Penis cancer management: insight into the future

Abstract

The report of Jakobson et al. [1] assesses the results of the sentinel node procedure for penis carcinoma in Denmark. The sentinel node procedure was done in four university hospitals. In this geographically small country with little more than 5.6 million inhabitants and a case load of 50 patients with penis cancer per year, a distribution of care of patients with penis cancer over four hospitals seems reasonable at first sight.The results show interesting elements. With a false-negative rate of 10.8%, the figure is in accordance with what is known from other series, albeit at the high end of the range [2]. The authors rightly acknowledge that there is room for improvement. It seems likely that centralising the procedure to two hospitals, as of 2009, will be instrumental in this endeavour.The authors did not find a learning curve, underscoring the safe introduction of this procedure.The experience testifies to the reliability of the procedure with a minimum of complications and morbidity. Despite interinstitutional variation no major differences were detected. The authors conclude that 76% of node dissections could be avoided.More than 15 years after the first publication on the sentinel node procedure in a urological cancer, the debate on how to manage clinically node-negative patients is still not completely settled and the sentinel node procedure in penis cancer is not universally accepted [3]. Why?There has been no randomised study comparing standard inguinal lymph node dissection to the sentinel node procedure. Comparisons of series with standard node dissection vs the sentinel node procedure have shown improved survival for the latter [4]. Nevertheless, in the absence of randomisation these figures have not convinced the whole urological community.Advocates of the sentinel node procedure tend to emphasise the avoidance of unnecessary inguinal node dissections. Opponents tend to emphasise the false-negative rates with its ensuing risk of seriously jeopardising the patients, as some of the patient die from disease.Oncological care has to seek the most rational balance between too much and too little, realising that 100% success does virtually not exist. It is reasonable to assume that if all elements of the chain necessary to deliver state-of-the-art treatment of penis cancer, the figures of false-negative sentinel node procedures should be around 4-5%. With meticulous follow-up, recurrences should be detected at the earliest possible moment, decreasing the risk of a fatal outcome. A 5% risk is a generally accepted figure to avoid a potentially harmful procedure. New tracers give hope that false-negative rates can even be improved, realising again that some failures have to be accepted as a fact of life [5,6].Opponents point to the technicalities of the procedure. True as it is, there is no modern hospital without all the equipment and the expertise, accumulated in other areas in oncology, necessary to perform a state of the art sentinel node procedure.Is there reluctance to refer patients with penis cancer...

Get insight into the cause of death distribution and epidemiology of penile squamous cell carcinoma: A population‐based study

“…Interestingly, we found that the proportion of patients who died of PSCC has increased significantly in recent years, and the proportion has exceeded that of the non‐cancer disease for the calendar of 2012–2017 (Table 3). Several previous studies pointed out that the tumor stage of PSCC was one of the most crucial prognostic factors 11,15,24–26 . For instance, patients with a metastasizing malignant tumor were accompanying distinctly shorter survival time and higher recurrence rate 25,26 .…”

“…prognostic factors. 11,15,[24][25][26] For instance, patients with a metastasizing malignant tumor were accompanying distinctly shorter survival time and higher recurrence rate. 25,26 In this study, the percentage of PSCC patients classified with localized stage were shown a decline ranging from 65.08% to 52.76% for the calendar of 1992-2001 and 2012-2017, respectively.…”

Cancer du pénis : problèmes pratiques du quotidien, de la biopsie à la chirurgie

“…A noter qu'en cas de positivité du ganglion sentinelle une lymphadenectomie inguinale totale est recommandée du côté pN+ et une lymphadenectomie superficielle du côté pN0.Le curage inguinal modifie ́ est définit par la réalisation d'un curage concerne les quadrants supérieur et central [autour de la veine saphène] chez les patients cN0 a ̀ risque[27].…”