMed  Google Scholar 

  57. Wang CS, Sun CF. C-reactive protein and malignancy: clinico-pathological association and therapeutic implication. Chang Gung Med J. 2009;32:471.

    PubMed  Google Scholar 

  58. Steffens S, Al Ghazal A, Steinestel J, et al. High CRP values predict poor survival in patients with penile cancer. BMC Cancer. 2013;13:223.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  59. Al Ghazal A, Steffens S, Steinestel J, et al. Elevated C-reactive protein values predict nodal metastasis in patients with penile cancer. BMC Urol. 2013;13:53.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  60. Li ZS, Yao K, Li YH, et al. Clinical significance of preoperative C-reactive protein and squamous cell carcinoma antigen levels in penile squamous cell carcinoma patients. BJU Int. 2016;118(2):272–8.

    CAS  CrossRef  PubMed  Google Scholar 

  61. Papadopoulos O, Betsi E, Tsakistou G, et al. Expression of cyclin D1 and Ki-67 in squamous cell carcinoma of the penis. Anticancer Res. 2007;27:2167.

    CAS  PubMed  Google Scholar 

  62. Campos RS, Lopes A, Guimaraes GC, et al. E-cadherin, MMP-2, and MMP-9 as prognostic markers in penile cancer: analysis of 125 patients. Urology. 2006;67:797.

    CrossRef  PubMed  Google Scholar 

  63. Vassallo J, Rodrigues AF, Campos AH, et al. Pathologic and imunohistochemical characterization of tumoral inflammatory cell infiltrate in invasive penile squamous cell carcinomas: Fox-P3 expression is an independent predictor of recurrence. Tumour Biol. 2015;36:2509.

    CAS  CrossRef  PubMed  Google Scholar 

  64. Faraj SF, Chaux A, Gonzalez-Roibon N, et al. Immunohistochemical expression of ARID1A in penile squamous cell carcinomas: a tissue microarray study of 112 cases. Hum Pathol. 2015;46:761.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julio M. Pow-Sang M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2017 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Sharma, P., Pow-Sang, M.R., Pow-Sang, J.M. (2017). Diagnostic Tools in the Evaluation and Management of Penile Cancer. In: Spiess, P. (eds) Penile Cancer. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-6679-0_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-6679-0_2

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-6677-6

  • Online ISBN: 978-1-4939-6679-0

  • eBook Packages: MedicineMedicine (R0)