Therapeutic Approaches to Penile Cancer: Standards of Care and Recent Developments

White, Joshua; Mason, Ross; Lawen, Tarek; Spooner, Jesse; Faria, Kauy VM; Rahman, Farah; Ramasamy, Ranjith

doi:10.2147/rru.s387228

Cited by 3 publications

(2 citation statements)

References 75 publications

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“…According to White et al, adjuvant multimodal therapy should be done for patients with high-risk features, principally pelvic lymph node metastases, extranodal extension, bilateral inguinal lymph node involvement, and tumor size >4 cm [ 13 ]. According to recent recommendations of the European Association of Urology (EAU), the optimal indication and order for multimodal treatment strategies for penile cancer with loco-regional lymph node involvement is difficult to discern.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Therapy of Locally-Advanced Penile Cancer: A Case Report With Literature Review

Bouabid,

Margoum,

BenSghier

et al. 2024

Cureus

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Cancer of the penis is a rare tumor that occurs in the elderly. Because of its rarity, it is often not diagnosed early, and its treatment poses difficulties for practicing oncologists. We report the case of an elderly patient treated for locally advanced squamous cell carcinoma (SCC) of the penis, with a review of the literature. A 71-year-old man, who had been complaining of pruritus on the penis two years ago, presented with an ulcerated lesion on the prepuce and the glans. A biopsy of the lesion with pathological study showed a SCC of the penis. Pelvic MRI showed tumor thickening centered on the glans of the penis, infiltrating the fascia and the spongy urethra with discrete upstream dilatation and bilateral inguinal adenomegaly. CT scan of the neck, chest, abdomen, and pelvis showed no secondary localizations. Treatment initially consisted of carcinological surgery by a partial penectomy with bilateral inguinal lymph node dissection. The tumor was therefore classified as pT3N3M0. A PET CT scan performed later was in favor of local and regional recurrence. Surgery was not feasible, so concomitant chemo-radiotherapy was indicated at a total dose of 70 Gy in 35 fractions of 2 Gy concomitantly with platinum-based chemotherapy, withgood evolution.

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Section: Discussionmentioning

confidence: 99%

Multimodal Therapy of Locally-Advanced Penile Cancer: A Case Report With Literature Review

Bouabid,

Margoum,

BenSghier

et al. 2024

Cureus

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“…In recent years, MRI has evolved to become an important adjunct to the physical examination or, in some equivocal cases, as an alternative investigation. In addition, it is important to recognise T2+ disease which carries an increased risk for micro-metastatic inguinal node involvement in patients with impalpable nodes who would then be considered for prophylactic groin node dissection or sentinel lymph node biopsy [ 9 ]. The use of an intra-cavernosal injection of prostaglandin E1 to attain an erection during MRI was thought to further improve the staging accuracy of the primary.…”

Section: Discussionmentioning

confidence: 99%

Does MRI Have a Role in the Preoperative Staging of Penile Cancer?

Iqbal,

Shendy,

McClune

et al. 2024

Cureus

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Background Penile cancer is a rare malignancy usually requiring surgery to achieve oncological control of the primary tumour but often at the expense of functional length. The presenting stage of the primary is a crucial factor in determining the most appropriate surgical procedure. Accurate preoperative staging is essential, and current modalities include clinical and radiological assessment. Clinical staging can, however, be hampered by patient body habitus and unreliable for more advanced T4 tumours, whereas radiological staging allows for more detailed identification of tissue planes and tumour involvement. There is no clear consensus on the preferred imaging technique, although, in the current European Association of Urology penile cancer guidelines, MRI is recommended with the use of ultrasound when MRI is not available. It was recommended that having the penis in an erect state by the administration of intra-cavernosal prostaglandin gave a more detailed picture enabling a greater predictor of corporal involvement. Recent studies have, however, suggested that there may be no such advantage. Methodology A retrospective review was conducted of all patients who underwent surgery for penile cancer comparing the preoperative MRI stage with the final pathological stage between July 2009 and June 2023. In addition to the MRI, patients were given an intra-cavernosal injection of prostaglandin E1 to induce tumescence unless otherwise indicated. All imaging was reported by a single consultant uro-radiologist with surgery undertaken by a single surgeon and pathology reviewed through the supra-regional penile multidisciplinary team. Results A total of 136 penile cancer patients were included in the review. Within this cohort, 98 patients had an MRI without intra-cavernosal prostaglandin and the number who had Ta, T1, T2, T3 and T4 histopathological stages was 3, 31, 45, 18, and 1, respectively. The preoperative MRI stage had a low agreement with the final histological stage for early tumours, with sensitivities and specificity of 35% and 97% for T1 and 56% and 80% for T2, respectively. Sensitivity and specificity increased for cavernosal involvement at 83% and 95%, respectively. In addition, a further 38 patients had an MRI in conjunction with an injection of prostaglandin E1 which failed to show any diagnostic improvement in sensitivity or specificity in the preoperative MRI stage. Conclusions The use of MRI as a preoperative modality for staging penile cancer performs best for identifying tumour involvement of the cavernosal bodies. Performing the MRI with the penis erect with the use of an intra-cavernosal injection did not offer any additional benefit in accurately staging penile cancer.

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Follow Up Care After Penile Sparing Surgery for Penile Cancer: Current Perspectives

Lasorsa,

Bignante,

Orsini

et al. 2024

RRU

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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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Therapeutic Approaches to Penile Cancer: Standards of Care and Recent Developments

Cited by 3 publications

References 75 publications

Multimodal Therapy of Locally-Advanced Penile Cancer: A Case Report With Literature Review

Multimodal Therapy of Locally-Advanced Penile Cancer: A Case Report With Literature Review

Does MRI Have a Role in the Preoperative Staging of Penile Cancer?

Follow Up Care After Penile Sparing Surgery for Penile Cancer: Current Perspectives

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