Penile cancer: incremental insights into etiology, diagnosis, staging, and management

Abstract

Penile cancer is a rare disease in developed countries and raises several diagnostic and therapeutic dilemmas. They range from the morbidity of treating the primary penile tumor with the potential for signiWcant loss of “quality of life,” to management of the inguinal region where literally one’s life could be jeopardized based upon disease burden. For this topic of World Journal of Urology, dedicated to penile cancer, we brought together a group of authors active in the Weld to address contemporary issues and advances in penile cancer. There are well known diVerences in the incidence of penile cancer, pointing to various etiological factors. The paper of Bleeker and coworkers explores in depth the current knowledge on the epidemiology and pathogenesis. Expanding their well known work on HPV in cervical cancer, they have used their knowledge to explore the role of HPV in penile cancer. Most important is their Wnding of Xat penile lesions as the presumed most infectious lesion, most probably responsible for the transmission of HPV. More insight into prognostic factors in order to tailor therapy is a continuous scientiWc endeavor in oncological surgery with very practical consequences. The Weld is moving away from clinical prognosticators to molecular ones. The paper of Muneer summarizes the literature on molecular prognostic factors. Unfortunately, so far, no clearcut prognostic factor has emerged from the numerous factors assessed to date. More work is needed in this Weld to better categorize patients in order to tailor therapy to risk, for the present pathological prognosticators still dominate risk assessment. In elegant studies, Cubilla has shown the various growth patterns in penile cancer such as perineurial invasion, vascular invasion, and high histological grade are the most important adverse pathological prognostic factors. While amputation with its ensuing physical and psychological consequences had been standard therapy, penis preservation is now being used more commonly. In a paper from London, combining the experience of two large referral centers, Hegarty et al. emphasize the role of penis preserving strategies. In T1 and most T2 tumors they give examples of a variety of penis preserving modalities aimed at maximal tissue preservation while not compromising oncological safety. In addition, radiation therapy is considered a penis preserving strategy. Crook et al. present the world literature and their personal series in this treatment modality. The presence and extend of lymph node metastasis can drastically alter one’s prognosis in penile cancer. Inguinal lymphadenectomy, while providing reliable pathologic staging, is morbid and in the setting of patients without metastasis provides no beneWt. It has been recognized for some time that histopathologic factors in the primary tumor can stratify one’s risk for lymph node metastasis. In their article, Ficarra et al. review the current status of the ability of such factors to stratify a patient’s likelihood of inguinal metastasis. In addition, they discuss the ability of newly developed nomograms to predict both nodal status and survival based upon clinical parameters. DeWning both non and minimally invasive staging modalities is critical to C. A. Pettaway (&) Department of Urology and Cancer Biology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1373, Houston, TX 77030, USA e-mail: cpettawa@mdanderson.org