Skip to main content
NCBI home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 2001 May;83(3):180–185.

Penile cancer: a case for guidelines.

N P Munro 1, P J Thomas 1, G P Deutsch 1, N J Hodson 1
PMCID: PMC2503582  PMID: 11432137

Abstract

INTRODUCTION: Aspects of the management of penile cancer remain controversial. In the management of early T1 N0 disease, treatments are divided between amputation and a variety of penis conserving techniques (PCT); local excision, laser techniques, chemotherapy and radiotherapy. We report on a retrospective series of patients with penile cancer. PATIENTS AND METHODS: Thirty-seven patients were diagnosed between 1987-1996. All patients records were retrieved. Data recorded included TNM stage, histological grade and treatment. The end-points were death, nodal progression and local recurrence. RESULTS: Median survivor follow-up of 42 months was obtained. Twenty-six patients (70%) presented with T1 disease, 7 (19%) T2 and 4 (11%) T3 or T4. Inguinal nodal disease was seen in 11 (30%). The mean age was 63 years. Overall, 13 penile amputations were performed, 13 underwent radiotherapy, 6 were locally excised in combination with radiotherapy and 3 underwent local excision alone. Two patients were unsuitable for treatment. Of the total (37 patients) 15 have died; 12 from penile cancer. Ten have suffered disease progression and 12 remain alive with no evidence of disease. Twenty-three patients presented with early T1 NO disease. They were treated with radiotherapy (12), local excision (2), combined radiotherapy and excision (2) and partial amputation (4). Outcome was not significantly related to treatment modality. Spread to the inguinal nodes or local recurrence has occurred in 10, of whom 2 have died. Only 13 (57%) appear disease-free. CONCLUSIONS: The characteristics of the patients and the disease in this series are similar to published series in Europe and North America. There is significant variability in the modalities of treatment used within this series. Local recurrence and disease progression occurs in 43% of T1 N0 lesions. There would seem to be some room for improvement. International data are retrospective and inconclusive with regard to best practice. There is an urgent requirement for randomised controlled trials to improve the outcome of these patients.

Full text

PDF
180

Images in this article

182Figure 1
on p.182

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adeyoju A. B., Thornhill J., Corr J., Grainger R., McDermott T. E., Butler M. Prognostic factors in squamous cell carcinoma of the penis and implications for management. Br J Urol. 1997 Dec;80(6):937–939. doi: 10.1046/j.1464-410x.1997.00477.x. [DOI] [PubMed] [Google Scholar]
  2. Bandieramonte G., Lepera P., Marchesini R., Andreola S., Pizzocaro G. Laser microsurgery for superficial lesions of the penis. J Urol. 1987 Aug;138(2):315–319. doi: 10.1016/s0022-5347(17)43132-6. [DOI] [PubMed] [Google Scholar]
  3. Brkovic D., Kälble T., Dörsam J., Pomer S., Lötzerich C., Banafsche R., Riedasch G., Staehler G. Surgical treatment of invasive penile cancer--the Heidelberg experience from 1968 to 1994. Eur Urol. 1997;31(3):339–342. doi: 10.1159/000474479. [DOI] [PubMed] [Google Scholar]
  4. Burgers J. K., Badalament R. A., Drago J. R. Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am. 1992 May;19(2):247–256. [PubMed] [Google Scholar]
  5. Cabanas R. M. Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am. 1992 May;19(2):267–276. [PubMed] [Google Scholar]
  6. Edsmyr F., Andersson L., Esposti P. L. Combined bleomycin and radiation therapy in carcinoma of the penis. Cancer. 1985 Sep 15;56(6):1257–1263. doi: 10.1002/1097-0142(19850915)56:6<1257::aid-cncr2820560606>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  7. Fraley E. E., Zhang G., Manivel C., Niehans G. A. The role of ilioinguinal lymphadenectomy and significance of histological differentiation in treatment of carcinoma of the penis. J Urol. 1989 Dec;142(6):1478–1482. doi: 10.1016/s0022-5347(17)39130-9. [DOI] [PubMed] [Google Scholar]
  8. Fraley E. E., Zhang G., Sazama R., Lange P. H. Cancer of the penis. Prognosis and treatment plans. Cancer. 1985 Apr 1;55(7):1618–1624. doi: 10.1002/1097-0142(19850401)55:7<1618::aid-cncr2820550735>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  9. Heyns C. F., van Vollenhoven P., Steenkamp J. W., Allen F. J. Cancer of the penis--a review of 50 patients. S Afr J Surg. 1997 Aug;35(3):120–124. [PubMed] [Google Scholar]
  10. Hoffman M. A., Renshaw A. A., Loughlin K. R. Squamous cell carcinoma of the penis and microscopic pathologic margins: how much margin is needed for local cure? Cancer. 1999 Apr 1;85(7):1565–1568. [PubMed] [Google Scholar]
  11. Horenblas S., van Tinteren H. Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol. 1994 May;151(5):1239–1243. doi: 10.1016/s0022-5347(17)35221-7. [DOI] [PubMed] [Google Scholar]
  12. Lindegaard J. C., Nielsen O. S., Lundbeck F. A., Mamsen A., Studstrup H. N., von der Maase H. A retrospective analysis of 82 cases of cancer of the penis. Br J Urol. 1996 Jun;77(6):883–890. doi: 10.1046/j.1464-410x.1996.02221.x. [DOI] [PubMed] [Google Scholar]
  13. Lopes A., Hidalgo G. S., Kowalski L. P., Torloni H., Rossi B. M., Fonseca F. P. Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol. 1996 Nov;156(5):1637–1642. doi: 10.1016/s0022-5347(01)65471-5. [DOI] [PubMed] [Google Scholar]
  14. Mohs F. E., Snow S. N., Messing E. M., Kuglitsch M. E. Microscopically controlled surgery in the treatment of carcinoma of the penis. J Urol. 1985 Jun;133(6):961–966. doi: 10.1016/s0022-5347(17)49334-7. [DOI] [PubMed] [Google Scholar]
  15. Ornellas A. A., Seixas A. L., Marota A., Wisnescky A., Campos F., de Moraes J. R. Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol. 1994 May;151(5):1244–1249. doi: 10.1016/s0022-5347(17)35222-9. [DOI] [PubMed] [Google Scholar]
  16. Pettaway C. A., Pisters L. L., Dinney C. P., Jularbal F., Swanson D. A., von Eschenbach A. C., Ayala A. Sentinel lymph node dissection for penile carcinoma: the M. D. Anderson Cancer Center experience. J Urol. 1995 Dec;154(6):1999–2003. [PubMed] [Google Scholar]
  17. Ravi R., Chaturvedi H. K., Sastry D. V. Role of radiation therapy in the treatment of carcinoma of the penis. Br J Urol. 1994 Nov;74(5):646–651. doi: 10.1111/j.1464-410x.1994.tb09199.x. [DOI] [PubMed] [Google Scholar]
  18. Senthil Kumar M. P., Ananthakrishnan N., Prema V. Predicting regional lymph node metastasis in carcinoma of the penis: a comparison between fine-needle aspiration cytology, sentinel lymph node biopsy and medial inguinal lymph node biopsy. Br J Urol. 1998 Mar;81(3):453–457. doi: 10.1046/j.1464-410x.1998.00562.x. [DOI] [PubMed] [Google Scholar]
  19. Shirahama T., Takemoto M., Nishiyama K., Nobori T., Kawahara M., Ohyama M., Ohi Y. A new treatment for penile conservation in penile carcinoma: a preliminary study of combined laser hyperthermia, radiation and chemotherapy. Br J Urol. 1998 Nov;82(5):687–693. doi: 10.1046/j.1464-410x.1998.00846.x. [DOI] [PubMed] [Google Scholar]
  20. Theodorescu D., Russo P., Zhang Z. F., Morash C., Fair W. R. Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol. 1996 May;155(5):1626–1631. [PubMed] [Google Scholar]
  21. Vapnek J. M., Hricak H., Carroll P. R. Recent advances in imaging studies for staging of penile and urethral carcinoma. Urol Clin North Am. 1992 May;19(2):257–266. [PubMed] [Google Scholar]
  22. Villavicencio H., Rubio-Briones J., Regalado R., Chéchile G., Algaba F., Palou J. Grade, local stage and growth pattern as prognostic factors in carcinoma of the penis. Eur Urol. 1997;32(4):442–447. [PubMed] [Google Scholar]
  23. de Kernion J. B., Tynberg P., Persky L., Fegen J. P. Proceedings: Carcinoma of the penis. Cancer. 1973 Nov;32(5):1256–1262. doi: 10.1002/1097-0142(197311)32:5<1256::aid-cncr2820320534>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES