Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review

Metastatic cancer to the penis: a multi-institutional comprehensive analysis of 31 patients

INTRODUCTION

The metastatic spread of cancer to the penis is a very rare clinical entity generally associated with disseminated disease and poor prognosis. The aim of this paper was to show the outcomes of a series of patients treated for metastatic cancer to the penis and enhance the understanding and the management of penile metastasis in order to improve patients' care and outcomes.

METHODS

We retrospectively analyzed the medical records of 31 patients diagnosed with metastatic cancer to the penis and treated at eight Ligurian urological departments between January 2014 and January 2024. Clinical characteristics, physical examination findings, diagnostic evaluations, treatment options and follow-up data were assessed.

RESULTS

27 (87%) patients had a prior history of malignancy with a metachronous metastasis. The most common primary site of malignancy was the genitourinary tract (71.1%) followed by the gastrointestinal tract (16.1%). The time interval from the diagnosis of the primary tumour to the detection of the penile metastasis was 36.0 months. The penile metastasis generally appeared with a mass (54.8%) and pain (29%), more rarely with priapism (6.5%), oedema (6.5%) and hematuria/urinary disorders (3.2%). The metastatic lesion required a total penectomy in 17 (54.8%) patients and a partial penectomy in 8 patients (25.8%). At a follow-up of 15.9 (1-75) months, 4 (18.2%) patients were still alive with disease.

CONCLUSIONS

Our data confirmed penile metastasis as a rare entity usually associated with clinical symptoms involving the penis in the context of a known primary malignancy, mainly from the neighboring pelvic organs, with a poor prognosis. The majority of our patients required a total penectomy with a negative impact on their quality of life. These aspects highlighted the importance of a penile examination and an early diagnosis of a penile metastasis during the follow-up schedule of many patients with a history of previous oncologic disease.

Sexual functioning after penile cancer surgery: comparison between surgical approaches in a large patient cohort

Very few studies examine sexuality after penile cancer (PeCa) surgery and/or evaluate predictors of sexual satisfaction. Since 2016, primary PeCa patients at our institute routinely received the International Index of Erectile Function (IIEF-15) questionnaire: preoperatively (baseline) and 3-, 6-, 12- and 24-months postoperatively. We included patients who were surgically treated at our institute and completed the baseline and ≥1 follow-up questionnaire. Sexually active patients were divided into groups: wide local excision (WLE), glansectomy, partial penectomy and total penectomy with perineal urethrostomy. Linear mixed effects models were used for longitudinal analyses with repeated measures to examine predictors of overall sexual satisfaction. 647 patients with (suspected) PeCa were evaluated and received questionnaires. 543 (83.9%) returned the questionnaires. 242 were suitable for analysis. Preoperatively, only 55/242 (22.7%) were sexually active. Postoperatively, the number of sexually active patients increased for WLE (30.8% at baseline, 43.5% at two-year follow-up) and glansectomy (35.0% to 40.0%, both p < 0.001). Sexual satisfaction was below the level of healthy men in all patients, both pre- and postoperatively. Longer follow-up time, younger age, and penile-sparing surgeries were predictors for better sexual satisfaction. Our findings underscore the importance of considering penile-sparing surgical approaches in the treatment of PeCa when oncologically feasible. The significant improvements in sexual activity and sexual satisfaction following WLE and glansectomy support this approach. However, the overall sexual satisfaction after all PeCa surgery remains below the level of the healthy men, both pre- and post-operative, emphasizing the importance of guidance throughout the treatment trajectory.

Fluorescence-guided surgery using cetuximab-800CW in patients with penile carcinoma

OBJECTIVE

To investigate the feasibility of fluorescence molecular imaging (FMI), using cetuximab-800CW, as an intraoperative tool to determine surgical margins in penile squamous cell carcinoma (PSCC).

PATIENTS AND METHODS

A total of 11 patients with PSCC received 75 mg cetuximab followed by 15 mg cetuximab-800CW 2 days before surgery. FMI of the whole excision specimen and tissue slices was performed. Fluorescence visualisation was correlated to histopathology. Based on tumour and healthy tissue regions of interest, mean fluorescence intensity was calculated for each individual patient.

RESULTS

Significant differences between tumour and healthy mean fluorescence intensity were found with tumour-to-background ratios of a median (IQR) of 1.51 (0.99) and a mean (SD) of 1.51 (0.32) in the excision specimen and tissue slices, respectively. One patient showed a high relative fluorescence intensity with a signal-to-background ratio of 1.79, corresponding to a tumour-positive margin on fresh frozen sectioning.

CONCLUSION

In this Phase I study we showed that cetuximab-800CW seems suitable to discriminate PSCC from background tissue. The tracer was well tolerated, and no false positive spots were seen.