Management Of Penile Cancer Research Articles

Is there a role for the development of a supra-regional network for the management of penile cancer in the Republic of Ireland?

IntroductionThere is an average of 25 cases of penile cancer in the Republic of Ireland each year. Due to the low volume of cases, the National Institute for Clinical Excellence recommends that treatment is centralised to allow the best standardised treatment for primary tumours and nodal disease. ObjectivesTo determine whether outcomes for patients with penile cancer differed significantly between secondary and tertiary referral centres in the Republic of Ireland. MethodsBetween 2001 and 2014, 36 patients were treated in the Mercy University Hospital (MUH) with penile cancer. Twenty patients were treated primarily in MUH and 16 patients underwent initial management in a secondary referral centre (SRC) with subsequent referral to the MUH. A retrospective matched case-control study was performed on this patient cohort. ResultsThere were no significant differences in length of follow-up or risk factors for the development of penile cancer between both groups (p = 0.6 and p = 0.5 respectively) Ultimately, the incidence of high risk disease, nodal metasases, high grade disease and pelvic lymph node dissection were significantly greater in patients that were initially managed in a SRC (p = 0.02, p = 0.03, p = 0.004 and p = 0.028 respectively). Patients undergoing initial treatment in a SRC had a non-significantly reduced rate of cancer specific survival (88 Vs 66%, MUH Vs SRCs, p = 0.495) and recurrence free survival (85 Vs 46%, MUH Vs SRCs, p = 0.24). ConclusionOur findings suggest that managing penile cancer in special interest centres may improve oncological outcome.

Prise en charge des cancers du pénis

The role of the nurse in the management of penile cancer sometimes used to make the diagnosis when the discovery of a suspicious lesion but also participates in the patient information on the therapeutic orientation and support for care. The purpose of this article is to make a focus of the management of penile cancer for nurses. A literature search on Pubmed was performed to make a focus on the management of penile cancer. Penile cancer is a rare tumor that occurs in mostly older people (over 60 years). The diagnosis of penile precancerous lesions is essential and can be made fortuitously by the nurse during care or catheterization. The staging of the penile tumor is based on clinical examination could be aided by MRI with a penile erection test. The treatment of penile tumor is conservative whenever possible. The first lymph node involvement is inguinal. Lymph node invasion is the most important prognostic value. Supported of the Lymph nodes must be systematic, bilateral and performed at diagnosis. The assessment is based on clinical examination, sentinel lymph node biopsy and (18)F-FDG PET-CT. Inguinal lymphadenectomy alone has a curative role and type of lymph node dissections is based on physical examination and staging. In some cases it may be associated with adjuvant or neoadjuvant chemotherapy. The problem is that penile cancer is a rare tumor for which the urological team is little confronted which can lead to defects in support care while national or international recommendations exist.

Multimodality imaging of penile cancer: what radiologists need to know.

The purpose of this article is to provide a comprehensive update on the role of imaging in the diagnosis and management of penile cancer. Imaging plays a major role in the initial assessment, treatment planning, and follow-up of patients with penile carcinoma. MRI helps in assessing the T staging of the primary and in detecting local recurrence. PET/CT and CT are useful for detecting regional nodal and distant metastases.

Neoadjuvant therapy combined with a BMP regimen for treating penile cancer patients with lymph node metastasis: a retrospective study in China.

Combination chemotherapy is emerging in the management of advanced penile cancer. However, evidence-based chemotherapeutic regimens in the current guidelines are lacking. The aim of this study was to evaluate the efficacy of preoperative neoadjuvant chemotherapy combined with a BMP regimen including bleomycin (BLM), methopterin (MTX) and cisplatin (DDP) for treating advanced penile cancer patients. We retrospectively audited the clinical and follow-up data of 24 penile cancer patients with fixed inguinal lymph node metastasis that were admitted in our hospital from 2001 to 2010 and received preoperative neoadjuvant chemotherapy. A total of 24 patients with advanced penile cancer (pN3) were recruited in this study. All patients received preoperative neoadjuvant chemotherapy combined with a BMP regimen. The average cycle of chemotherapy was two cycles (range 1-4 cycles). Among 24 adjuvant cases, 15 patients that responded to neoadjuvant chemotherapy underwent penectomy and inguinal lymphadenectomy. In contrast, nine cases did not respond to chemotherapy and received palliative local radiotherapy. Overall, the 1-, 2- and 5-year survival rates were 70.8, 50.0 and 45.8 %, respectively. The 5-year survival rate between the responder and non-responder groups was statistically significant (73.3 vs. 0 %, P < 0.001). Neoadjuvant chemotherapy combined with a BMP regimen followed by surgery is beneficial to patients with advanced penile cancer.

51 The effect of centralisation on the management of penile cancer

51 The effect of centralisation on the management of penile cancer

Recent developments and current management of penile cancer

Penile carcinoma is a rare disease, with over 95% of tumors being squamous cell carcinomas. Due to the low case numbers there has been a paucity of good-quality prospective studies available on which to base best clinical practice. The development of specialist high-volume centers in both the UK and Europe has started to permit multicenter collaboration and analysis of larger cohorts, with a knock-on improvement in patient care. Advances in diagnostic imaging, surgical techniques for both the penis and inguinal regions, and improved delivery of radiotherapy have helped to improve outcomes and quality of life. Molecular biology has started to shed light on the pathogenesis of the disease and the role that human papillomavirus may play. The aim of this article is to give an up-to-date review of the management of penile cancer encompassing the above.

Penile cancer – Guideline adherence produces optimum results

ObjectiveTo audit the management and outcome of penile cancer in a tertiary university teaching hospital, comparing our results to international best practice and published guidelines. MethodsThe Hospital Inpatient Enquiry database of the Mercy University Hospital was interrogated for penile cancer patients treated between 2001 and 2012. Data relating to presentation, local treatment, histology, lymph-node management, outcome and survival was recorded. Data were analysed using the Log Rank test, with significance defined as P ≤ 0.05. ResultsTwenty-five patients were identified with a median age of 61 years. The majority of cases at presentation were ≥T2 (54%) and intermediate to high grade (76%). The median follow-up of patients was 3.75 years (range 9 months–10 years). Overall survival was 76% (n = 19), these patients are all disease free to date. Disease-specific survival was 85% at 10 years. Penile cancer related mortality was 8% (n = 2), 4 patients (16%) died of non-penile cancer related causes. Twenty-two patients (88%) had surgery and 3 patients (12%) had radiotherapy. Based on EAU guidelines inguinal lymph node dissection (ILND) was performed in 64% (n = 16) of cases with 44% (n = 7) of these patients requiring concurrent bilateral pelvic lymph node dissection. Fifty percent (n = 8) of ILNDs showed metastatic disease. Ten year disease-specific survival for node negative versus node positive disease is 100% versus 57%. Thirty-two percent (n = 8) of patients received chemotherapy. ConclusionsPenile cancer is a rare oncological condition that often requires bilateral inguinal ± pelvic lymph node dissection and should be managed according to published guidelines, in specialist centres in order to maximize outcomes.

Surgical management trends of penile cancer in the United States between 2000 and 2010.

379 Background: Penile cancer may cause significant morbidities to those who are treated with aggressive surgery. Conversely, there has been no improvement in penile cancer survival rates since 1990. While the causes for this stagnation may be multifactorial, one potential cause is undertreatment of high-risk disease. This study aimed to examine both the trend in the stage-dependent surgical treatment for penile cancer from 2000 to 2010 and the patterns of possible over and/or undertreatment during this period. Methods: The National Cancer Database (NCDB) Datalinks Portal was queried. Diagnosis by year, first course surgery by stage, in all hospitals from 2000-2010 was first obtained. Data was grouped into no surgery, penile sparing, and radical surgery. Data was also obtained for first course surgery by stage in community hospitals (C), comprehensive centers (CC), and teaching research hospitals (TR), individually. Groups were similar as above, with the exclusion of the no surgery group. Results: There were 1,405 patients with recorded first course surgical treatments in community hospitals, 3,930 in comprehensive hospitals, and 3,667 in teaching research hospitals from 2000 to 2010. Graphically, there has been no change in the trend in the pattern of surgical management of penile cancer from 2000 to 2010 in high or low stage penile cancers. Consistent overtreatment of stage I penile cancer with radical surgery was observed in all hospitals during this period. A variable, but high, percentage of penile-sparing surgery was observed for advanced stages among all hospital types. Conclusions: Corresponding to the stagnation in the survival rates of penile cancer, the surgical management trends ded not change between 2000 and 2010. Contrary to the 2013 National Comprehensive Cancer Network (NCCN) Guidelines, penile-sparing surgery continues to be performed in all types of treating hospitals for higher stage penile cancers, which may represent an undertreatment of potentially fatal penile cancers. Conversely, there was a persistent pattern of overtreatment of stage I penile cancer. [Table: see text]

Should centralized histopathological review in penile cancer be the global standard?

Objective To assess the role of centralized pathological review in penile cancer management. Materials and Methods Newly diagnosed squamous cell carcinomas (SCC) of the penis, including squamous cell carcinoma in situ (CIS), from biopsy specimens were referred from 15 centres to the regional supra‐network multidisciplinary team (Sn‐MDT) between 1 January 2008 and 30 March 2011. Biopsy histology reports and slides from the respective referring hospitals were reviewed by the Sn‐MDT pathologists. The biopsy specimens’ histological type, grade and stage reported by the Sn‐MDT pathologist were compared with those given in the referring hospital pathology report, as well as with definitive surgery histology. Any changes in histological diagnosis were sub‐divided into critical changes (i.e. those that could alter management) and non‐critical changes (i.e. those that would not affect management). Results A total of 155 cases of squamous cell carcinoma or CIS of the penis were referred from 15 different centres in North‐West England. After review by the Sn‐MDT, the histological diagnosis was changed in 31% of cases and this difference was statistically significant. A total of 60.4% of the changes were deemed to be critical changes that resulted in a significant change in management. When comparing the biopsy histology reported by the Sn‐MDT with the final histology from the definitive surgical specimens, a good correlation was generally found. Conclusions In the present study a significant proportion of penile cancer histology reports were revised after review by the Sn‐MDT. Many of these changes altered patient management. The present study shows that accurate pathological diagnosis plays a crucial role in determining the correct treatment and maximizing the potential for good clinical outcomes in penile cancer. In the case of histopathology, centralization has increased exposure to penile cancer and thereby increased diagnostic accuracy, and should therefore be considered the ‘gold standard’.

Modern management of penile cancer

AbstractIn this article, the authors outline a contemporary management algorithm for penile cancer, with emphasis on developments in organ‐sparing surgical techniques and inguinal lymph node detection and management. Copyright © 2013 John Wiley &amp; Sons

Current Concepts in Penile Cancer

This review highlights the significant advances made in the diagnosis and management of penile cancer. This often-aggressive tumor phenotype has been characterized by its poor prognosis, mostly attributable to its late presentation and heterogeneity of surgical care because of the paucity of cases treated at most centers. Recent advances in understanding of the risk factors predisposing to penile cancer, including its association with the human papilloma virus (HPV), have brought forth the socioepidemiologic concept of HPV vaccination in certain high-risk populations and countries, which remains highly debated. The management of penile cancer has evolved in recent years with the adoption of penile-sparing and minimally invasive surgical approaches to the inguinal lymph nodes, which are a frequent site of regional spread for this malignancy. Lastly, this review highlights the importance of adopting a multimodal approach consisting of neoadjuvant systemic chemotherapy followed by consolidative surgical resection in patients presenting with bulky/locally advanced nodal metastases from penile cancer.

752 ONCOLOGICAL OUTCOMES OF PRIMARY PENILE CANCER TREATMENT IN A UK SUPRA-REGIONAL CENTRE

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (II)1 Apr 2013752 ONCOLOGICAL OUTCOMES OF PRIMARY PENILE CANCER TREATMENT IN A UK SUPRA-REGIONAL CENTRE Rajan Veeratterapillay, Luke Teo, Susan Asterling, and Damian Greene Rajan VeeratterapillayRajan Veeratterapillay Sunderland, United Kingdom More articles by this author , Luke TeoLuke Teo Sunderland, United Kingdom More articles by this author , Susan AsterlingSusan Asterling Sunderland, United Kingdom More articles by this author , and Damian GreeneDamian Greene Sunderland, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.315AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Squamous cell carcinoma of the penis (SCC) is rare and,in the UK, is managed in supra-regional centres.There have been few reports in the literature about long-term outcomes of SCC treatment. We describe our experience over the past decade. METHODS Patients with biopsy proven penile SCC treated at our centre (Sunderland Royal Hospital, UK) in the period January 2000 to December 2010, were identified. Data were collected including stage at presentation, mode of therapy (penile preserving surgery, amputative surgery, chemo/radiotherapy), pathological findings, recurrence and cancer specific survival. Kaplan Meier (KM) analysis was performed to compare survival outcomes. RESULTS 192 patients (median age 63 years) with complete follow-up were identified.The median follow-up was 48 months. At presentation, 7 patients had metastatic disease and 31 patients had node positive disease. Initial treatment included penile preserving surgery(49%), partial penectomy(26%), radical penectomy(21%) and chemo/radiotherapy for metastatic disease(4%). 26 patients required further penile surgery due to recurrent disease. Local recurrences occurred after a median of 11.3 months and were managed by CO2 laser therapy (5%), repeat organ preserving surgical techniques (5%), or radical penectomy (4%). Histopathological staging of the final specimen showed pTis (24%), pT1 (28%), pT2 (36%), pT3 (10%) and pT4(2%). 75% of tumours were grade 2 or 3. Seventy seven patients (40%) underwent modified inguinal lymph node dissection out of whom 31 (16%) had node positive disease. 25 patients (13%) died as a result of penile cancer. KM analysis showed overall 5-year cancer specific survival of 86%. Five-year cancer specific survival was noted to decrease with advancing stage (Figure 1) with N0 tumours (92.6%), N1 (71.6%), N2 (60.6%), N3 (57.1%) and M1 (0%) [p<0.0001]. CONCLUSIONS Supra-regional penile cancer management has lead to considerable clinical experience in our centre over the past decade. Nearly half of all tumours are now managed by organ preserving techniques and overall oncological outcomes are good with a 5-year cancer specific survival of 86%. Close follow-up is vital to pick up local recurrence or progression. We confirm the association of worsening prognosis with increasing nodal and metastatic disease. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e309-e310 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajan Veeratterapillay Sunderland, United Kingdom More articles by this author Luke Teo Sunderland, United Kingdom More articles by this author Susan Asterling Sunderland, United Kingdom More articles by this author Damian Greene Sunderland, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Optimal management of T1G2 penile cancer remains unclear

Whether or not inguinal lymphadenectomy benefits patients with superficial penile carcinoma and clinically impalpable lymph nodes is a controversial issue. New evidence supports active surveillance for patients with T1G1 tumours and inguinal lymphadenectomy for those with T1G3 cancer, but the optimal management of patients with T1G2 disease remains unclear.

Dynamic sentinel lymph node biopsy as the new paradigm for the management of penile cancer

ObjectivesThe management of patients with penile cancer who have high-risk features for micrometastasis with clinically negative inguinal lymph nodes is controversial. We describe the history of the sentinel lymph node biopsy and how it has evolved to become a useful adjunct in the management of penile caner. Materials and methodsUsing a PubMed search, we identified the evidence relating to the management of the inguinal lymph nodes in penile cancer between 1977 and 2010. ResultsThe concept of the sentinel lymph node (SLN) was first described in 1977 for penile carcinoma where lymphangiograms were performed via the dorsal lymphatics of the penis to locate the primary lymphatic drainage zone of the penis situated near the saphenofemoral junction. Then, in 1992, the lymphatic mapping concept was further advanced by performing intradermal injections of blue dye to directly visualize the lymphatic channels and SLN in the treatment of melanoma. In 1994, investigators from The Netherlands pioneered the use of dynamic sentinel lymph node biopsies (DSLNB) for penile cancer by combining the use of peri-lesional blue dye injection, lymphoscintigraphy, and other future modifications of the technique to achieve low false negative biopsy rates (4.8%) as well as much lower morbidity (5.7%), compared with the 30%–50% morbidity associated with a full inguinal node dissection. ConclusionDSLNB significantly decreases the morbidity associated with performing a standard or even modified inguinal lymph node dissection in patients with clinically negative inguinal lymph nodes. Performing DSLNB requires a multidisciplinary team of urologists, nuclear medicine radiologists, and pathologists working in cohesion to attain the best SLN detection rates with the lowest possible false-negative rates.

Current Management of Penile Cancer

Current Management of Penile Cancer

The development of a supraregional network for the management of penile cancer

Although its incidence is increasing, penile cancer remains a rare disease in the UK. In view of this low volume, the National Institute for Clinical Excellence recommended that treatment is centralised in a limited number of centres arranged as supraregional networks. The aim of this centralisation is to allow the best standardised treatment for the primary tumours and nodal disease, thereby avoiding under or overtreatment. In this paper we review the formation and functioning of our network in the East Midlands. Data were collected up to August 2010 from our prospective penile network database since its inception in 2005. These data were analysed to see our workload, patterns of referral and surgeries performed over this time period. The structure and function of the East Midlands network are described. There has been an increase in the number of cases discussed since its formation. There has also been a trend towards more conservative surgery, both of the primary tumour and of nodal management. Between September 2009 and August 2010, 16 glansectomies were performed versus 5 total and 9 partial penectomies. The same period saw 18 dynamic sentinel lymph node biopsies against 7 bilateral and 3 unilateral superficial groin dissections. There was a very high patient satisfaction rate, with patients feeling they had good support and information. On reviewing the literature it can be clearly seen that supraregional networks have led to a decrease in overtreatment and better recognition of the need to manage lymph node status optimally. Our network has demonstrated the trend toward conservative surgery and sentinel node biopsy. The formation of supraregional networks with a multidisciplinary approach will facilitate high volume centres that will offer optimal surgical therapy and also allow recruitment into studies and new chemotherapeutic regimens. It will also allow better data collection to aid clinical studies that hopefully will also demonstrate better outcomes.

747 ORGAN PRESERVING SURGERY FOR PENILE CANCER – DESCRIPTION OF TECHNIQUES AND SURGICAL OUTCOMES

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease II1 Apr 2012747 ORGAN PRESERVING SURGERY FOR PENILE CANCER – DESCRIPTION OF TECHNIQUES AND SURGICAL OUTCOMES Rajan Veeratterapillay, Aluru Pavan, Susan asterling, Sam Rao, and Damien Greene Rajan VeeratterapillayRajan Veeratterapillay Sunderland, United Kingdom More articles by this author , Aluru PavanAluru Pavan Sunderland, United Kingdom More articles by this author , Susan asterlingSusan asterling Sunderland, United Kingdom More articles by this author , Sam RaoSam Rao Durham, United Kingdom More articles by this author , and Damien GreeneDamien Greene Sunderland, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.833AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally, radical surgery or radiotherapy has been used for malignant penile lesions with little thought to organ preservation. Recent evidence has paved the way for glansectomy and wide local excision for management of penile cancer confined to the glans. METHODS Patients at Sunderland Hospital (UK) between 2001 and 2008 who had squamous cell tumours limited to the glans penis underwent penile preserving surgery including total glansectomy and glanuloplasty, partial glansectomy, glans relining and distal penectomy with glans reconstruction. Recurrence rates, cosmetic and functional outcomes were recorded. RESULTS 65 patients were identified with a median followup of 40 months. Local recurrence was present in 4 patients (6%) despite 72% having intermediate or poorly differentiated tumours and 30% with T2 disease. Complications included partial graft loss (1.5%), graft contractures (4.5%), meatal stenosis (7.5%) and positive margin (3%). 5%were deemed to have poor cosmetic outcome and 85% described good erections at one year postop. CONCLUSIONS Penile preserving surgery can achieve good penile cancer control with minimal morbidity and reduced psychosexual side effects. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e306 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajan Veeratterapillay Sunderland, United Kingdom More articles by this author Aluru Pavan Sunderland, United Kingdom More articles by this author Susan asterling Sunderland, United Kingdom More articles by this author Sam Rao Durham, United Kingdom More articles by this author Damien Greene Sunderland, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Reconstrucción del glande con injerto cutáneo libre según técnica de Bracka

Introduction We analyse our experience in the conservative surgical management of penile cancer and/or penile skin pathologies at our institution. Material and methods We have retrospectively reviewed all the skin grafting procedures performed in penile surgery in the last eight years. We show the indications and results of these surgical procedures and the detailed surgical technique originally described by Bracka. Results Ten patients had several types of partial penile removal surgery followed by free-skin graft resurfacing, creating a neoglans. There were no relevant or major complications; two patients suffered partial necrosis of the skin graft. There was no local recurrence. 6 Patients returned to normal sexual activity after complete healing. Conclusions There is a significant number of patients with penile cancer and/or other penile skin pathologies who can undergo definitive and non-mutilating surgery with excellent oncologic, cosmetic and functional results with skin grafting.

Current and Future Strategies in the Diagnosis and Management of Penile Cancer

Penile cancer is an uncommon malignancy that has a devastating effect on the patient while also being challenging to diagnose and treat. By implementing preventive measures, we can decrease the incidence of this disease and improve the quality of life of our patients. Early detection plays an important role in disease control and proper diagnostic modalities must be used in order to accurately identify the cancer and its progression. Primary penile lesions should be initially approached when surgically feasible and clinically appropriate with penile preserving surgical techniques. Advances in inguinal lymph node detection and management, has improved the clinical outcome of penile cancer. Advanced penile cancer still portends a poor prognosis and should be approached via a multimodal treatment regimen. In this review, we address the importance of prevention, early detection, and the contemporary management of primary penile lesions, as well as the advances in inguinal lymph node disease detection and surgical treatment, for both localized and advanced disease.

Outcome of Glansectomy and Skin Grafting in the Management of Penile Cancer

Purpose. To report outcome data for patients with penile cancer treated surgically with glansectomy and skin grafting. Materials and Methods. We retrospectively reviewed data on all patients undergoing surgical management of penile cancer by a single surgeon between 1998 and 2008. Outcomes in patients who underwent glansectomy and skin grafting were analysed. Results. Between 1998 and 2008 a total of 25 patients with a mean age 60 (39–83) underwent glansectomy and skin grafting. Six patients had carcinoma in situ (CIS); the stage in the remaining patients ranged from T1G1 to T3G3. Mean followup for patients was 28 months (range 6–66). Disease specific survival was 92% with 2 patients who had positive nodes at lymph node dissection developing groin recurrence. One patient developed a local recurrence requiring a partial penectomy. Conclusions. Penile preserving surgery with glansectomy and skin grafting is a successful technique with minimal complications for local control of penile carcinoma arising on the glans. Careful followup to exclude local recurrence is required.