SUO 2017: Penile Cancer – Introduction and Discussion of New 2018 Staging

Washington, DC ( To begin the penile cancer session at the 2017 Society of Urologic Oncology (SUO) meeting, Dr. Viraj Master from Emory University presented the changes in the 8th edition penile cancer staging guidelines.  The most significant of these changes are the new definitions of pT2 and pT3 disease. 

pTis disease, or penile carcinoma in-situ, will also be referred to as penile intraepithelial neoplasia (PeIN). pTa disease was previously defined as non-invasive verrucous carcinoma, while it is now defined as either localized non-invasive squamous cell carcinoma, or verrucous carcinoma.

For pT1 disease, lamina propria invasion remains the defining characteristic of this stage, however pT1a disease now requires a lack of perineural invasion (PNI), lymphovascular invasion (LVI), and grade III tumor, whereas previously PNI was not used for staging.  pT1b disease is defined by PNI, LVI, or grade III disease.

Whereas pT2 disease used to be defined by corpus spongiosum invasion or corpora cavernosa invasion, in the 8th edition guidelines, pT2 disease is now defined by corpus spongiosum invasion only (with or without urethral invasion).

pT3 disease was previously defined by urethral invasion, however in the 8th edition guidelines, this is now defined by corpus cavernosum invasion (including tunica albuginea), with or without urethral invasion

The definition of pT4 disease remains unchanged, requiring tumor invasion into adjacent structures such as the scrotum, prostate, or pubis. 

There are also several changes with in nodal staging in the 8th edition guidelines.  pN0 status remains defined by no evidence of nodal disease. While pN1 disease was previously defined by disease in a solitary node, it is now defined by ≤2 unilateral inguinal node involved without extranodal extension. pN2 disease is now defined as ≥3 unilateral nodes involved, or bilateral nodal involvement.  pN3 disease is defined by extranodal extension or pelvic lymph node involvement.

Presented by: Viraj Master, MD, PhD Professor of Urology at the Emory University School of Medicine, Associate Chair for Clinical Affairs and Quality, and Director of Clinical Research Unit. 

Written by: Brian Kadow, MD, Fox Chase Cancer Center, Philadelphia, PA at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC