Bernhard Scher, MD¹, Michael Seitz, MD², Martin Reiser, BS¹, Edwin Hungerhuber, MD², Klaus Hahn, MD¹, Reinhold Tiling, MD¹, Peter Herzog, MD³, Maximilian Reiser, MD³, Peter Schneede, MD² and Stefan Dresel, MD¹

1.        Department of Nuclear Medicine, University of Munich, Munich, Germany

2.        Department of Urology, University of Munich, Munich, Germany

3.        Department of Radiology, University of Munich, Munich, Germany

The value of PET or PET/CT with ¹⁸F-FDG for the staging of penile cancer has yet to be determined. The objective of this study was to investigate the pattern of ¹⁸F-FDG uptake in the primary malignancy and its metastases and to determine the diagnostic value of ¹⁸F-FDG PET/CT in the staging and restaging of penile cancer. Methods: Thirteen patients (mean ± SD age, 64 ± 14.0 y) with suspected penile cancer or suspected recurrent disease were examined with a Gemini PET/CT system (200 MBq of ¹⁸F-FDG). The reference standard was based on histopathologic findings obtained at biopsy or during surgery. Results: Both the primary tumor and regional lymph node metastases exhibited a pattern of ¹⁸F-FDG uptake typical for malignancy. Sensitivity in the detection of primary lesions was 75% (6/8), and specificity was 75% (3/4). On a per-patient basis, sensitivity in the detection of lymph node metastases was 80% (4/5), and specificity was 100% (8/8). On a nodal-group basis, PET/CT showed a sensitivity of 89% (8/9) in the detection of metastases in the superficial inguinal lymph node basins and a sensitivity of 100% (7/7) in the deep inguinal and obturator lymph node basins. The mean ± SD maximum standardized uptake value for the 8 primary lesions was 5.3 ± 3.7, and that for the 16 lymph node metastases was 4.6 ± 2.0. Conclusion: According to our results, the main indication for ¹⁸F-FDG PET in the primary staging or follow-up of penile cancer patients may be the prognostically crucial search for lymph node metastases. With the use of a PET/CT unit, the additional information provided by CT may be especially useful for planning surgery. Implementing ¹⁸F-FDG PET and PET/CT in future staging algorithms may lead to a more precise and stage-appropriate therapeutic strategy. Furthermore, invasive procedures with a high morbidity rate, such as general bilateral lymphadenectomy, may be avoided.

Key Words: PET/CT • ¹⁸F-FDG • penile cancer

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