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Authors Veeratterapillay R, Teo L, Asterling S, Greene D.
Review Date July 2015
Citation Urology 2015; 85: 1097-1103
Penile cancer is a rare cancer in western countries but more common in some Asian, African and South American countries. Most penile cancers are squamous cell carcinomas. In the past, treatments (radical radiotherapy and amputative penile surgery) have had poor functional outcomes but more recently organ-preserving surgery has been more common with much better functional outcomes. However, due to the rarity of penile cancer, long-term outcomes of contemporary treatments are not well described.
The authors used data from a single centre over a 10-year period to report contemporary treatment outcomes of penile squamous cell carcinoma at a UK tertiary supraregional center. The outcomes included type of treatment, oncologic results, and long-term survival.
Patients with squamous cell carcinoma treated during the period January 2000 to January 2011, with complete medical records and follow-up data of at least 3 years, were included in the study. Medical records were reviewed to identify the mode of therapy (penile preserving or amputative surgery), pathology reports (reclassified according to the 2009 tumor-nodes-metastasis (TNM) classification), recurrence patterns, and cancer-specific survival (CSS). Kaplan-Meier plots were used for survival analyses.
203 patients (median age 62.6 years; range 32-89) were identified with a median follow-up of 61 months. At presentation, 165 patients (82%) were node negative, 31 (15%) were node positive, and 7 (3%) had metastatic disease. Initial treatments included penile preserving surgery (n = 99, 49%), partial penectomy (n = 49, 24%), radical penectomy (n = 48, 24%), and chemotherapy or radiotherapy for metastatic disease (n = 7, 3%).
After organ-preserving surgery, local recurrence occurred in 18 patients (18%, compared with 4% for amputative surgery), with 17 of the 18 recurrences occurring within 3 years. Of the 18 recurrences, only 3 had radical penectomy while the other 15 had repeat organ-preserving surgery or laser therapy.
Histopathologic staging was as follows, with pTis (20%), pT1 (27%), pT2 (27%), pT3 (7%), and pT4 (1%). Over the study period, 27 (13%) patients died of penile cancer. Kaplan-Meier analysis showed a 5-year CSS of 85% and a 10-year CSS of 81%. Five-year CSS was noted to decrease with advancing stage with pN0 tumors (92%), N1 (73%), N2 (61%), N3 (33%), and M1 (0%; P <.0001).
Data from this supraregional centre in the UK with substantial experience in penile cancer management shows good outcomes for penile cancers over the past decade with improvements over time. There has been an increase in the use of penile-preserving surgery over the years resulting in improved functional, psychosexual and cosmetic outcomes. However, close follow-up is vital to pick up local recurrence after penile-preserving surgery as most had successful salvage treatment with further organ-preserving surgery. Overall oncologic outcomes are good with a 5-year CSS of 85% (92% for node-negative disease).
Points to Note
- This contemporary follow-up study of patients treated for penile cancer showed that survival after treatment for localised penile cancer is good, particularly when there is no nodal involvement.
- The increasing use of organ-sparing surgery rather than amputative surgery has not resulted in adverse survival outcomes and has better cosmetic, functional and psychosexual outcomes.
- The decreased survival with increasing nodal involvement suggests early diagnosis is important, although this may be hampered by the rarity of penile cancer leading to limited experience of doctors with diagnosis and treatment.
- The limitations of the study include the retrospective nature of the data collection and the fact that only those with complete medical records were included; the number of patients excluded due to follow-up care being provided outside this centre was not stated.
- This study was based in the UK but it is likely that similar contemporary treatments – surgical and other forms of treatment – are being used in Australia.