MAGNET AND THE PENILE CANCER:- Role of MRI in Penile cancer
Many people were interested in knowing how I manage penile cancer patients as it is a males very private area of discussion. As result of this some people try to hide and seek treatment very late, perhaps due to the stigma attached. Many people sent me private messages asking me to cast more light on the MRI scan as they had never heard of it before. Yes, I agree that we hear MRI spine, brain, abdomen but don’t hear much about MRI penis.
MRI Penis is a highly specialised investigation, which requires involvement of trained urologist, specifically in Andrology. Fortunately, my vigorous training and work in Andrology not only helps me with such highly specialised investigation but also to manage all andrology related cases. The urologist must be aware about the medication required with required amount of concentration to be injected in penis, including where exactly it needs to be injected to get the desired effect avoiding injury to the neurovascular bundle (nerves and vessels of penis). The injury to these structures can be disastrous.
I searched extensively for centres in Gujarat who offers this type of MRIs but so far couldn’t find anyone doing it. I am not sure about other states of India but if anyone has come across it can guide me or enlighten me. However, once the elective work starts post corona lockdown, I would be carrying out penile MRI scans in Surat (off course with radiologist) to the identify level of muscle invasion and local staging of this patient’s penile cancer. I was fortunate to receive my Andrology training under extremely senior and highly regarded urologist, who gave me many valuable tricks to handle any complex Andrology cases. I highly trained and experience in delivering such injection in penis for the purpose of MRI of Penis and other areas of Andrology practice.
In any cancers including Penile cancer precise staging before the treatment is vital to assist with best treatment option for the patient (due to multiple treatment options available). Recently the American Joint Committee on Cancer-Tumour Node and Metastasis (AJCC-TNM) revised the staging for penile cancers, with invasion of corpora cavernosa (one of the main muscles of penis forming 2 tubes) upstaged from T2 to T3 and invasion of urethra down staged. Because of this, MRI has become essential part due to its accuracy in detecting invasion of corpora cavernosa. Even recent European Urology Association (EAU) guidelines recommend MRI to rule out invasion of the corpora cavernosa. It also helps with measurement of residual-penile-length for surgical planning as well as to detect and extent of enlarged and abnormal inguinal and pelvic lymph nodes (National Comprehensive Cancer Network (NCCN)treatment guidelines).