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Organ-sparing treatment for penile cancer

Nature Clinical Practice Urology volume 4, pages 596–604 (2007)Cite this article

Abstract

Penile carcinoma is an aggressive disease with significant treatment-associated psychosexual morbidity. For this reason, despite local control rates greater than 90% with radical surgical approaches, several organ-preserving treatments have been described during the past 30 years. Conservative surgery, Mohs micrographic surgery, radiotherapy, laser ablation and chemotherapy have been frequently used in order to interfere as little as possible with functional anatomy without compromising local cancer control. The aim of this article is to provide an overview of the current concepts of these organ-preserving procedures for penile cancer, and describe some of their indications, results and associated complications.

Key Points

  • Conservative surgery can provide good local control in selected cases, with recurrence rates of 3–30%, but outcomes are generally poor in patients with node-positive disease

  • When performing conservative surgery, a traditional 2.0 cm margin is unnecessary for oncologic control; a 1.0 cm margin is adequate for grade 1 and 2 lesions and a 1.5 cm margin is adequate for grade 3 lesions

  • Mohs micrographic surgery allows the removal of penile malignancies with microscopically controlled tumor-free borders; however, it is time-consuming and good results are observed only when applied to lesions 1 cm or less in size

  • Radiotherapy is usually indicated in tumors <4 cm in size and with either no or minimal involvement of the corpora cavernosa; it can be delivered by external beam radiotherapy (EBR), radioactive mould or interstitial brachytherapy (IB); EBR and IB-related complications include tissue swelling, moist desquamation, secondary infection, penile ulceration (8%), penile necrosis (3–16%) and urethral strictures (10–45%)

  • Laser therapy is best for stage Tis and T1 tumors exclusively and only selected patients with T2 tumors (small and low-to-intermediate grade lesions) should be treated in combination with early lymph node resection; recurrence rates range from 6.6% to 48%

  • Results of irradiation treatment combined with bleomycin in stage N0 can be equivalent to that of surgical therapy with the advantage of preserving sexual ability; however, these results need to be confirmed by large, randomized, prospective trials

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Author notes

  1. AA Antunes and MF Dall'Oglio are both Assistant Professors in the Division of Urology, University of São Paulo Medical School and Staff Members at the Hospital das Clinicas at University of São Paulo Medical School. M Srougi is Professor of Urology in the Department of Surgery, University of São Paulo Medical School and Chairman of the Division of Urology, Hospital das Clinicas at University of São Paulo Medical School, São Paulo, Brazil.

Authors and Affiliations

  1. Rua Barata Ribeiro, 414, 7o. andar, Bela Vista, São Paulo, Cep: 01308-000, SP, Brazil

    Miguel Srougi

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  1. Alberto A Antunes
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  2. Marcos F Dall'Oglio
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  3. Miguel Srougi
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Correspondence to Miguel Srougi.

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Antunes, A., Dall'Oglio, M. & Srougi, M. Organ-sparing treatment for penile cancer. Nat Rev Urol 4, 596–604 (2007). https://doi.org/10.1038/ncpuro0918

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