Trends in treatment of cT1 penile cancer: Analysis of the National Cancer Database

Local Tumor Destruction Versus Partial Penectomy for T1a Squamous Cell Carcinoma of the Penis

BACKGROUND

Local tumor destruction (LTD) represents a relatively novel approach for the management of early-stage squamous cell carcinoma of the penis (SCCP). Its cancer control efficacy has never been tested in large-scale epidemiologic studies. We addressed this knowledge gap and tested for differences in cancer-specific mortality (CSM) between LTD versus partial penectomy (PP) in T1aN0M0 SCCP.

METHODS

Within the Surveillance, Epidemiology, and End Results database (2000-2020), we identified T1aN0M0 SCCP patients treated with LTD or PP. Cumulative incidence plots as well as multivariable competing risks regression models addressed CSM. Additional accounting was made for the confounding effect of other-cause mortality.

RESULTS

Of 1,239 patients with T1aN0M0 SCCP, 615 (49.6%) underwent LTD versus 624 (50.4%) PP. The majority of patients were Caucasian in LTD 393 (63.9%) and in PP 406 (65.1%) groups. Local tumor destruction patients were young (median age 65 versus 70 years). In cumulative incidence plots, 10-year CSM was 12.4% in LTD versus 13.5% in PP SCCP patients (p = 0.8). In multivariable competing risks regression models, LTD did not independently predict higher CSM relative to PP (hazard ratio 0.99; p = 0.97).

CONCLUSIONS

In this large population-based cohort of T1a SCCP patients, the rate of LTD virtually perfectly approximated that of PP. Local tumor destruction patients exhibited virtually the same cancer-control outcomes as their PP counterparts. In consequence, LTD may be considered a safe alternative to PP in T1aN0M0 SCCP based on cancer-control outcomes.

Characteristics, trends, and management of Penile cancer in the United States: A population-based study

BACKGROUND

Penile cancer (PeCa) is a rare disease. HPV infection, smoking, phimosis, and lichen sclerosus represent well-known associated risk factors.

OBJECTIVES

Primary aim of our study is to evaluate the incidence and risk factors of PeCa and to outline the adopted diagnostic and therapeutic approaches. Secondary aim is to investigate risk factors associated with aggressive disease and to identify the complications arising from its surgical treatment.

MATERIALS AND METHODS

We conducted a retrospective analysis using the PearlDiver™ Mariner database, from January 1, 2011, to December 31, 2021, identifying all patients diagnosed with PeCa and PeIN, evaluating comorbidities, risk factors, and social and economic conditions. We evaluated the imaging modalities employed for staging as well as the treatment strategies. Finally, we evaluated the most frequent complications associated with inguinal lymphadenectomy (ILND).

RESULTS

During the study period, 17,494 patients were diagnosed with PeCa and 5,965 with penile intraepithelial neoplasia (PeIN). US was the most frequently utilized imaging modality, followed by PET and PET/CT. Use of CT and MRI was around 5%. Surgical treatment was the predominant strategy, utilized in 31.3% of PeCa and 22.9% of PeIN. Wide Local Excision/Glansectomy emerged as the most common surgical procedures. MLR analysis identified smoking as a risk factor for metastatic PeCa (OR; 95% CI = 1.49; 1.379-1.609), HPV infections were associated with a 35% decrease in risk (OR; 95% CI = 0.65; 0.562-0.744) (all P < 0.001). Lichen sclerosus and phimosis were associated with a doubled risk of demolitive surgery. Approximately 40% of patients experienced complications associated with ILND.

CONCLUSION

Despite advances in PeCa management, there's no significant move toward more conservative treatments. Surgical treatments are still marked by high rates of complications, potentially affect the sexual and psychosocial health of patients. These issues may foster a tendency toward avoidance behaviors, contributing to a delayed clinical presentation and treatment.

Penile Sparing Techniques For Penile Cancer

Penile cancers are rare malignancies. Traditional surgical options, including partial and total penectomy, can dramatically affect a patient's quality of life and mental health. In select patients, penile sparing techniques (PST) have the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual function, and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of the various PST currently available for men seeking an organ-preserving option for their penile cancer.