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Peniskarzinom: Diagnose und Staging

Penile cancer: diagnosis and staging

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Zusammenfassung

Obwohl der Primärtumor des Peniskarzinoms oft eine eindeutige Blickdiagnose darstellt, sollte immer eine histologische Sicherung vor der definitiven Therapie angestrebt werden. Die klinische Untersuchung soll das Ausmaß und die mögliche Infiltration von Schwellkörper und Urethra feststellen sowie die inguinalen Lymphknoten beurteilen. Eine präoperative Bildgebung der Primärläsion ist nur in unklaren Fällen indiziert. Das Lymphknotenmanagement ist der zentrale prognoseentscheidende Faktor. Kein bildgebendes Verfahren wie Sonographie, Computertomographie (CT), Magnetresonanztomographie (MRT) oder Positronenemissionstomographie (PET)/CT kann eine lymphogene Mikrometastasierung zuverlässig detektieren. Für alle Primärtumoren ab pT1G2 ist deshalb eine invasive Lymphknotendiagnostik notwendig. Die Heilungsrate kann bei entsprechender regelmäßiger Selbstuntersuchung bzw. im Rahmen der Vorsorge und der Nachsorge durch frühzeitige Diagnose und korrekte Therapie >90 % betragen, wobei oftmals Organerhalt möglich ist.

Abstract

Penile cancer is often an obvious visual diagnosis but histologic verification should be obtained prior to treatment. The clinical examination should determine the tumor stage and whether it has infiltrated the cavernous bodies and/or the urethra and it should adequately assess the inguinal lymph nodes. Preoperative imaging of the lesion is only indicated in equivocal cases. Curative treatment requires the complete removal of the primary tumor and all metastatic lymph nodes. Lymph node management is the key prognostic factor in the treatment of penile cancer. No imagining technique such as the ultrasound, CT, MRI or PET/CT is able to adequately detect micrometastatic lymph nodes. Therefore, invasive (inguinal) lymph node diagnosis is indicated for all tumour stages from pT1G2. Over 90% of penile cancer cases can be cured with early diagnosis and adequate treatment if routine self-examination and physical examinations are regularly performed.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    K.-D. Sievert, D.-L. Dräger, S. Milerski & O. W. Hakenberg

  2. Andrologicum München, München, Deutschland

    F.-M. Köhn

  3. Fachbereich Urologie, Helios Klinik Schwerin, Schwerin, Deutschland

    C. Protzel

Authors
  1. K.-D. Sievert
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  2. D.-L. Dräger
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  3. F.-M. Köhn
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  4. S. Milerski
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  5. C. Protzel
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  6. O. W. Hakenberg
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Correspondence to K.-D. Sievert.

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Interessenkonflikt

K.-D. Sievert, D.-L. Dräger, F.-M. Köhn, S. Milerski, C. Protzel und O.W. Hakenberg geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Sievert, KD., Dräger, DL., Köhn, FM. et al. Peniskarzinom: Diagnose und Staging. Urologe 57, 418–422 (2018). https://doi.org/10.1007/s00120-018-0602-x

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