Multiparametric Magnetic Resonance Imaging Without Artificial Erection for Preoperative Staging of Primary Penile Carcinoma

Background and objective Surgery is the most common treatment option for penile carcinoma. The aim of this prospective study was to strengthen the evidence for the use of multiparametric magnetic resonance imaging (mpMRI) without artificial erection in the preoperative assessment of penile cancer. Methods Seventy-one patients with penile cancer referred between August 2022 and September 2025 were included. Preoperative mpMRI and fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) were performed. Correlation between mpMRI and histopathology for tumor diameter and infiltration depth, along with the sensitivity and specificity of mpMRI, physical examination and FDG-PET/CT for T and N staging, were recorded. Imaging differences between human papillomavirus (HPV)-positive and HPV-negative tumors were also recorded. Key findings and limitations mpMRI was highly sensitive and specific for the assessment of T stage, involvement of anatomical structures, and detection of skip lesions. mpMRI performed better than physical examination for T staging and had lower sensitivity but higher specificity than FDG-PET/CT for regional N staging. Moreover, significant differences between HPV-positive and HPV-negative tumors were demonstrated on functional MRI. The impact of observer variability and the need for expertise and specialized training in interpreting penile MRI are not known and may be recognized as a limitation. Conclusions and clinical implications In this prospective single-center cohort, mpMRI without artificial erection was associated with improved preoperative locoregional assessment compared with physical examination.