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Yadlapati S, Rosa‐Nieves PM, Lauck KC, Tolkachjov SN. Mohs Micrographic Surgery Versus Wide Local Excision in the Treatment of Anogenital Squamous Cell Carcinoma: A Systematic Review. Int J Dermatol 2025; 64:1042-1048. [PMID: 39988466 PMCID: PMC12082619 DOI: 10.1111/ijd.17689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/25/2025] [Accepted: 01/31/2025] [Indexed: 02/25/2025]
Abstract
Primary anogenital squamous cell carcinoma (SCC) is a locally aggressive malignancy that requires careful consideration of surgical margins. Anogenital SCC impacts the quality of life due to tissue removal, scarring, and sexual dysfunction. Mohs micrographic surgery (MMS) offers a compelling alternative to wide local excision (WLE) due to its complete margin control and potential tissue-sparing properties. This analysis systematically reviews surgical modalities used for the management of anogenital SCC. Articles meeting eligibility criteria were identified using MEDLINE (via PubMed), Embase, Cochrane, and Scopus databases. All studies investigating surgical management of anogenital SCC with WLE (including vulvectomy) or MMS were considered. A total of 70 studies met inclusion criteria: 46 examined WLE patients, 8 utilized vulvectomy, and 24 examined MMS patients. MMS patients experienced lower local recurrence rates; regional and distant recurrence rates did not differ. The local, regional, and distant recurrence rates for WLE were 17.7%, 5.1%, and 6.0%, respectively, and 5.0%, 3.8%, and 4.3% for MMS. Local recurrence was more likely in patients treated with WLE (p < 0.0001). No differences were noted in regional recurrence (p = 0.444) and distant recurrence (p = 0.420). Study limitations include differences in tumor characteristics and follow-up durations between the groups. The WLE group had larger tumors at presentation. Overall, MMS had superior outcomes for local recurrence compared to WLE and vulvectomy, making it a reasonable option for managing anogenital SCC.
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Affiliation(s)
- Sujitha Yadlapati
- HCA Corpus Christi Medical Center‐ Bay Area Dermatology Residency ProgramMcAllenTexasUSA
| | | | - Kyle C. Lauck
- Division of DermatologyBaylor University Medical CenterDallasTexasUSA
| | - Stanislav N. Tolkachjov
- Division of DermatologyBaylor University Medical CenterDallasTexasUSA
- Epiphany DermatologyFort WorthTexasUSA
- Texas A&M School of MedicineBryanTexasUSA
- Department of DermatologyUniversity of Texas Southwestern Medical SchoolDallasTexasUSA
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Lasorsa F, Bignante G, Orsini A, Rossetti SS, Marchioni M, Porpiglia F, Ditonno P, Lucarelli G, Autorino R, Manfredi C. Follow Up Care After Penile Sparing Surgery for Penile Cancer: Current Perspectives. Res Rep Urol 2024; 16:225-233. [PMID: 39371106 PMCID: PMC11456267 DOI: 10.2147/rru.s465546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 09/21/2024] [Indexed: 10/08/2024] Open
Abstract
Penile cancer (PeCa) is a rare urologic tumor worldwide. In 2024, 2100 new cases and 500 deaths are estimated in the United States. Radical surgery via total penectomy has historically been the cornerstone of treatment, since it provides excellent long-term oncological control. The rationale of surgery for penile cancer was to achieve a 2 cm macroscopic surgical margin that is historically advocated to reduce recurrences. Over time, numerous studies have demonstrated that resection margin status does not affect patients' survival. Different penile-sparing techniques are currently recommended in the European Association of Urology-American Society of Clinical Oncology (EAU-ASCO) guidelines for the treatment of localized primary PeCa. Centralization of care could yield multiple benefits, including improved disease awareness, higher rates of penile-sparing surgery, enhanced detection rates, increased utilization of less invasive lymph node staging techniques, enhanced quality of specialized histopathological examinations, and the establishment of specialized multidisciplinary teams. Compared to more aggressive treatments, the higher recurrence rates after penile-sparing surgery do not hamper neither the metastasis-free survival nor the overall survival. Repeated penile-sparing surgery could be considered for selected cases. The psychological impact of penile cancer is not negligible since the perceived loss of masculinity might adversely affect mental health and overall well-being. Quality of life may be compromised by sexual and urinary dysfunction which may be the result either of the loss of penile tissue or the psychological status of the patient. It is of utmost importance to offer rehabilitative treatment as sexual therapy, physical therapy, occupational therapy, family and peer counseling.
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Affiliation(s)
- Francesco Lasorsa
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Precision and Regenerative Medicine and Ionian Area- Urology, Andrology and Kidney Transplantation Unit, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Gabriele Bignante
- Department of Urology, Rush University, Chicago, IL, USA
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Angelo Orsini
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University, Chieti, Italy
| | | | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Pasquale Ditonno
- Department of Precision and Regenerative Medicine and Ionian Area- Urology, Andrology and Kidney Transplantation Unit, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area- Urology, Andrology and Kidney Transplantation Unit, University of Bari ‘Aldo Moro’, Bari, Italy
| | | | - Celeste Manfredi
- Department of Woman, Unit of Urology, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”NaplesItaly
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Pang KH, Yunis M, Haider A, Freeman A, Hadway P, Nigam R, Rees R, Muneer A, Alnajjar HM. Outcomes of Intraoperative Frozen Section Examination of Surgical Resection Margins of the Penis in Penile Cancer. Clin Genitourin Cancer 2024; 22:102189. [PMID: 39232874 DOI: 10.1016/j.clgc.2024.102189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 08/02/2024] [Accepted: 08/04/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Frozen section examination (FSE) of the tumor resection margins is important during penile-preserving surgery (PPS) in penile cancer. The margin status will impact on how much penile or urethral tissue is excised. We aim to evaluate the outcomes of intraoperative FSE of resection margins in PPS. PATIENTS AND METHODS A retrospective analysis of patients with penile squamous cell carcinoma (SCC) who underwent a FSE of resection margins between 2010 and 2022 was conducted. FSEs were compared with the final histopathological analysis and the Diagnostic Testing Accuracy (DTA): sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. RESULTS Overall, 137 FSE were performed. The median (IQR) age was 65 (53-75) years. 118 (86.1%) patients had negative FSE margins, 16 (11.7%) had positive FSE margins and 3 (2.2%) had equivocal (atypical cells) results. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of penile FSE were 66.7%, 100%, 100%, 93.2% and 94% respectively. 18 patients underwent further resection in the same episode due to a positive or equivocal FSE and 12 (66.7%) achieved negative margins. Limitations include the retrospective nature of the study and lack of control arm to compare with. CONCLUSIONS Intraoperative FSE performed at our center for the assessment of penile SCC margins is 66.7% sensitive and 100% specific. FSE should be considered in PPS, as it's an essential and a reliable diagnostic tool in minimizing over-treatment.
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Affiliation(s)
- Karl H Pang
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Aiman Haider
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Hadway
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Raj Nigam
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Rowland Rees
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Asif Muneer
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Surgical Biotechnology, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hussain M Alnajjar
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
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Falcone M, Preto M, Gül M, Şahin A, Scavone M, Cirigliano L, Peretti F, Ferro I, Plamadeala N, Gontero P. Functional outcomes of organ sparing surgery for penile cancer confined to glans and premalignant lesions. Int J Impot Res 2024:10.1038/s41443-024-00967-7. [PMID: 39187573 DOI: 10.1038/s41443-024-00967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/04/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
The first-line treatment of penile cancer confined to the glans (Tis-T2) is based on organ-sparing approaches. Our aim is to report functional outcomes of total glans resurfacing (TGR), wide local excision (WLE) and glansectomy. A retrospective analysis was conducted from January 2013 to October 2022. Ninety-nine patients were enrolled (22 TGR, 29 WLE, and 48 glansectomy). Sexual and urinary outcomes were explored using ad hoc and validated questionnaires (IIEF-15 and IPSS). The mean follow-up was 25.28 ± 24.87 months [95% CI: 20.38; 30.18]. 44 patients (12 TGR, 10 WLE, and 22 glansectomy) were assessed for functional outcomes. Overall, 86.36% of patients were satisfied with the surgery. The mean IIEF-15 score pre-operation was 54.91 ± 21.38 [95% CI: 48.41-61.41], and at 12 months post-operation, it was 44.39 ± 23.01 [95% CI: 37.39-51.39], with the change being statistically significant (mean difference: -10.52, (-19.15), p < 0.001). During the 0-12-month interval, IIEF-15 scores decreased across all techniques. Glansectomy and WLE showed significant decreases (Glansectomy: -12.955, -24.14%, [95% CI: -21.52, -4.38], p = 0.002; WLE: -14.1, -22.92%, [95% CI: -26.8, -1.39], p = 0.025 respectively), whereas TGR experienced a non-significant decrease (-3.083, -5.97%, CI: [-14.68, 8.51], p = 1.0). Concerning urinary function, only 18.18% of overall patients reported a negative impact of surgery. At 12-months, patients returned almost to pre-intervention IPSS values. Organ-sparing surgery guarantees a decent preservation of both erectile and voiding functions. TGR seems to provide better sexual outcomes when compared to other organ sparing approaches.
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Affiliation(s)
- Marco Falcone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy.
- Neurourology Clinic-A.O.U. "Città della Salute e della Scienza"-Unità Spinale Unipolare, Turin, Italy.
- Department of Urology, Biruni University School of Medicine, İstanbul, Turkey.
| | - Mirko Preto
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Murat Gül
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Ali Şahin
- Selcuk University School of Medicine, Konya, Turkey
| | - Martina Scavone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Lorenzo Cirigliano
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Federica Peretti
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Ilaria Ferro
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Natalia Plamadeala
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
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Tang H, Su Z, Huang Q, Li Y, Chen R, Ban C, Liu C, Lu H, Yi XL, Tang Y. A model of tertiary lymphatic structure-related prognosis for penile squamous cell carcinoma. BMC Urol 2024; 24:165. [PMID: 39090582 PMCID: PMC11295339 DOI: 10.1186/s12894-024-01532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND We investigated the feasibility of the tertiary lymphoid structure (TLS) as a prognostic marker for penile squamous cell carcinoma(SCC). METHODS We retrospectively collected data from 83 patients with penile squamous cell carcinoma. H&E-stained slides were reviewed for TLS density. In addition, clinical parameters were analyzed, the prognostic value of these parameters on overall survival (OS) was evaluated using ‒ Kaplan-Meier survival curves, and the prognostic value of influencing factors was evaluated using Cox multifactor design nomogram analysis. RESULT BMI, T, N, and M are significant in the survival curve with or without tertiary lymphoid structure. BMI, T, N, M and TLS were used to construct a prognostic model for penile squamous cell carcinoma, and the prediction accuracy reached a consensus of 0.884(0.835-0.932), and the decision consensus reached 0.581(0.508-0.655). CONCLUSION TLS may be a positive prognostic factor for penile squamous cell carcinoma, and the combination of BMI, T, N and M can better evaluate the prognosis of patients.
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Affiliation(s)
- Han Tang
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Zhengwei Su
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Qingming Huang
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Yongpeng Li
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Rongchao Chen
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Chengjie Ban
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Chanzhen Liu
- Department of Gynecology and Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
| | - Haoyuan Lu
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Xian-Lin Yi
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China.
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China.
| | - Yong Tang
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China.
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China.
- Department of Urology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China.
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Nijboer TS, van der Fels CAM, de Wit JG, Keizers B, Huizinga HK, Voskuil FJ, Voskamp MJH, van den Heuvel MC, Witjes MJH, de Jong IJ. Fluorescence-guided surgery using cetuximab-800CW in patients with penile carcinoma. BJU Int 2024; 134:268-275. [PMID: 38659306 DOI: 10.1111/bju.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To investigate the feasibility of fluorescence molecular imaging (FMI), using cetuximab-800CW, as an intraoperative tool to determine surgical margins in penile squamous cell carcinoma (PSCC). PATIENTS AND METHODS A total of 11 patients with PSCC received 75 mg cetuximab followed by 15 mg cetuximab-800CW 2 days before surgery. FMI of the whole excision specimen and tissue slices was performed. Fluorescence visualisation was correlated to histopathology. Based on tumour and healthy tissue regions of interest, mean fluorescence intensity was calculated for each individual patient. RESULTS Significant differences between tumour and healthy mean fluorescence intensity were found with tumour-to-background ratios of a median (IQR) of 1.51 (0.99) and a mean (SD) of 1.51 (0.32) in the excision specimen and tissue slices, respectively. One patient showed a high relative fluorescence intensity with a signal-to-background ratio of 1.79, corresponding to a tumour-positive margin on fresh frozen sectioning. CONCLUSION In this Phase I study we showed that cetuximab-800CW seems suitable to discriminate PSCC from background tissue. The tracer was well tolerated, and no false positive spots were seen.
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Affiliation(s)
- Thomas S Nijboer
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Jaron G de Wit
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bas Keizers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henrik K Huizinga
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Floris J Voskuil
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maarten J H Voskamp
- Department of Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marius C van den Heuvel
- Department of Pathology and Medical Biology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Centre Groningen, Groningen, The Netherlands
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Zekan D, Praetzel R, Luchey A, Hajiran A. Local Therapy and Reconstruction in Penile Cancer: A Review. Cancers (Basel) 2024; 16:2704. [PMID: 39123432 PMCID: PMC11311999 DOI: 10.3390/cancers16152704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Local therapy for penile cancer provides robust survival and can preserve the penis functionally and cosmetically. Interventions must target the appropriate clinical stage. We reviewed studies regarding the primary therapy in penile cancer, from topical therapy to radical penectomy, and reconstructive techniques. Topical therapy (5-FU or Imiquimod) provides a robust oncologic response in patients with Ta or Tis disease. Multiple laser therapies are available for localized patients and those with low-grade T1 disease. There is a non-trivial risk of progression and nodal metastases in poorly selected patients. Wide local excision provides an oncologically sound option in patient with up to T1 disease; less evidence exists for Mohs microsurgery in the setting of penile cancer. Increasingly aggressive approaches include glansectomy and partial/radical penectomy, which provide 5- and 10-year cancer-specific survival rates of over 80%. Meticulous reconstruction is necessary for the durable function of the remaining penis. Preservation of voiding and sexual function occurs via penile skin grafting, glans resurfacing, creation of a functional penile stump, and phalloplasty with a penile implant. Perineal urethrostomy provides an alternative in pathology demanding extensive partial or radical penectomy, and a durable option for seated voiding. Clinical suspicion and timely diagnosis are paramount in terms of management as less-invasive options for earlier-stage disease develop.
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Affiliation(s)
- David Zekan
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (A.L.); (A.H.)
| | - Rebecca Praetzel
- College of Osteopathic Medicine, Liberty University, Lynchburg, VA 24502, USA;
| | - Adam Luchey
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (A.L.); (A.H.)
| | - Ali Hajiran
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (A.L.); (A.H.)
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Urabe F, Tsuzuki S, Kimura T. Considerations on treatment outcomes for penile carcinoma: A letter regarding Manurung et al. study. Int J Urol 2024; 31:837. [PMID: 38741344 DOI: 10.1111/iju.15490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Gerald T, Joshi E, Gold SA, Woldu SL, Meng X, Bagrodia A, Gaston K, Margulis V. Impact of pathologic features on local recurrence in penile squamous cell carcinoma after penectomy. Surg Oncol 2024; 54:102066. [PMID: 38581916 DOI: 10.1016/j.suronc.2024.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Penile squamous cell carcinoma (PSCC) is a rare malignancy that may be cured in cases of local disease by resection of the primary tumor. Risk factors and patterns of local recurrence (LR) have not been well described in cases requiring partial or radical penectomy. In this study, we evaluated risk factors for LR and the impact of frozen and final margin assessment. MATERIALS AND METHODS We evaluated 119 patients with PSCC who had undergone partial or radical penectomy from 2007 to 2023. Data regarding clinical and pathologic features were collected by retrospective chart review. The primary outcome of interest was LR. Determinants of LR were analyzed by Student's t, Fisher's exact, chi-square and logistic regression analysis. Predictive statistics of frozen margin status on final margin were assessed and LR rates for subsets of frozen and final margin interaction were defined. Finally, all cases of positive margins and LR were described to highlight patterns of LR and the importance of margin status in these cases. RESULTS There were 8 (6.7%) cases of local recurrence. There were no significant predictors of LR, although a trend toward increased LR risk was observed among those with a positive final margin. Positive final margins were found in 15 (13%) cases. Frozen margin analysis was utilized in 79 cases, of which 10 (13%) were positive. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen margin status for final margins were 44%, 92%, 40%, and 93%, respectively. There were no LR among cases in which frozen margin was not sent. Analysis of all cases with positive margin and/or LR identified three subsets of patients: CIS or focally positive margin resulting in either no LR or LR managed with minimal local intervention, bulky disease in which survival is determined by response to subsequent therapy rather than local recurrence, and clinically significant local recurrence requiring continued surveillance and intervention despite negative margins. CONCLUSIONS LR is rare, even in cases of larger, proximal tumors requiring partial or radical penectomy. In this study, no statistically significant risk factors for local recurrence were identified; however, analysis of frozen and final margins provided insight into the importance of margin status and patterns of local recurrence. When feasible, visibly intra-operative negative margins are an excellent predictor of low risk for LR, and, in cases of CIS or focally positive margins, further resection to achieve negative margins is unlikely to reduce the risk of clinically significant LR. Additionally, in cases of bulky disease, the goals of resection should be focused toward palliation and next line therapy.
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Affiliation(s)
- Thomas Gerald
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Eshan Joshi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samuel A Gold
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Kris Gaston
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Thumma N, Pitla N, Gorantla V, du Plessis M. A comprehensive review of current knowledge on penile squamous cell carcinoma. Front Oncol 2024; 14:1375882. [PMID: 38841163 PMCID: PMC11150677 DOI: 10.3389/fonc.2024.1375882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Neoplasm of the penis is relatively rare in most regions representing 0-2% of cancers worldwide. While the penis can be affected by sarcomas, basal cell carcinomas or even melanoma, Penile Squamous Cell Carcinoma (PSCC) represents approximately 95% of all penile neoplasms. Despite its rarity and most common presentation at later decades of life most individuals diagnosed with PSCC are faced with significant decrease in quality of life. The prevalence and incidence vary among different regions and populations, but a common trend is for diagnosis to occur late (stage 4). Underdeveloped countries are traditionally reported to have higher incidence rates; however, rates may vary significantly between urban and rural areas even in developed countries. Age adjusted rates are on the rise in some countries that used to have incidence rates of 1:100 000 or less. The list of associated risk factors is long and includes among others, lack of neonatal circumcision, poor genital hygiene, socioeconomic status, history of human papillomavirus (HPV) infection and penile intraepithelial neoplasia (PeIN). Many risk factors are widely debated among experts however HPV and PeIN are indisputable risk factors, and both also form part of the classification system for PSCC. Both conditions may have occurred in the past or be present at the time of diagnosis and identifying them plays a major role in management strategies. For such a rare condition PSCC can present in many different forms clinically making diagnosis no easy feat. Diagnosis of PSCC is done through clinical examination, including lymph node palpation, followed by a biopsy, which is essential for the classification. Lymph node involvement is a common finding at first presentation and investigation of spread to deep nodes is important and can be done with the aid of PET-CT. Treatment options for PSCC include surgery, chemotherapy, and radiation therapy. Surgical removal of the tumor is considered the most effective however can lead to severe decrease of quality of life. Chemotherapy is used in the case of fixed or bulky lymph nodes, where surgery is not indicated, and for distant metastasis. Radiation therapy is particularly effective in the case of HPV-positive PSCC.
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Affiliation(s)
| | | | | | - Maira du Plessis
- Department of Anatomical Sciences, School of Medicine, St George's University, True Blue, Grenada
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11
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Vreeburg MTA, de Vries HM, van der Noort V, Horenblas S, van Rhijn BWG, Hendricksen K, Graafland N, van der Poel HG, Brouwer OR. Penile cancer care in the Netherlands: increased incidence, centralisation, and improved survival. BJU Int 2024; 133:596-603. [PMID: 38403729 DOI: 10.1111/bju.16306] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate penile squamous cell carcinoma (PSCC) incidence and centralisation trends in the Netherlands over the past three decades, as well as the effect of centralisation of PSCC care on survival. PATIENTS AND METHODS In the Netherlands PSCC care is largely centralised in one national centre of expertise (Netherlands Cancer Institute [NCI], Amsterdam). For this study, the Netherlands Cancer Registry, an independent nationwide cancer registry, provided per-patient data on age, clinical and pathological tumour staging, follow-up, and vital status. Patients with treatment at the NCI were identified and compared to patients who were treated at all other centres. The age-standardised incidence rate was calculated with the European Standard Population. The probability of death due to PSCC was estimated using the relative survival. Multivariable Cox regression analysis was performed to evaluate predictors of survival. RESULTS A total of 3160 patients were diagnosed with PSCC between 1990 and 2020, showing a rising incidence (P < 0.001). Annual caseload increased at the NCI (1% in 1990, 65% in 2020) and decreased at other (regional) centres (99% to 35%). Despite a relatively high percentage of patients with T2-4 (64%) and N+ (33%) at the NCI, the 5-year relative survival was higher (86%, 95% confidence interval [CI] 82-91%) compared to regional centres (76%, 95% CI 73-80%, P < 0.001). Patients with a pathological T2 tumour were treated with glans-sparing treatment more often at the reference centre than at the regional centres (16% vs 5.0%, P < 0.001). After adjusting for age, histological grading, T-stage, presence of lymph node involvement and year of diagnosis, treatment at regional centres remained a predictor for worse survival (hazard ratio 1.22, 95% CI 1.05-1.39; P = 0.006). CONCLUSION The incidence of PSCC in the Netherlands has been gradually increasing over the past three decades, with a noticeable trend towards centralisation of PSCC care and improved relative survival rate.
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Affiliation(s)
- Manon T A Vreeburg
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hielke-Martijn de Vries
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Vincent van der Noort
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Niels Graafland
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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12
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Nazzani S, Catanzaro M, Bruniera M, Torelli T, Macchi A, Stagni S, Tesone A, Silvani C, Ceccato T, Bernasconi V, Lanocita R, Cascella T, Claps M, Giannatempo P, Zimatore M, Cattaneo L, Biasoni D, Montanari E, Nicolai N. Surveillance or Dynamic Sentinel Lymph-Node Biopsy in Low-Risk Clinically N0 Penile Squamous Cell Carcinoma: Single-Institution Real World Data. Clin Genitourin Cancer 2024; 22:544-548. [PMID: 38278655 DOI: 10.1016/j.clgc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Surveillance is the standard management in low-risk cN0 penile squamous cell carcinoma (peSCC) patients. However, no previous analysis focused on early and long-term outcomes of these patients. We report on main oncological outcomes of a large series of low-risk cN0 peSCC patients. PATIENTS AND METHODS Between 1980 and 2017 included, 93 evaluable consecutive low-risk (ie, pT1a G1 cN0M0) peSCC patients underwent primary tumor surgery and either observation (74) or dynamic sentinel node biopsy (DSNB) (19) following a clinical diagnosis of T1 in 66 (71%), T2 in 15 (16.1%) and Tx in 12 (12.9%) patients, respectively. The statistical significance of differences in medians and proportions was tested with the Kruskal-Wallis and chi-square tests. Kaplan-Meier plots illustrated 5-year inguinal relapse (IR)-free survival rates. RESULTS Median age was 60 years (IQR: 50-69 years). Median follow-up was 92 months (IQR 54-133 months). Surveillance was more frequently adopted in clinical (c)T1 than in cT2 tumors (79.7% vs. 36.8%). None of 19 patients who had DSNB had nodal metastasis. Overall, 7 (7.5%) out of 93 pT1aG1cN0 peSCC patients had IR after a median interval of 9 months. Of note, 1 patient only relapsed after 12 months of surveillance. After stratification according to IR, relapses occurred more frequently in younger patients (59 vs. 64 years, P < .001). The 5-year IR-free survival rates for the entire cohort was 92% (95% Confidence interval [CI] 87-98%). CONCLUSIONS Observation is a safe and effective management for low-risk peSCC patients. Younger patients may be offered a mini-invasive staging as an alternative.
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Affiliation(s)
- Sebastiano Nazzani
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Mario Catanzaro
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Bruniera
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Torelli
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Macchi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stagni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonio Tesone
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Silvani
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Tommaso Ceccato
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Bernasconi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Rodolfo Lanocita
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Melanie Claps
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Giannatempo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Zimatore
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Cattaneo
- Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Montanari
- Università degli Studi di Milano, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Testis surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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13
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Musi G, de Cobelli O, Molinari F, Mistretta FA, Piccinelli ML, Nardini S, Tozzi M, Bianchi R, Fontana M, Di Trapani E, Cioffi A, Brescia A, Cordima G, Bottero D, Ferro M, Matei DV, Fusco N, Luzzago S. Oncological Outcomes of Thulium-Yttrium-Aluminum-Garnet (Tm:YAG) Laser Ablation for Penile Cancer. Urology 2024; 184:149-156. [PMID: 38092326 DOI: 10.1016/j.urology.2023.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To report oncological outcomes after thulium-yttrium-aluminum-garnet (Tm:YAG) laser ablation for penile cancer patients. MATERIALS AND METHODS We retrospectively analyzed 71 patients with ≤cT1 penile cancer (2013-2022). All patients underwent Tm:YAG ablation with a RevoLix 200W continuous-wave laser. First, Kaplan-Meier plots and multivariable Cox regression models tested local tumor recurrence rates. Second, Kaplan-Meier plots tested progression-free survival (≥T3 and/or N1-3 and/or M1). RESULTS Median (interquartile range) follow-up time was 38 (22-58) months. Overall, 33 (50.5%) patients experienced local tumor recurrence. Specifically, 19 (29%) vs 9 (14%) vs 5 (7.5%) patients had 1 vs 2 vs 3 recurrences over time. In multivariable Cox regression models, a trend for higher recurrence rates was observed for G3 tumors (hazard ratio:6.1; P = .05), relative to G1. During follow-up, 12 (18.5%) vs 4 (6.0%) vs 2 (3.0%) men were retreated with 1 vs 2 vs 3 Tm:YAG laser ablations. Moreover, 11 (17.0%) and 3 (4.5%) patients underwent glansectomy and partial/total penile amputation. Last, 5 (7.5%) patients experienced disease progression. Specifically, TNM stage at the time of disease progression was: (1) pT3N0; (2) pT2N2; (3) pTxN3; (4) pT1N1 and (5) pT3N3, respectively. CONCLUSION Tm:YAG laser ablation provides similar oncological results as those observed by other penile-sparing surgery procedures. In consequence, Tm:YAG laser ablation should be considered a valid alternative for treating selected penile cancer patients.
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Affiliation(s)
- Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Filippo Molinari
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | | | - Sara Nardini
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Tozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Fontana
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Cioffi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Brescia
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Giovanni Cordima
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Danilo Bottero
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Fusco
- Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy; Division of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy.
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14
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Switlyk MD, Hopland A, Reitan E, Sivanesan S, Brennhovd B, Axcrona U, Hole KH. Multiparametric Magnetic Resonance Imaging of Penile Cancer: A Pictorial Review. Cancers (Basel) 2023; 15:5324. [PMID: 38001583 PMCID: PMC10670261 DOI: 10.3390/cancers15225324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The role of multiparametric magnetic resonance imaging (mpMRI) in assessing penile cancer is not well defined. However, this modality may be successfully applied for preoperative staging and patient selection; postoperative local and regional surveillance; and assessments of treatment response after oncological therapies. Previous studies have been mostly limited to a few small series evaluating the accuracy of MRI for the preoperative staging of penile cancer. This review discusses the principles of non-erectile mpMRI, including functional techniques and their applications in evaluating the male genital region, along with clinical protocols and technical considerations. The latest clinical classifications and guidelines are reviewed, focusing on imaging recommendations and discussing potential gaps and disadvantages. The development of functional MRI techniques and the extraction of quantitative parameters from these sequences enables the noninvasive assessment of phenotypic and genotypic tumor characteristics. The applications of advanced techniques in penile MRI are yet to be defined. There is a need for prospective trials and feasible multicenter trials due to the rarity of the disease, highlighting the importance of minimum technical requirements for MRI protocols, particularly image resolution, and finally determining the role of mpMRI in the assessment of penile cancer.
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Affiliation(s)
- Marta D. Switlyk
- Department of Radiology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (E.R.); (K.H.H.)
| | - Andreas Hopland
- Department of Urology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (A.H.); (S.S.); (B.B.)
| | - Edmund Reitan
- Department of Radiology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (E.R.); (K.H.H.)
| | - Shivanthe Sivanesan
- Department of Urology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (A.H.); (S.S.); (B.B.)
- Institute of Clinical Medicine (KlinMED), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Bjørn Brennhovd
- Department of Urology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (A.H.); (S.S.); (B.B.)
| | - Ulrika Axcrona
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway;
| | - Knut H. Hole
- Department of Radiology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (E.R.); (K.H.H.)
- Institute of Clinical Medicine (KlinMED), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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15
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Scornajenghi CM, Asero V, Bologna E, Basile G, De Angelis M, Moschini M, Del Giudice F. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review. Curr Opin Urol 2023; Publish Ahead of Print:00042307-990000000-00098. [PMID: 37377374 DOI: 10.1097/mou.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Penile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1-2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. RECENT FINDINGS Patient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SUMMARY OSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.
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Affiliation(s)
- Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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16
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Brassetti A, Anceschi U, Cozzi G, Chavarriaga J, Gavrilov P, Gaya Sopena JM, Bove AM, Prata F, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Torregiani G, Covotta M, Camacho D, Musi G, Varela R, Breda A, De Cobelli O, Simone G. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement. Curr Oncol 2023; 30:1882-1892. [PMID: 36826107 PMCID: PMC9954864 DOI: 10.3390/curroncol30020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. METHODS A purpose-built multicenter, multi-national database was queried for stage I-IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan-Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. RESULTS A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11-27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan-Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94-0.99; p = 0.04). CONCLUSIONS Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652666772
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Julian Chavarriaga
- Division of Urology, Clinica Imbanaco, Quiron Salud, Cali 760042, Colombia
- Division of Urology, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Pavel Gavrilov
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | | | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Diego Camacho
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Rodolfo Varela
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Alberto Breda
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
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Multi-parametric MRI without artificial erection for preoperative assessment of primary penile carcinoma: A pilot study on the correlation between imaging and histopathological findings. Eur J Radiol Open 2023; 10:100478. [PMID: 36793771 PMCID: PMC9922909 DOI: 10.1016/j.ejro.2023.100478] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/29/2023] Open
Abstract
Purpose We aimed to evaluate the diagnostic potential of non-erectile multi-parametric magnetic resonance imaging (mpMRI) for preoperative assessment of primary penile squamous cell carcinoma (SCC). Method Twenty-five patients who underwent surgery for penile SCC were included. Preoperative mpMRI without artificial erection was performed in all patients. The preoperative MRI protocol consisted of high-resolution morphological and functional sequences (diffusion-weighted imaging and dynamic contrast-enhanced MRI perfusion) covering the penis and lower pelvis. T and N staging, according to the 8th edition of the Union for International Cancer Control TNM classification, as well as the largest diameter and thickness/infiltration depth of the primary lesions were determined in all patients. Imaging data were retrospectively collected and compared with the final histopathology reports. Results Very good agreement was observed between MRI and histopathology for the involvement of corpus spongiosum (p = 0.002) and good agreement was observed for the involvement of penile urethra and tunica albuginea/corpus cavernosum (p < 0.001 and p = 0.007, respectively). Good agreement was observed between MRI and histopathology for overall T staging and weaker, but still good agreement was observed for N staging (p < 0.001 and p = 0.002, respectively). A strong and significant correlation was observed between MRI and histopathology for the largest diameter and thickness/infiltration depth of the primary lesions (p < 0.001). Conclusions Good concordance was observed between MRI and histopathological findings. Our initial findings indicate that non-erectile mpMRI is useful in preoperative assessment of primary penile SCC.
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Elst L, Vreeburg M, Brouwer O, Albersen M. Challenges in Organ-sparing Surgery for Penile Cancer: What Are the Limits? Eur Urol Focus 2023; 9:241-243. [PMID: 36653257 DOI: 10.1016/j.euf.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
Organ-sparing surgery (OSS) is endorsed by the European Association of Urology (EAU) guidelines as the preferred treatment for distal primary penile cancer. The recommendation states that OSS should be used whenever possible, without exactly defining what constitutes "possible". This recommendation is based on findings showing that this approach has no detrimental impact on survival. At the same time, OSS results in preservation of quality of life (QoL) and of various functions of the penis. However, while narrow tumor-free margins (>1 mm) are deemed oncologically safe, there is a higher risk of local recurrence. Recent data have emerged that question the dogma that a local recurrence does not impact survival outcomes. In this mini review, we highlight areas of discrepancy in current guidelines and describe challenges for a surgical approach with a delicate balance between oncological safety on the one hand and maximal preservation of QoL and penile functions on the other. PATIENT SUMMARY: Organ-sparing surgery has been recommended as the preferred treatment for primary cancer of the penis, as quality of life and sexual function are maximally preserved. In this review we identify challenges and limitations in routinely adopting this approach.
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Affiliation(s)
- Laura Elst
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Manon Vreeburg
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar Brouwer
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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19
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Long XY, Zhang S, Tang LS, Li X, Liu JY. Conversion therapy for advanced penile cancer with tislelizumab combined with chemotherapy: A case report and review of literature. World J Clin Cases 2022; 10:12305-12312. [PMID: 36483823 PMCID: PMC9724507 DOI: 10.12998/wjcc.v10.i33.12305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Locally advanced penile squamous cell carcinoma with unresectable inguinal lymph node metastasis has a poor prognosis, and surgical treatment alone offers limited benefits. Effective conversion therapy regimens are urgently needed.
CASE SUMMARY We describe a locally advanced penile squamous cell carcinoma patient with bulky, fixed inguinal lymph node metastasis complicated with genital skin ulcers who underwent inguinal lymph node dissection and achieved a pathological complete response with conversion therapy comprising immunotherapy plus chemotherapy.
CONCLUSION For unresectable locally advanced penile squamous cell carcinoma, neoadjuvant immunotherapy combined with chemotherapy is a potential treatment approach. Biomarkers of immunotherapy efficacy need to be explored, and clinical trials are needed to test these strategies.
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Affiliation(s)
- Xiang-Yu Long
- Department of Oncology, Guang’an People’s Hospital, Guang’an 638500, Sichuan Province, China
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shuang Zhang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Sha Tang
- Department of Biotherapy, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiang Li
- Department of Urology, West China Medical School, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ji-Yan Liu
- Department of Biotherapy, Sichuan University, Chengdu 610041, Sichuan Province, China
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20
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Pang KH, Muneer A, Alnajjar HM. Glansectomy and Reconstruction for Penile Cancer: A Systematic Review. Eur Urol Focus 2022; 8:1318-1322. [PMID: 34903488 DOI: 10.1016/j.euf.2021.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/24/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022]
Abstract
Penile cancer (PeCa) is a rare disease, with a global incidence of 36068 new cases reported in the 2020 GLOBOCAN database. Narrower excision margins are now acceptable without compromising survival. Glansectomy is commonly performed for invasive PeCa confined to the glans penis. The majority of data on glansectomy are from small single-centre series. We provide a contemporary update on the outcomes of glansectomy via a systematic review of glansectomy for PeCa. Overall, 20 studies were included in the analysis. The local recurrence rate was 2.6-16.7%. The incidence of salvage penectomy for positive margins and/or recurrence was 1.2-8.3%. The disease-specific survival rate was 89-96.6%. A split-thickness skin graft was commonly used to reconstruct a neoglans and the graft loss rate was 1.5-23.5%. The incidence of meatal stenosis was 2.8-14.3%. Good cosmetic outcomes and normal erections were reported in 95-100% and 50-100% of cases, respectively. Glansectomy provides acceptable oncological control without significantly compromising functional outcomes. PATIENT SUMMARY: Penile cancer invading into the head of the penis can be surgically treated with a procedure called glansectomy that has good cancer control and cosmetic outcomes. In addition, penile length can be preserved, which allows men to urinate standing up and to achieve penetrative sexual intercourse.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Section of Andrology, Pyrah Department of Urology, St James' Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Asif Muneer
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; UCL Male Genital Cancer Centre, Division of Surgery and Interventional Science, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Hussain M Alnajjar
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.
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21
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Sakalis VI, Campi R, Barreto L, Garcia-Perdomo HA, Greco I, Zapala Ł, Kailavasan M, Antunes-Lopes T, Marcus JD, Manzie K, Osborne J, Ayres B, Moonen LM, Necchi A, Crook J, Oliveira P, Pagliaro LC, Protzel C, Parnham AS, Albersen M, Pettaway CA, Spiess PE, Tagawa ST, Rumble RB, Brouwer OR. What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes. EUR UROL SUPPL 2022; 40:58-94. [PMID: 35540709 PMCID: PMC9079254 DOI: 10.1016/j.euros.2022.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
Context The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh’s micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. Objective To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. Evidence acquisition The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. Evidence synthesis The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh’s micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. Conclusions Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. Patient summary We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh’s micrographic surgery could be used for smaller lesions.
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22
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Genes WP, Fierro MC, Guerrero AE, Lozano AMM, Rozo YCT, Sánchez AFP. Guia de cáncer de pene de la Sociedad Colombiana de Urología. Rev Urol 2022. [DOI: 10.1055/s-0041-1740533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ResumenEl cáncer de pene tiene una incidencia de 1.11 por 100.000 habitantes en Colombia, representado en el 95% por carcinoma de células escamosas el cual representa una alta morbilidad y mortalidad, La Sociedad Colombiana de Urología realizo la adaptación de la guía de cáncer de pene para el año 2021 con revisión de la literatura, esta guía permite realizar una evaluación y tratamiento del cáncer de pene, en muchas ocasiones con el objetivo de preservación de órgano utilizando la ecografía como determinante para evaluar el compromiso de la lesión a las estructuras del pene, los estudios de extensión dependerán de hallazgos al examen físico como ganglios o compromiso local de la enfermedad, de acuerdo al tipo de lesión y su estadificación puede recibir terapia con agentes tópicos, radioterapia, cirugía láser, cirugía preservadora de órgano o penectomía total; La linfadenectomía inguinal permitirá mejorar la supervivencia en tumores de riesgo intermedio y alto (>pT1G2), posteriormente la quimioterapia adyuvante esta en el grupo de pacientes en el cual la intención sea curativa, aunque en terapia paliativa de segunda línea se encuentran los platinos y texanos como alternativa pero con pobre respuesta (<30%); los esquemas de seguimiento se realiza de acuerdo al estadio y el compromiso ganglionar. Al final se presentan los resultados de actividad sexual después de cirugía preservadora de órgano; Esta guía abarca la literatura actualizada del cáncer de pene, el cual es útil para el manejo por parte de los profesionales de salud del país.
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Affiliation(s)
- William Pertuz Genes
- Department of Oncological Urology, Universidad de Cartagena, Cartagena de Indias, Colombia
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23
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Li N, Xu T, Zhou Z, Li P, Jia G, Li X. Immunotherapy Combined With Chemotherapy for Postoperative Recurrent Penile Squamous Cell Carcinoma: A Case Report and Literature Review. Front Oncol 2022; 12:837547. [PMID: 35402270 PMCID: PMC8984464 DOI: 10.3389/fonc.2022.837547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/27/2022] Open
Abstract
Penile squamous cell carcinoma (SCC) is a rare malignant tumor in males with a poor prognosis. Currently, the primary treatment is surgery. Recurrent cases have limited treatment options after failed radiotherapy and chemotherapy. The therapeutic effect of immunotherapy in penile SCCs has not been reported. Tislelizumab, a new PD1 inhibitor, has shown a satisfactory impact in treating head and neck SCC and lung SCC combined with chemotherapy. However, there is currently no report on its efficacy in penile SCC. Here, a 76-year-old man with multiple enlarged inguinal lymph nodes 11 months after radical surgery for penile SCC was administered immunotherapy (tislelizumab) combined with chemotherapy (albumin paclitaxel plus nedaplatin) for 2 cycles. Pelvic Magnetic resonance imaging (MRI) showed that the multiple lymph nodes in the groin area disappeared. To our knowledge, this is the first case report of immunotherapy combined with chemotherapy showing promising results in recurrent penile SCC. It provides a basis for developing a new treatment option combining immunotherapy and chemotherapy, whose efficacy needs to be further evaluated in penile SCC.
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Affiliation(s)
- Na Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tangpeng Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhen Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guohua Jia
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiangpan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Xiangpan Li,
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24
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Zhan X, Chen L, Jiang M, Fu B. Get insight into the cause of death distribution and epidemiology of penile squamous cell carcinoma: A population-based study. Cancer Med 2022; 11:2308-2319. [PMID: 35238488 PMCID: PMC9160805 DOI: 10.1002/cam4.4614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Penile squamous cell carcinoma (PSCC) survival had no significant improvement since 1990 in the United States. This study aims to get insight into the changing trend and distribution of death causes of PSCC. The epidemiology of PSCC is also investigated. Methods The Surveillance, Epidemiology, and End Results (SEER) (1992–2018) database is utilized to get patients diagnosed with penile squamous cell carcinoma. The trend of incidence, distribution of age, changing trend and distribution of death cause, and survival outcome are analyzed for all PSCC patients and each race. Results Three thousand four hundred and twenty‐three male patients with PSCC are enrolled in our study. The age‐adjusted incidence rate of the white has a slight increase (Annual percent change [APC] = 0.647%). American Indian/Alaska Native men have the highest average annual incidence, while Asian /Pacific Islander men have the lowest. PSCC patients aged 70–80 are the most common, and patients over 80 years have the highest 3‐year (50%) and 5‐year (63.93%) mortality rate. Non‐cancer disease, especially circulatory system disease, is the most common cause of death, whereas the proportion of patients who died of PSCC significantly increased from 21.17% (1992–2001) to 41.3% (2012–2017) in PSCC patients (p < 0.001). These results have not changed significantly when we only focus on primary PSCC without previous malignant tumors. Hispanics are shown better overall survival than non‐Hispanic White and non‐ Hispanic Black men. (p < 0.001) No statistical differences in cancer‐specific survival are observed (p = 0.15). Conclusion The current study provides essential initial data regarding the presentation and clinical outcomes of PSCC patients. Notably, non‐cancer disease, especially circulatory system disease, is the more common cause of death than PSCC. However, the proportion of patients who died of penile squamous cell carcinoma has a relatively significant increase in recent years. The increasing trends in the advanced stage of PSCC patients might account for this change.
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Affiliation(s)
- Xiangpeng Zhan
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ming Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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25
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Pang KH, Alnajjar HM, Muneer A. Advances in penile-sparing surgical approaches. Asian J Urol 2022; 9:359-373. [DOI: 10.1016/j.ajur.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
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26
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Falcone M, Preto M, Blecher G, Timpano M, Peretti F, Ferro I, Mangione C, Gontero P. The outcomes of glansectomy and split thickness skin graft reconstruction for invasive penile cancer confined to glans. Urology 2022; 165:250-255. [PMID: 35038491 DOI: 10.1016/j.urology.2022.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report surgical, functional and patient reported outcomes(PROs) of glansectomy(GS) and split-thickness skin graft(STSG) reconstruction in case of locally invasive penile cancer(PC) MATERIALS AND METHODS: : A retrospective analysis from May 2015 to August 2019 was conducted. Inclusion criteria were age<80, a "de novo" malignancy, clinically confined PC (≤T2) with histological confirmation. Complications, recurrence-free(RFS), cancer-free(CFS) and overall survival(OS) were described. Functional outcomes and PRO's were explored using validated questionnaires and "ad hoc" created questionnaire respectively. Kaplan-Meier analysis, t-Student and the Mann-Whitney U test were used to estimate survival and postsurgical functional changes respectively. RESULTS 34 patients were enrolled. Median follow-up was 12(IQR:12-41) months. Positive surgical margins were detected in 2.9% of cases, requiring salvage surgery.Postoperative complications occurred in 29.4%, most commonly being a graft partial loss(17.6%), meatal stenosis(5.8%) or genital wound infection(5.8%). Disease recurrence occurred in 17.6% of cases with a median elapsed time of 16 months(12-41). 12-month RFS was 88.2%, whilst CSS and OS were 91 % at the same time point. Glans sensation was preserved in 91.2% of cases. 88.2% of patients reported to be fully satisfied with the postoperative aesthetic appearance of the penis, 91.2% of patients would recommend the same procedure to someone else. Limitations include retrospective design and the lack of a control group CONCLUSIONS: : GS with STSG minimizes the impact on urinary and sexual functions without jeopardizing oncological control in locally advanced PC.
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Affiliation(s)
- Marco Falcone
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy; Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Italy
| | - Mirko Preto
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy.
| | - Gideon Blecher
- Adjunct Lecturer, Department of Surgery. Monash University. Melbourne (Australia) Wellington Rd, Clayton VIC 3800, Australia; Urology Consultant. Department of Urology, The Alfred Hospital. Melbourne, (Australia) 55 Commercial Rd, Melbourne VIC 3004, Australia
| | - Massimiliano Timpano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Federica Peretti
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Ilaria Ferro
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Carlotta Mangione
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
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27
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Update on penile sparing surgery for penile cancer. Curr Opin Urol 2022; 32:1-7. [PMID: 34750321 DOI: 10.1097/mou.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Penile sparing surgery (PSS) is considered the standard of care in penile cancer where appropriate, as preservation of the penis may enable the patient to maintain urinary and sexual function. This review will focus on the latest developments over the past two years. RECENT FINDINGS In this review, we discuss the latest findings in oncological outcomes in PSS, specifically glansectomy. We also introduce technology that may be useful in improving the precision of surgical resection margins in PSS. Finally, we consider the value of patient-reported outcome measures (PROMs) and consider how research in this area can be improved. SUMMARY A recent study has found a correlation between local recurrences (LR) and worse overall and cancer-specific survival in glansectomy, which challenges the belief that LR do not confer worse oncological outcomes. Despite numerous studies evaluating PROMs in penile cancer/PSS, few of these studies provide quality evidence of the 'supportive care needs'. A shift in research is required to identify those men at most risk of distress and to identify ways to support men diagnosed with penile cancer.
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28
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Brambullo T, Azzena GP, Toninello P, Masciopinto G, De Lazzari A, Biffoli B, Vindigni V, Bassetto F. Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review. Front Oncol 2021; 11:783257. [PMID: 34950589 PMCID: PMC8690035 DOI: 10.3389/fonc.2021.783257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.
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Affiliation(s)
- Tito Brambullo
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Gian Paolo Azzena
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Paolo Toninello
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Giuseppe Masciopinto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alberto De Lazzari
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Bernardo Biffoli
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
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29
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Li H, Ma Y, Jian Z, Jin X, Xiang L, Li H, Wang K. Lymph Node Dissections for T3T4 Stage Penile Cancer Patients Without Preoperatively Detectable Lymph Node Metastasis Bring More Survival Benefits: A Propensity Matching Analysis. Front Oncol 2021; 11:712553. [PMID: 34631537 PMCID: PMC8497980 DOI: 10.3389/fonc.2021.712553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Aims The current guidelines for the treatment of penile cancer patients with clinically non-invasive normal inguinal lymph nodes are still broad, so the purpose of this study is to determine which patients are suitable for lymph node dissection (LND). Methods Histologically confirmed penile cancer patients (primary site labeled as C60.9-Penis) from 2004 to 2016 in the Surveillance, Epidemiology, and Results database were included in this analysis. Univariate and multivariate Cox regression analyses were applied to determine an overall estimate of LND on overall survival and cancer-specific survival. A 1:1 propensity matching analysis (PSM) was applied to enroll balanced baseline cohort, and further Kaplan-Meier (KM) survival analysis was used to get more reliable results. Results Out of 4,458 histologically confirmed penile cancer patients with complete follow-up information, 1,052 patients were finally enrolled in this analysis. Age, pathological grade, T stage, and LND were identified as significant predictors for overall survival (OS) in the univariate Cox analysis. In the multivariate Cox regression, age, pathological grade, T stage, and LND were found significant. The same results were also found in the univariate and multivariate Cox regression analyses for cancer-specific survival (CSS). After the successful PSM, further KM analysis revealed that LND could bring significant OS and CSS benefits for T3T4 patients without lymph node metastasis. Conclusion Lymph node dissection may bring survival benefits for penile cancer patients without preoperatively detectable lymph node metastasis, especially for T3T4 stage patients. Further randomized control trial is needed.
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Affiliation(s)
- Han Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, Chengdu No. 5 People's Hospital, Chengdu, China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Liyuan Xiang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
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30
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Ghosh P, Chandra A, Mukhopadhyay S, Chatterjee A, Lingegowda D, Gehani A, Gupta B, Gupta S, Midha D, Sen S. Accuracy of MRI without intracavernosal prostaglandin E1 injection in staging, preoperative evaluation, and operative planning of penile cancer. Abdom Radiol (NY) 2021; 46:4984-4994. [PMID: 34189611 DOI: 10.1007/s00261-021-03194-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the performance of non-erectile MRI in staging and preoperative evaluation of penile carcinomas, compared to postoperative histopathology. METHODS In this retrospective study, MRI scans of patients who had undergone surgery for penile carcinoma (n = 54) between January 2012 and April 2018 were read by two radiologists; and disagreement was solved in the presence of a third experienced radiologist. Data necessary for preoperative evaluation and staging were collected and compared with final postoperative histology and the type of surgery performed. All MRI had been performed without intracavernosal injection of prostaglandin E1 and with IV Gadolinium, as per local protocol. RESULTS 54 patients were included in the study (mean age 57.52 ± 12.78). The number of patients with T1, T2, and T3 staging in histopathology were 32, 14, and 8. Moderate interobserver agreement was found for staging, disease-free penile length, and all subsites except urethra, which had weak agreement. Strong agreement of consensus MRI with final histopathological staging was found (49/54, weighted κ = 0.85), with high sensitivity and specificity. Sensitivity and specificity for involvement of corpus spongiosum, corpora cavernosa, and urethra were 95.5% and 93.8%, 87.5% and 97.8%, and 90.9% and 86.1%, respectively. Sensitivity (89.6%) and specificity (100%) of MRI for predicting adequate disease-free penile length were high. CONCLUSION There were acceptable interobserver agreement and good diagnostic performance of MRI for staging and preoperative assessment without intracavernosal injection, especially for higher stages and higher degrees of invasion which require more extensive surgery.
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Affiliation(s)
- Priya Ghosh
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India.
| | - Aditi Chandra
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Argha Chatterjee
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Dayananda Lingegowda
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Anisha Gehani
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Bharat Gupta
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Sujoy Gupta
- Department of Urological Oncology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, Kolkata, West Bengal, 700160, India
| | - Divya Midha
- Department of Pathology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, Kolkata, West Bengal, 700160, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
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Luzzago S, Serino A, Aurilio G, Mistretta FA, Piccinelli ML, Lorusso V, Morelli M, Bianchi R, Catellani M, Cozzi G, Di Trapani E, Cioffi A, Verri E, Ferro M, Cossu Rocca M, Matei DV, Nolè F, de Cobelli O, Musi G. Penile-sparing surgery for patients with superficial or initially invasive squamous cell carcinoma of the penis: long-term oncological outcomes. Urol Oncol 2021; 39:736.e1-736.e7. [PMID: 34301457 DOI: 10.1016/j.urolonc.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/05/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report long-term oncological outcomes after penile-sparing surgery (PSS) for superficial (Ta-Tis) or initially invasive (T1) penile cancer patients. METHODS We retrospectively analysed 85 patients with Ta/Tis/T1cN0cM0 penile cancer (1996-2018). All patients underwent PSS: circumcision, excision or laser ablation. First, Kaplan-Meier plots and multivariable Cox regression models tested tumor recurrence rates (any local/regional/metastatic). Second, Kaplan-Meier plots depicted progression-free survival (≥T2 or N1-3 or M1 disease). RESULTS Median (IQR) follow-up time was 64 (48-95) months. Overall, 48 (56%) patients experienced tumor recurrence. Median (IQR) time to tumor recurrence was 34 (7-52) months. Higher recurrence rates were observed for Tis (65%) and T1 (64%), compared to Ta (40%), but these differences were not significant on multivariable Cox regression analyses (HR:2.0 with 95% CI [0.9-5.1] and HR:2.2 with 95% CI [0.9-5.9], respectively). Moreover, higher recurrence rates were observed for G2-3 tumors (74%), compared to G1 (57%), but these differences were not significant on multivariable Cox regression analyses (HR:1.6; 95% CI [0.8-3.2]). During follow-up, 15 (17.5%) vs. 18 (21.2%) vs. 10 (11.5%) patients underwent 1 vs. 2 vs. ≥3 PSS. Moreover, 26 (30.6%) and 4 (4.7%) men were treated with glansectomy and partial/total penile amputation due to local progression, tumor size or patient preference. Additionally, 24 (28%) men underwent invasive nodal staging. Last, 22 (25.9%) patients experienced disease progression. Median (IQR) time to disease progression was 51 (31-82) months. CONCLUSION Patients treated with PSS for newly diagnosed superficial or initially invasive squamous cell carcinoma of the penis should be informed about the non-negligible risk of tumor recurrence and disease progression over time. In consequence, strict follow-up protocols are needed.
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Affiliation(s)
- Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
| | - Alessandro Serino
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Gaetano Aurilio
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Mattia Luca Piccinelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Vito Lorusso
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Michele Morelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Catellani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Cioffi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Elena Verri
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Franco Nolè
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
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Anderson E, Yao HH, Chee J. Optimal surgical margin for penile‐sparing surgery in management of penile cancer—Is 2 cm really necessary? BJUI COMPASS 2021; 2:281-285. [PMID: 35475297 PMCID: PMC8988642 DOI: 10.1002/bco2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Classical teaching of a 2 cm macroscopic surgical margin for surgical treatment of primary penile cancer is overly aggressive. Contemporary evidence suggests narrow but clear margins have similar survival outcomes for localized disease. This study aims to determine the oncological outcome of using a risk‐adapted algorithm to selection of macroscopic surgical margin based on biopsy grade of disease: 5 mm margin for grade 1, 10 mm margin for grade 2, and 20 mm margin for grade 3. Methods This is a retrospective case series of patients who underwent penile‐sparing surgery for biopsy‐proven penile SCC by a single surgeon from May 2010 through to January 2019. Clinicopathological data were extracted from medical records. Primary outcome was the positive margin rate. Secondary outcomes were overall survival (OS), cancer‐specific survival (CSS), metastasis‐free survival (MFS), and local recurrence‐free survival (RFS). Kaplan‐Meier survival analysis was used to determine survival outcomes. Results A total of 21 patients were included in this study. The median age was 65. Pre‐operative biopsy grade was grade 1 in 19.1% of patients, grade 2 in 47.6%, and grade 3 in 33.3%. The median size of tumor on examination was 20 mm. Using a grade‐stratified algorithm for macroscopic surgical margin, only one patient (4.8%) had a positive margin. This patient had G1T3 disease and proceeded to have a total penectomy for oncological clearance. The median margin clearance was 7 mm. The 12‐month OS, CSS, MFS, and local RFS were 94.6%, 94.6%, 81.0%, and 92.3%, respectively. Conclusion This study suggests that using a grade‐stratified approach to aim for a narrower macroscopic surgical margin does not appear to significantly alter the oncological outcome, with a negative margin rate of 95.2% in our this series. This enables more men to be eligible for organ preserving surgery and thereby improve their quality of life in the urinary function and sexual function domain. Larger prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Elliot Anderson
- Department of Urology Western Health Melbourne VIC Australia
- Department of Urology Alfred Health Melbourne VIC Australia
| | - Henry Han‐I Yao
- Department of Urology Western Health Melbourne VIC Australia
- Eastern Health Clinical School Monash University Melbourne VIC Australia
| | - Justin Chee
- Department of Urology Western Health Melbourne VIC Australia
- Eastern Health Clinical School Monash University Melbourne VIC Australia
- Department of Urology Alfred Health Melbourne VIC Australia
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Miyamoto H. Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis. Pathol Int 2021; 71:567-580. [PMID: 34154033 DOI: 10.1111/pin.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022]
Abstract
Despite recent improvements in diagnostic and surgical techniques in urological oncology, positive resection margin remains a significant concern for surgeons. Meanwhile, intraoperative pathology consultation with frozen section assessment (FSA), particularly for histological diagnosis of the lesions incidentally found or enlarged or sentinel lymph nodes, generally provides critical information which enables immediate decision making for optimal patient care. The intraoperative evaluation of surgical margins is also often requested, although there are some differences in its application between institutions and surgeons. Importantly, it remains to be determined whether intraoperative FSA indeed contributes to reducing the risk of final positive margins and thereby improving long-term patient outcomes. This review summarizes available data indicating the potential impact of FSA at the surgical margins during urological surgeries, including radical or partial cystectomy, partial nephrectomy, radical prostatectomy, penectomy, and orchiectomy. The accuracy and pitfalls of the intraoperative consultation/FSA diagnosis are also discussed.
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Affiliation(s)
- Hiroshi Miyamoto
- Departments of Pathology & Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, New York, USA
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34
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Stecca CE, Alt M, Jiang DM, Chung P, Crook JM, Kulkarni GS, Sridhar SS. Recent Advances in the Management of Penile Cancer: A Contemporary Review of the Literature. Oncol Ther 2021; 9:21-39. [PMID: 33454930 PMCID: PMC8140030 DOI: 10.1007/s40487-020-00135-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
Penile cancer is a rare condition, which mostly affects men in their sixth decade of life. The most common histology is squamous cell carcinoma (SCC), with about half of the cases linked to human papilloma virus (HPV) infection. The lack of awareness and significant social and psychological stigma associated with penile cancer often leads to delays in presentation, diagnosis and management. Timely multidisciplinary care at experienced centers is therefore critical for improving outcomes. For patients with advanced disease, treatment options are limited and prognosis remains poor. Large international efforts are underway to further define the optimal standards of care. Targeted therapies and immune checkpoint inhibitors could potentially play a role in advanced disease and are under evaluation in clinical trials. In this review, we discuss the current management of penile cancer and future directions.
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Affiliation(s)
- Carlos E Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marie Alt
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Juanita M Crook
- Department of Radiation Oncology, BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, Vancouver, British Columbia, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Preto M, Falcone M, Blecher G, Capece M, Cocci A, Timpano M, Gontero P. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021; 18:1099-1103. [PMID: 37057466 DOI: 10.1016/j.jsxm.2021.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date. AIM The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC). METHODS From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12. OUTCOMES Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item "ad hoc" telephone questionnaire administered at 1 year post procedure. RESULTS 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13-77) months. Median age was 62 (IQR 55-68). Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients. CLINICAL IMPLICATIONS TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions STRENGTHS AND LIMITATIONS: Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking. CONCLUSION TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions. M. Preto, M. Falcone, G. Blecher, et al. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021;18:1099-1103.
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Affiliation(s)
- Mirko Preto
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy.
| | - Marco Falcone
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy; Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Italy
| | - Gideon Blecher
- Adjunct Lecturer, Department of Surgery. Monash University. Melbourne (Australia) Wellington Rd, Clayton VIC, Australia; Urology Consultant. Department of Urology, The Alfred Hospital. Melbourne, Melbourne VIC, Australia
| | - Marco Capece
- Urology department, Federico II Hospital, University of Naples, Italy
| | - Andrea Cocci
- Urology department, Careggi Hospital, University of Florence, Florence, Italy
| | - Massimiliano Timpano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
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Oo MM, Leow JJ, Lau W. Penile preserving surgery in penile cancer management. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Mon M Oo
- Khoo Teck Puat Hospital, Singapore
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37
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Oncologic outcomes and subsequent treatment following organ sparing surgery for penile carcinoma: The University of Texas M.D. Anderson Cancer Center Experience. Urol Oncol 2021; 39:302.e19-302.e27. [PMID: 33612354 DOI: 10.1016/j.urolonc.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the oncologic outcomes of organ sparing surgery (OSS) for penile cancer and to determine the management of and risk factors for local recurrence at a tertiary referral center in the United States. METHODS AND MATERIALS Patients undergoing OSS from 1996 to 2018 at The University of Texas, MD Anderson Cancer Center were identified using a prospective database. Organ sparing procedures included: wide local excision (WLE; including circumcision and glans resurfacing), partial or total glansectomy, laser therapy, or OSS combined with laser ablation (i.e., laser combination). Clinical and pathologic data were collected for descriptive analysis. Recurrences (local and regional) were identified, and the association between overall and local recurrences was determined using Cox proportional hazards regression. Overall and recurrence free survival analyses were performed using Kaplan-Meier estimates. RESULTS A total of 129 patients undergoing OSS were identified with a median follow up interval of 28.0 months. The most common OSS was laser combination (38.8%), and 65.1% of patients presented with pTis or ≤pT1a disease. Twenty (15.5%) recurrences were identified, of which 17 (13.2%) were local and 3 (2.3%) were regional. There were no distant recurrences as the initial site of recurrence. The median time to local recurrence was 20.9 months, and 88.2% were identified within 5 years of surgery. Most (76.5%) local recurrences were successfully treated with further penile preservation without a detrimental impact on overall survival. Patients with pathologic Ta or T1a disease treated with laser or laser combination surgery were more likely to present with local recurrence. CONCLUSION OSS using a variety of techniques to achieve negative surgical margins provides long-term effective local control for localized penile cancer. Most local recurrences can be successfully treated with further penile preserving strategies and long follow-up is essential. Laser therapy or laser combination with OSS should be used with caution in patients with invasive penile cancer.
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Emmanuel A, Watkin N. Update on organ preserving surgical strategies for penile cancer. Urol Oncol 2021; 40:179-183. [PMID: 33610446 DOI: 10.1016/j.urolonc.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/13/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
With the passage of time, there has been a major paradigm shift in the surgical management of penile cancer from radical to organ preserving penile surgical techniques, with closer surgical margins which offer good oncological, cosmetic and functional outcomes with improved physical and psychosexual well-being. This article aims to provide an update of the current organ preserving surgical strategies for penile cancer.
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Affiliation(s)
- Anthony Emmanuel
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Nick Watkin
- Penile Cancer Centre, St George's Healthcare NHS Trust, London, UK
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Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran ATH, Van Rompuy AS, Spiess PE, Albersen M. Penile cancer. Nat Rev Dis Primers 2021; 7:11. [PMID: 33574340 DOI: 10.1038/s41572-021-00246-5] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/27/2022]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.
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Affiliation(s)
- Anita Thomas
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Andrea Necchi
- Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Asif Muneer
- Department of Urology, University College London Hospitals, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Marcos Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, Instituto do Cancer Vieira de Carvalho, São Paulo, Brazil
| | - Anna Thi Huyen Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium. .,Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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Thomas A, Kölling F, Haferkamp A, Tsaur I. [Quality of care criteria in the treatment of penile cancer]. Urologe A 2021; 60:186-192. [PMID: 33452551 DOI: 10.1007/s00120-020-01429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Penile cancer is a rare malignancy and the wide range of quality of care associated with it often results in inferior oncologic and functional treatment outcomes. OBJECTIVES Assessment of the current healthcare situation in clinical routine and identification of the relevant key features and reference values for quality of care. MATERIALS AND METHODS Search for relevant peer-reviewed articles and published congress abstracts in Medline, Embase and other databases as well as Google web search engine. RESULTS Key quality features of penile cancer management include organ-sparing surgery of the primary tumor, invasive inguinal lymph node staging and systemic treatment. Adherence to treatment guidelines is currently low. Centralization of care has already led to a considerable improvement in the quality of care in some areas and increasing conformity with the guidelines' recommendations. CONCLUSION Centralization of care and networks based on this can significantly improve patient outcomes. Thus, reference values for core parameters of quality cancer care can be generated and validated. Moreover, organ-sparing surgery, invasive lymph node staging and systemic therapy should be increasingly utilized. As a reference value, 90% adherence to the guidelines for these three features is recommended. However, before centralization of care can be introduced, aspects relevant to practical implementation must be addressed, such as the reimbursement of travel costs for those affected, infrastructure costs and instruments to measure quality of life and patient satisfaction after centralization.
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Affiliation(s)
- A Thomas
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - F Kölling
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Haferkamp
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - I Tsaur
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Chahoud J, Skelton WP, Spiess PE, Walko C, Dhillon J, Gage KL, Johnstone PAS, Jain RK. Case Report: Two Cases of Chemotherapy Refractory Metastatic Penile Squamous Cell Carcinoma With Extreme Durable Response to Pembrolizumab. Front Oncol 2020; 10:615298. [PMID: 33425770 PMCID: PMC7793656 DOI: 10.3389/fonc.2020.615298] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/17/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Penile squamous cell carcinoma (PSCC) is a rare malignancy, and those patients with metastatic disease have limited treatment options. Treatment is largely comprised of platinum-based chemotherapy; however, patients progressing after initial chemotherapy have a median overall survival (OS) of less than 6 months. Based on a high percentage of PD-L1 expression in patients with PSCC, and its biological similarities to other squamous cell carcinomas, we present two patient cases treated with pembrolizumab with extraordinary durable treatment response far beyond treatment with standard therapy. MAIN BODY The first patient is a 64 year old male with PSCC who was treated with neoadjuvant chemotherapy, partial penectomy, and adjuvant radiation prior to developing metastatic disease. He had a high TMB (14 mutations/Mb) and was started on pembrolizumab with a complete response, which has been maintained for 38 months. The second patient is an 85 year old male with PSCC who was treated with partial penectomy and adjuvant chemotherapy and radiation prior to developing metastatic disease. He had positive PD-L1 expression CPS 130) and was started on pembrolizumab with a partial response, which has been maintained for 18 months after starting treatment. CONCLUSIONS These two cases of extreme durable response with pembrolizumab (with molecular data including TMB and PD-L1 status) represent a significant clinical benefit in this patient population. With limited treatment options that result in a median OS of less than 6 months, along with the toxicity profile of chemotherapy which may not be tolerated in elderly patients with comorbidities, this survival benefit with pembrolizumab, along with advances in tumor sequencing and clinical trials shows that there is a potentially significant benefit with novel therapies in this patient population.
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Affiliation(s)
- Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - William Paul Skelton
- Division of Medical Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Philippe E. Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Christine Walko
- Division of Individualized Cancer Management, Personalized Medicine, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Jasreman Dhillon
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Kenneth L. Gage
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Peter A. S. Johnstone
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Rohit K. Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
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42
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Lukowiak TM, Perz AM, Aizman L, Kovell RC, Kovach S, Fischer JP, Krausz A, Giordano C, Higgins HW, Shin TM, Sobanko JF, Etzkorn JR, McMurray S, Chelluri R, Guzzo T, Miller CJ. Mohs micrographic surgery for male genital tumors: Local recurrence rates and patient-reported outcomes. J Am Acad Dermatol 2020; 84:1030-1036. [PMID: 33279645 DOI: 10.1016/j.jaad.2020.11.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Local recurrence rates (LRRs) after Mohs micrographic surgery (MMS) for male genital cancers have been reported in only a few small case series, and patient-reported outcomes (PROs) have not been studied. OBJECTIVE To determine the LRR and PROs after MMS for male genital skin cancers. METHODS Retrospective review of all male genital skin cancers removed with MMS between 2008 and 2019 at an academic center. LRR was determined by chart review and phone calls. PROs were assessed by survey. RESULTS A total of 119 skin cancers in 108 patients were removed with MMS. Tumors were located on the penis (90/119) and scrotum (29/119). Diagnoses included squamous cell carcinoma in situ (n = 71), invasive squamous cell carcinoma (n = 32), extramammary Paget disease (n = 13), melanoma (n = 2), and basal cell carcinoma (n = 1). The LRR was 0.84% (1/119), with a mean follow-up time of 3.25 years (median, 2.36 years). The majority of survey respondents reported no changes in urinary (66%) or sexual functioning (57.5%) after surgery. LIMITATIONS Retrospective single-center experience; short follow-up time; low survey response rate; no baseline functional data. CONCLUSION MMS for male genital skin cancer has a low LRR and high patient-reported satisfaction with urinary and sexual function.
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Affiliation(s)
- Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Leora Aizman
- George Washington School of Medicine and Health Sciences, Washington, DC
| | - Robert Caleb Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Stephen Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
| | - Aimee Krausz
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy McMurray
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raju Chelluri
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Thomas Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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43
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Abstract
Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.
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Affiliation(s)
- Henry Han-I Yao
- Department of Urology, Eastern Health, Melbourne, Australia.,Department of Urology, Western Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia.,Department of Urology, Alfred Health, Melbourne, Australia
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44
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O'Neill S, Barns M, Vujovic F, Lozinskiy M. The role of penectomy in penile cancer-evolving paradigms. Transl Androl Urol 2020; 9:3191-3194. [PMID: 33457290 PMCID: PMC7807362 DOI: 10.21037/tau.2019.08.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Penile cancer is a rare cancer, with the majority treated with penile preserving methods. There remains a role for partial and totally penectomy for advanced and more proximal penile cancers. Significant functional and psychological morbidity can ensue for patients undergoing surgical management. Recent studies and guidelines are changing the way Urologists approach surgical management of penile malignancies. Reductions in safe surgical margin recommendations from 2 cm to 3–5 mm provide surgeons with the ability to perform penile preserving techniques to maximise patient functionality. These guidelines are reflected by recent studies showing that smaller surgical margins; although heralding higher rates of local recurrence, have no detriment on cancer specific or overall survival rate. Although oncological clearance remains the primary outcome for surgical management of penile cancer, the ability to perform radical salvage surgery at a later date means patients are more likely to experience a longer period of functionality without sacrificing oncologic outcomes. The importance of patient education on regular self-examination as well as clinic follow up are key in identifying local recurrence and planning salvage surgery if needed to maintain oncologic control. Ongoing studies into the functional and psychological outcomes of patients undergoing partial penectomy show encouraging results however further studies are needed to elucidate long-term outcomes. The evolving paradigm of surgical management in penile malignancy is shifting to favour organ preserving techniques in order to maximise functional, psychological and aesthetic outcomes without compromising patients’ oncologic outcomes—however a role still exists for radical surgery in advanced penile malignancy.
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Affiliation(s)
- Sarah O'Neill
- Department of Urology, Royal Perth Hospital, Perth, Australia
| | - Mitchell Barns
- Department of Urology, Royal Perth Hospital, Perth, Australia
| | - Filip Vujovic
- Department of Urology, Royal Perth Hospital, Perth, Australia
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45
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Roussel E, Peeters E, Vanthoor J, Bozzini G, Muneer A, Ayres B, Sri D, Watkin N, Bhattar R, Parnham A, Sangar V, Lau M, Joice G, Bivalacqua TJ, Chipollini J, Spiess PE, Hatzichristodoulou G, de Vries L, Brouwer O, Albersen M. Predictors of local recurrence and its impact on survival after glansectomy for penile cancer: time to challenge the dogma? BJU Int 2020; 127:606-613. [PMID: 33180969 DOI: 10.1111/bju.15297] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify predictive pathological factors for local recurrence (LR) and to study the impact of LR on survival in patients treated with glansectomy for penile squamous cell carcinoma (pSCC). PATIENTS AND METHODS We retrospectively studied patients treated with glansectomy at international, high-volume reference centres. We analysed histopathological predictors of LR, stratified patients into risk groups based on the number of risk factors present, and studied the impact of LR on survival outcomes using Kaplan-Meier survival analysis and stepwise Cox proportional hazards regression models. Subsequently, we performed sensitivity analyses excluding margin-positive cases, pT3 disease, and cN+ disease, or all of these factors. RESULTS Across nine institutions, 897 patients were included, of whom 94 experienced LR. On multivariable analysis, presence of high-grade disease and pT3 stage were independent predictors of LR. LR-free survival rates significantly differed according to the number of risk factors present, with a hazard ratio (HR) of 1.90 (95% confidence interval [CI] 1.17-3.07; P = 0.01) for the intermediate-risk group (one risk factor) and 6.11 (95% CI 3.47-10.77; P < 0.001) for the high-risk group (two risk factors), using the low-risk group (no risk factors) as reference. Patients who experienced LR had significantly worse overall survival (OS; HR 2.89, 95% CI 2.02-4.14; P < 0.001) and cancer-specific survival (CSS; HR 5.64, 95% CI 3.45-9.22; P < 0.001). LR (HR 3.82, 95% CI 2.14-6.8; P < 0.001), lymphovascular invasion and cN status were significant predictors of decreased CSS. LR remained a strong predictor of both OS and CSS in all sensitivity analyses. CONCLUSIONS Pathological T3 stage and presence of high-grade disease were independent histopathological predictors of LR after glansectomy for primary pSCC, which allowed risk stratification into three groups with significantly different risk of developing LR. Additionally, LR is related to poor OS and CSS, indicating that LR is a manifestation of underlying aggressive disease and clearly challenging the dogma of using organ-sparing surgery whenever possible since survival is unaffected by higher LR rates.
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Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Eline Peeters
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Joren Vanthoor
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto A. Varese, Lombardia, Italy
| | - Asif Muneer
- Department of Urology and NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Ben Ayres
- Department of Urology, NHS Foundation Trust, St.-George's University Hospitals, London, UK
| | - Denosshan Sri
- Department of Urology, NHS Foundation Trust, St.-George's University Hospitals, London, UK
| | - Nick Watkin
- Department of Urology, NHS Foundation Trust, St.-George's University Hospitals, London, UK
| | - Rohit Bhattar
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Arie Parnham
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Vijay Sangar
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Maurice Lau
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Gregory Joice
- Department of Urology, Johns Hopkins Medical Institutes, Baltimore, MD, USA
| | | | - Juan Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Lieke de Vries
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar Brouwer
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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46
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Ahmed ME, Khalil MI, Kamel MH, Karnes RJ, Spiess PE. Progress on Management of Penile Cancer in 2020. Curr Treat Options Oncol 2020; 22:4. [PMID: 33230601 DOI: 10.1007/s11864-020-00802-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OPINION STATEMENT Management of penile cancer represents a challenge to urologic oncologists due to the disease's rarity and sparse data in the literature. Squamous cell carcinoma represents the most common histologic subtype of penile cancer. Penile cancer has a disastrous effect on patients' psychological and physical health. Penile cancer accounts for approximately 1% of cancer deaths in the USA annually. However, in recent years, the management of penile cancer has achieved marked progress in both diagnostic and therapeutic approaches with the intent to avoid radical surgeries. The traditional total penile amputation has been replaced by penile preserving procedures in many patients. Nowadays, total penile amputation (total penectomy) is preserved only for patients with proximal lesions. The introduction of minimally invasive surgical techniques in the management of penile cancer-infiltrated lymph nodes has been reported. Given the dismal prognosis with conventional cytotoxic therapies, new systemic therapies have been investigated in patients with locally advanced or metastatic penile cancer. Multiple studies have shown promising outcomes. All these efforts have resulted in a remarkable improvement in patient quality of life. The objectives of our review are to update clinicians on the advances in the management of penile cancer and to summarize the recent guidelines and recommendations.
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Affiliation(s)
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | | | - Philippe E Spiess
- Department of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. .,Department of GU Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA. .,Urology and Oncology, University of South Florida, Tampa, FL, USA.
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47
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Abstract
Penile cancers are rare malignancies. Traditional surgical options, including partial and total penectomy, can dramatically affect a patient's quality of life and mental health. In select patients, penile sparing techniques (PST) have the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual function, and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of the various PST currently available for men seeking an organ-preserving option for their penile cancer.
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Affiliation(s)
- Andrew Fang
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA
| | - James Ferguson
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA.,The University of Alabama, Birmingham School of Medicine- O'Neal Comprehensive Cancer Center , Birmingham, AL, USA
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48
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Falcone M, Preto M, Oderda M, Timpano M, Russo GI, Capogrosso P, Cocci A, Fode M, Gontero P. Total Glans Resurfacing for the Management of Superficial Penile Cancer: A Retrospective Cohort Analysis in a Tertiary Referral Center. Urology 2020; 145:281-286. [DOI: 10.1016/j.urology.2020.06.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
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49
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Abualruz AR, O'Malley R, Ponnatapura J, Holbert BL, Whitworth P, Tappouni R, Lalwani N. MRI of common penile pathologies and penile prostheses. Abdom Radiol (NY) 2020; 45:2825-2839. [PMID: 31154485 DOI: 10.1007/s00261-019-02080-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
MRI can delineate finer details of penile anatomy and pathology due to inherent higher soft-tissue contrast and spatial resolution. It can characterize inflammation and identify abscesses, localize penile fractures, guide surgical planning in penile fibrosis and Peyronie's disease, and depict components of the penile prosthesis and its complications. MRI is a great investigative tool for penile neoplasms, including locally infiltrative neoplasms where clinical examination is limited, and local staging is crucial for surgical planning.
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Affiliation(s)
- Abdul-Rahman Abualruz
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ryan O'Malley
- University of Washington, 1959 NE Pacific St, Seatle, WA, 98195, USA
| | - Janardhana Ponnatapura
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Brenda L Holbert
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Pat Whitworth
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Rafel Tappouni
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Neeraj Lalwani
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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50
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Current management and future perspectives of penile cancer: An updated review. Cancer Treat Rev 2020; 90:102087. [PMID: 32799062 DOI: 10.1016/j.ctrv.2020.102087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
Penile cancer (PeCa) is a rare disease worldwide, accounting for less than one percent of all malignancies in men. It usually presents as a painless ulcer or lump on the head of the penis. Squamous cell carcinoma represents the most common histological subtype of PeCa, with pathogenesis intimately linked to chronic Human Papilloma Virus (HPV) infection. Surgery is the cornerstone for the treatment of primary PeCa with potential mutilating outcome depending on the nodal extension of the disease. However, in case of extensive lymph node involvement, multidisciplinary treatment including perioperative chemotherapy and inclusion in clinical trial should be considered. To date, advanced or metastatic disease still have poor prognosis and are a therapeutic challenge with limited options, highlighting the need of new treatments and further investigations. Growing efforts to identify molecular alterations, understand the role of HPV and characterize immune contexture have expanded over the past years, providing further perspectives in prognostication, predictive biomarkers and therapeutic intervention. In this review, we provide an updated overview of current management of PeCa focusing on perioperative strategy. We discuss about new insights of the biology of PeCa and comment future directions in the field.
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