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Musi G, de Cobelli O, Molinari F, Mistretta FA, Piccinelli ML, Nardini S, Tozzi M, Bianchi R, Fontana M, Di Trapani E, Cioffi A, Brescia A, Cordima G, Bottero D, Ferro M, Matei DV, Fusco N, Luzzago S. Oncological Outcomes of Thulium-Yttrium-Aluminum-Garnet (Tm:YAG) Laser Ablation for Penile Cancer. Urology 2024; 184:149-156. [PMID: 38092326 DOI: 10.1016/j.urology.2023.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To report oncological outcomes after thulium-yttrium-aluminum-garnet (Tm:YAG) laser ablation for penile cancer patients. MATERIALS AND METHODS We retrospectively analyzed 71 patients with ≤cT1 penile cancer (2013-2022). All patients underwent Tm:YAG ablation with a RevoLix 200W continuous-wave laser. First, Kaplan-Meier plots and multivariable Cox regression models tested local tumor recurrence rates. Second, Kaplan-Meier plots tested progression-free survival (≥T3 and/or N1-3 and/or M1). RESULTS Median (interquartile range) follow-up time was 38 (22-58) months. Overall, 33 (50.5%) patients experienced local tumor recurrence. Specifically, 19 (29%) vs 9 (14%) vs 5 (7.5%) patients had 1 vs 2 vs 3 recurrences over time. In multivariable Cox regression models, a trend for higher recurrence rates was observed for G3 tumors (hazard ratio:6.1; P = .05), relative to G1. During follow-up, 12 (18.5%) vs 4 (6.0%) vs 2 (3.0%) men were retreated with 1 vs 2 vs 3 Tm:YAG laser ablations. Moreover, 11 (17.0%) and 3 (4.5%) patients underwent glansectomy and partial/total penile amputation. Last, 5 (7.5%) patients experienced disease progression. Specifically, TNM stage at the time of disease progression was: (1) pT3N0; (2) pT2N2; (3) pTxN3; (4) pT1N1 and (5) pT3N3, respectively. CONCLUSION Tm:YAG laser ablation provides similar oncological results as those observed by other penile-sparing surgery procedures. In consequence, Tm:YAG laser ablation should be considered a valid alternative for treating selected penile cancer patients.
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Affiliation(s)
- Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Filippo Molinari
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | | | - Sara Nardini
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Tozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Fontana
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Cioffi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Brescia
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Giovanni Cordima
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Danilo Bottero
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Fusco
- Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy; Division of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy.
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2
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Scornajenghi CM, Asero V, Bologna E, Basile G, De Angelis M, Moschini M, Del Giudice F. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review. Curr Opin Urol 2023; Publish Ahead of Print:00042307-990000000-00098. [PMID: 37377374 DOI: 10.1097/mou.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Penile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1-2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. RECENT FINDINGS Patient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SUMMARY OSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.
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Affiliation(s)
- Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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3
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Chadha J, Chahoud J, Spiess PE. An update on treatment of penile cancer. Ther Adv Med Oncol 2022; 14:17588359221127254. [PMID: 36172172 PMCID: PMC9511530 DOI: 10.1177/17588359221127254] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Penile cancer is a rare malignancy, particularly in industrialized nations. In the United States, rates are approximately less than 1 per 100,000 men per year with just over 2000 new cases per year. However, there is significantly increased prevalence in developing nations, with limited treatment expertise and reduced access to care, further driving an unmet clinical need. The most noteworthy risk factor for penile cancer is the association with human papillomavirus infection, which may be present in up to 50% of all penile carcinomas. In addition to local primary tumor approaches, multimodality treatment strategies are vital to patients with clinical regional nodal disease, locally advanced disease. Presence and degree of lymph node involvement remains the most important prognostic factor and patients may benefit from multiple treatment strategies. Interim analysis data from the first randomized clinical trial is expected to yield results in mid/late 2024–early 2025. These treatment approaches include neoadjuvant chemotherapy, adjuvant therapy, including chemotherapy and radiation. Systemic therapy for distant recurrent or metastatic disease is primarily a platinum-based chemotherapy, however with poor overall response. As poor outcomes remain high, particularly in indigent populations, there remains an unmet need for these patients, particularly for high level randomized trials and novel therapeutics. In this review, we will highlight treatment updates for penile cancer. In addition to standard of care, we will review novel lines of therapies including immunotherapies and targeted therapies as well as sequencing approaches.
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Affiliation(s)
- Juskaran Chadha
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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4
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Sakalis VI, Campi R, Barreto L, Garcia-Perdomo HA, Greco I, Zapala Ł, Kailavasan M, Antunes-Lopes T, Marcus JD, Manzie K, Osborne J, Ayres B, Moonen LM, Necchi A, Crook J, Oliveira P, Pagliaro LC, Protzel C, Parnham AS, Albersen M, Pettaway CA, Spiess PE, Tagawa ST, Rumble RB, Brouwer OR. What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes. EUR UROL SUPPL 2022; 40:58-94. [PMID: 35540709 PMCID: PMC9079254 DOI: 10.1016/j.euros.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
Context The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh’s micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. Objective To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. Evidence acquisition The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. Evidence synthesis The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh’s micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. Conclusions Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. Patient summary We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh’s micrographic surgery could be used for smaller lesions.
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5
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Ragonese M, Dibitetto F, Bassi P, Pinto F. Laser technology in urologic oncology. Urologia 2022; 89:338-346. [PMID: 35422152 DOI: 10.1177/03915603221088721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laser technology has been used in Urology since the 80s with a lot of different applications in endoscopic and open surgery. With the developments of the technology and the introduction of new active medium and source of laser energy, this technology have become the gold standard not only in stone surgery but even in benign prostate enlargement (BPE) surgical treatment. Regarding urologic oncology, laser energy has now reached an important role in focal therapy and in conservative treatment. The possibility of having better functional outcomes without any relevant impact on oncological results led to an increased use of laser in penile surgery, with a significant mention in urological guidelines for this option. In urothelial cancers as well, both in conservative management of upper tract tumors that in the treatment of non muscle invasive bladder cancer, a clear role of these relatively new source of energy have been demonstrated. Finally, both in prostate that in renal cancer the strategy of focal therapy may take advantage from this precise and fine technology. In this review we analyzed and described the applications of laser energy in urological cancers with a specific focus on penile, urothelial and prostate cancer.
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Affiliation(s)
- Mauro Ragonese
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - Francesco Dibitetto
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - PierFrancesco Bassi
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - Francesco Pinto
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
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6
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Pang KH, Alnajjar HM, Muneer A. Advances in penile-sparing surgical approaches. Asian J Urol 2022; 9:359-373. [DOI: 10.1016/j.ajur.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
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7
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Luzzago S, Serino A, Aurilio G, Mistretta FA, Piccinelli ML, Lorusso V, Morelli M, Bianchi R, Catellani M, Cozzi G, Di Trapani E, Cioffi A, Verri E, Ferro M, Cossu Rocca M, Matei DV, Nolè F, de Cobelli O, Musi G. Penile-sparing surgery for patients with superficial or initially invasive squamous cell carcinoma of the penis: long-term oncological outcomes. Urol Oncol 2021; 39:736.e1-736.e7. [PMID: 34301457 DOI: 10.1016/j.urolonc.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/05/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report long-term oncological outcomes after penile-sparing surgery (PSS) for superficial (Ta-Tis) or initially invasive (T1) penile cancer patients. METHODS We retrospectively analysed 85 patients with Ta/Tis/T1cN0cM0 penile cancer (1996-2018). All patients underwent PSS: circumcision, excision or laser ablation. First, Kaplan-Meier plots and multivariable Cox regression models tested tumor recurrence rates (any local/regional/metastatic). Second, Kaplan-Meier plots depicted progression-free survival (≥T2 or N1-3 or M1 disease). RESULTS Median (IQR) follow-up time was 64 (48-95) months. Overall, 48 (56%) patients experienced tumor recurrence. Median (IQR) time to tumor recurrence was 34 (7-52) months. Higher recurrence rates were observed for Tis (65%) and T1 (64%), compared to Ta (40%), but these differences were not significant on multivariable Cox regression analyses (HR:2.0 with 95% CI [0.9-5.1] and HR:2.2 with 95% CI [0.9-5.9], respectively). Moreover, higher recurrence rates were observed for G2-3 tumors (74%), compared to G1 (57%), but these differences were not significant on multivariable Cox regression analyses (HR:1.6; 95% CI [0.8-3.2]). During follow-up, 15 (17.5%) vs. 18 (21.2%) vs. 10 (11.5%) patients underwent 1 vs. 2 vs. ≥3 PSS. Moreover, 26 (30.6%) and 4 (4.7%) men were treated with glansectomy and partial/total penile amputation due to local progression, tumor size or patient preference. Additionally, 24 (28%) men underwent invasive nodal staging. Last, 22 (25.9%) patients experienced disease progression. Median (IQR) time to disease progression was 51 (31-82) months. CONCLUSION Patients treated with PSS for newly diagnosed superficial or initially invasive squamous cell carcinoma of the penis should be informed about the non-negligible risk of tumor recurrence and disease progression over time. In consequence, strict follow-up protocols are needed.
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Affiliation(s)
- Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
| | - Alessandro Serino
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Gaetano Aurilio
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Mattia Luca Piccinelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Vito Lorusso
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Michele Morelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Catellani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Cioffi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Elena Verri
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Franco Nolè
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
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8
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Issa A, Sebro K, Kwok A, Janisch F, Grossmann NC, Lee E, Lucky M, Oliveira P, Lau M, Parnham A, Sangar V, Fankhauser CD. Treatment Options and Outcomes for Men with Penile Intraepithelial Neoplasia: A Systematic Review. Eur Urol Focus 2021; 8:829-832. [PMID: 33994168 DOI: 10.1016/j.euf.2021.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/18/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Penile intraepithelial neoplasia (PeIN) is a rare skin condition with potential to progress to invasive penile cancer. We performed a systematic review of treatment options and outcomes for PeIN. Topical agents showed response and recurrence rates of 40-100% and 20% for imiquimod, and 48-74% and 11% for 5-fluorouracil, respectively. Discontinuation of topical agents because of side effects was observed in 12% of cases. Response rates for laser therapies were 52-100%, with recurrence in 7-48% of cases and a change in penile sensitivity in 50%. Circumcision cleared preputial PeIN. Rates of recurrence after surgical treatment of glans PeIN were 25% for wide local excision, 4% for Mohs surgery, 5% for total glans resurfacing, and 10% for glansectomy. There are limited data on factors predictive of treatment response and on sequencing of treatment options. PATIENT SUMMARY: Several treatment options are available for men with precancerous lesions of the foreskin or glans. Close follow-up is necessary as lesions can recur or progress to invasive penile cancer.
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Affiliation(s)
- Allaudin Issa
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Kirby Sebro
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Abigail Kwok
- Department of Urology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Florian Janisch
- Department of Urology, Medical University of Hamburg, Hamburg, Germany
| | | | - Esther Lee
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Marc Lucky
- Department of Urology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Pedro Oliveira
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Maurice Lau
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Arie Parnham
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Vijay Sangar
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Christian D Fankhauser
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; Luzerner Kantonsspital, Luzern, Switzerland.
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9
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Oncologic outcomes and subsequent treatment following organ sparing surgery for penile carcinoma: The University of Texas M.D. Anderson Cancer Center Experience. Urol Oncol 2021; 39:302.e19-302.e27. [PMID: 33612354 DOI: 10.1016/j.urolonc.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the oncologic outcomes of organ sparing surgery (OSS) for penile cancer and to determine the management of and risk factors for local recurrence at a tertiary referral center in the United States. METHODS AND MATERIALS Patients undergoing OSS from 1996 to 2018 at The University of Texas, MD Anderson Cancer Center were identified using a prospective database. Organ sparing procedures included: wide local excision (WLE; including circumcision and glans resurfacing), partial or total glansectomy, laser therapy, or OSS combined with laser ablation (i.e., laser combination). Clinical and pathologic data were collected for descriptive analysis. Recurrences (local and regional) were identified, and the association between overall and local recurrences was determined using Cox proportional hazards regression. Overall and recurrence free survival analyses were performed using Kaplan-Meier estimates. RESULTS A total of 129 patients undergoing OSS were identified with a median follow up interval of 28.0 months. The most common OSS was laser combination (38.8%), and 65.1% of patients presented with pTis or ≤pT1a disease. Twenty (15.5%) recurrences were identified, of which 17 (13.2%) were local and 3 (2.3%) were regional. There were no distant recurrences as the initial site of recurrence. The median time to local recurrence was 20.9 months, and 88.2% were identified within 5 years of surgery. Most (76.5%) local recurrences were successfully treated with further penile preservation without a detrimental impact on overall survival. Patients with pathologic Ta or T1a disease treated with laser or laser combination surgery were more likely to present with local recurrence. CONCLUSION OSS using a variety of techniques to achieve negative surgical margins provides long-term effective local control for localized penile cancer. Most local recurrences can be successfully treated with further penile preserving strategies and long follow-up is essential. Laser therapy or laser combination with OSS should be used with caution in patients with invasive penile cancer.
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10
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Emmanuel A, Watkin N. Update on organ preserving surgical strategies for penile cancer. Urol Oncol 2021; 40:179-183. [PMID: 33610446 DOI: 10.1016/j.urolonc.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/13/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
With the passage of time, there has been a major paradigm shift in the surgical management of penile cancer from radical to organ preserving penile surgical techniques, with closer surgical margins which offer good oncological, cosmetic and functional outcomes with improved physical and psychosexual well-being. This article aims to provide an update of the current organ preserving surgical strategies for penile cancer.
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Affiliation(s)
- Anthony Emmanuel
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Nick Watkin
- Penile Cancer Centre, St George's Healthcare NHS Trust, London, UK
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11
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Abstract
Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.
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Affiliation(s)
- Henry Han-I Yao
- Department of Urology, Eastern Health, Melbourne, Australia.,Department of Urology, Western Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia.,Department of Urology, Alfred Health, Melbourne, Australia
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Ahmed ME, Khalil MI, Kamel MH, Karnes RJ, Spiess PE. Progress on Management of Penile Cancer in 2020. Curr Treat Options Oncol 2020; 22:4. [PMID: 33230601 DOI: 10.1007/s11864-020-00802-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OPINION STATEMENT Management of penile cancer represents a challenge to urologic oncologists due to the disease's rarity and sparse data in the literature. Squamous cell carcinoma represents the most common histologic subtype of penile cancer. Penile cancer has a disastrous effect on patients' psychological and physical health. Penile cancer accounts for approximately 1% of cancer deaths in the USA annually. However, in recent years, the management of penile cancer has achieved marked progress in both diagnostic and therapeutic approaches with the intent to avoid radical surgeries. The traditional total penile amputation has been replaced by penile preserving procedures in many patients. Nowadays, total penile amputation (total penectomy) is preserved only for patients with proximal lesions. The introduction of minimally invasive surgical techniques in the management of penile cancer-infiltrated lymph nodes has been reported. Given the dismal prognosis with conventional cytotoxic therapies, new systemic therapies have been investigated in patients with locally advanced or metastatic penile cancer. Multiple studies have shown promising outcomes. All these efforts have resulted in a remarkable improvement in patient quality of life. The objectives of our review are to update clinicians on the advances in the management of penile cancer and to summarize the recent guidelines and recommendations.
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Affiliation(s)
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | | | - Philippe E Spiess
- Department of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. .,Department of GU Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA. .,Urology and Oncology, University of South Florida, Tampa, FL, USA.
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Abstract
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.
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Affiliation(s)
- Andrew Fang
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA
| | - James Ferguson
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA.,The University of Alabama, Birmingham School of Medicine- O'Neal Comprehensive Cancer Center , Birmingham, AL, USA
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Lindner AK, Schachtner G, Steiner E, Kroiss A, Uprimny C, Steinkohl F, Horninger W, Heidegger I, Madersbacher S, Pichler R. Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival. World J Urol 2020; 38:417-424. [PMID: 31062123 PMCID: PMC6994547 DOI: 10.1007/s00345-019-02793-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/26/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To report on the oncological outcome of organ-sparing surgery (OSS) compared to (total or partial) penectomy regarding recurrence patterns and survival in squamous cell carcinoma (SCC) of the penis. METHODS This was a retrospective study of all patients with penile SCC and eligible follow-up data of at least 2 years at our institution. Patients with tumors staged ≥ pT1G2 underwent invasive lymph node (LN) staging by dynamic sentinel-node biopsy or modified inguinal lymphadenectomy. Radical inguinal lymphadenectomy was performed when LNs were palpable at diagnosis and in those with a positive LN status after invasive nodal staging. Follow-up visits were assessed, and local, regional and distant recurrences were defined and analyzed. RESULTS 55 patients were identified with a mean follow-up of 63.7 months. Surgical management was OSS in 26 patients (47.2%) and partial or total penectomy in 29 cases (52.8%). Histopathological staging was: pTis (12.7%), pTa (16.3%), pT1a (18.2%), pT1b (5.5%), pT2 (29.1%) and pT3 (18.2%), respectively. Patients in the penectomy group were significantly older (mean 68 vs. 62 years; p = 0.026) with a higher rate of advanced tumor stage (≥ pT2: 44.8% vs. 11.5%; p = 0.002). The local recurrence rate was 42.3% (n = 11) following OSS compared to 10.3% (n = 3) after penectomy (p = 0.007). Kaplan-Meier curves showed no significant differences between the two groups regarding metastasis-free and overall survival. CONCLUSIONS OSS is associated with a higher local recurrence rate compared to penectomy, yet it has no negative impact on overall and metastasis-free survival.
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Affiliation(s)
| | - Gert Schachtner
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Eberhard Steiner
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Alexander Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Steinkohl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Stephan Madersbacher
- Department of Urology, Kaiser Franz Josef Hospital, Sigmund Freud Private University, Vienna, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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15
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Organ-sparing surgical and nonsurgical modalities in primary penile cancer treatment. Curr Opin Urol 2019; 29:156-164. [DOI: 10.1097/mou.0000000000000587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Babbar P, Yerram N, Crane A, Sun D, Ericson K, Sun A, Khanna A, Wood H, Stephenson A, Angermeier K. Penile-sparing modalities in the management of low-stage penile cancer. Urol Ann 2018; 10:1-6. [PMID: 29416267 PMCID: PMC5791443 DOI: 10.4103/ua.ua_93_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Penile-sparing modalities are gaining widespread adoption for the management of low-stage penile cancer due to an increasing demonstration of sound oncologic, cosmetic, sexual, psychosocial, and quality of life outcomes. This review aims to provide a comprehensive overview of the respective treatment options in the armamentarium of the practicing urologist in dealing with this rare but problematic condition.
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Affiliation(s)
- Paurush Babbar
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nitin Yerram
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alice Crane
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Sun
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kyle Ericson
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andrew Sun
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Abhinav Khanna
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hadley Wood
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andrew Stephenson
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kenneth Angermeier
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Role of perioperative dynamic sentinel node biopsy for cN0 penile cancer management: experience from an Italian tertiary referral center. TUMORI JOURNAL 2017; 104:66-70. [PMID: 29192738 DOI: 10.5301/tj.5000700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Inguinal lymphadenectomy (iLAD) reduces mortality in patients with cN0 penile cancer but yields high complication rates. Thus, its prophylactic role has been questioned and dynamic sentinel node biopsy (DSNB) was introduced to select men who should undergo the procedure. Our aim was to investigate the accuracy of a contemporary DSNB cohort. METHODS We performed a retrospective analysis of ≥T1 or ≥G2 cN0 penile cancer undergoing perioperative DSNB from June 2009 to June 2015 at a tertiary referral center. We excluded men with <18 months follow-up or with local recurrence after primary curative treatment. Complications were graded according to the Clavien-Dindo classification. RESULTS Thirty-five men underwent DSNB; 85.71% had ≤T2 penile cancer with ≤G2a histology. Per groin detection rate was 80% (scintigraphy being positive bilaterally in 60% and unilaterally in 20.0%). In no cases did DSNB prolong the postoperative course compared to primary surgery. Nine men (n = 15/109 nodes removed) had positive results, 8 of whom underwent iLAD. Among negative DSNB patients, 2 developed nodal penile cancer recurrence; none of them had node biopsy due to inconclusive scintigraphy. At a median follow-up of 42 months (interquartile range 30-78 months), if considering only men with scintigraphy detected inguinal nodes, per-patient sensitivity and specificity were 50% and 80% whereas positive predictive value and negative predictive value were 25% and 92.3%, respectively. CONCLUSIONS Perioperative DSNB is a safe procedure, yielding promising results when performed at a tertiary referral center. Future prospective large studies are needed to investigate how to optimize detection rate and reduce false-negative rates.
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Musi G, Russo A, Conti A, Mistretta FA, Di Trapani E, Luzzago S, Bianchi R, Renne G, Ramoni S, Ferro M, Matei DV, Cusini M, Carmignani L, de Cobelli O. Thulium–yttrium–aluminium–garnet (Tm:YAG) laser treatment of penile cancer: oncological results, functional outcomes, and quality of life. World J Urol 2017; 36:265-270. [DOI: 10.1007/s00345-017-2144-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022] Open
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Tang DH, Yan S, Ottenhof SR, Draeger D, Baumgarten AS, Chipollini J, Protzel C, Zhu Y, Ye DW, Hakenberg OW, Horenblas S, Watkin NA, Spiess PE. Laser ablation as monotherapy for penile squamous cell carcinoma: A multi-center cohort analysis. Urol Oncol 2017; 36:147-152. [PMID: 29097087 DOI: 10.1016/j.urolonc.2017.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/01/2017] [Accepted: 09/29/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although the trend towards penile sparing therapy is increasing for penile squamous cell carcinoma, outcomes for laser ablation therapy have not been widely reported. We assessed the clinical outcomes of penile cancer patients treated with only laser ablation. MATERIALS AND METHODS A retrospective review was performed on 161 patients across 5 multi-center tertiary referral centers from 1985 to 2015. All patients underwent penile sparing surgery with only laser ablation for squamous cell carcinoma of the penis. Laser ablation was performed with neodymium-doped yttrium aluminum garnet or carbon dioxide. Overall and recurrence-free survival was calculated using the Kaplan-Meier method and compared with the log rank test. RESULTS A total of 161 patients underwent laser ablation for penile cancer. The median age was 62 (IQR: 52-71) years and median follow-up was 57.7 (IQR: 28-90) months. The majority of patients were pTa/Tis (59, 37%) or pT1a (62, 39%). Only 19 (12%) had a poorly differentiated grade. The 5-year recurrence-free survival was 46%. When stratified by stage, the 5-year local recurrence-free survival was pTa/Tis: 50%; pT1a: 41%; pT1b: 38%; and pT2: 52%. The inguinal/pelvic nodal recurrence was pTa/Tis: 2%; pT1a: 5%; pT1b: 18%; and pT2: 22%. There were no differences among stages with respect to recurrence-free survival (P = 0.98) or overall survival (P = 0.20). CONCLUSION Laser ablation therapy is safe for appropriately selected patients with penile squamous cell carcinoma. Due to the increased risk of nodal recurrence, laser ablation coupled with diagnostic nodal staging is indicated for patients with pT1b or higher.
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Affiliation(s)
- Dominic H Tang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
| | - Sylvia Yan
- Department of Urology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Sarah R Ottenhof
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Désirée Draeger
- Department of Urology, University Hospital Rostock, Rostock, Germany
| | - Adam S Baumgarten
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Juan Chipollini
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Chris Protzel
- Department of Urology, University Hospital Rostock, Rostock, Germany
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | | | - Simon Horenblas
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nicholas A Watkin
- Department of Urology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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22
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Chipollini J, Yan S, Ottenhof SR, Zhu Y, Draeger D, Baumgarten AS, Tang DH, Protzel C, Ye DW, Hakenberg OW, Horenblas S, Watkin NA, Spiess PE. Surgical management of penile carcinoma in situ
: results from an international collaborative study and review of the literature. BJU Int 2017; 121:393-398. [DOI: 10.1111/bju.14037] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Juan Chipollini
- Department of Genitourinary Oncology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL USA
| | - Sylvia Yan
- Department of Urology; St George׳s Healthcare NHS Trust; London UK
| | - Sarah R. Ottenhof
- Department of Urological Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Yao Zhu
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
| | - Désirée Draeger
- Department of Urology; University Hospital Rostock; Rostock Germany
| | - Adam S. Baumgarten
- Department of Urology; University of South Florida Morsani College of Medicine; Tampa FL USA
| | - Dominic H. Tang
- Department of Genitourinary Oncology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL USA
| | - Chris Protzel
- Department of Urology; University Hospital Rostock; Rostock Germany
| | - Ding-wei Ye
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
| | | | - Simon Horenblas
- Department of Urological Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | | | - Philippe E. Spiess
- Department of Genitourinary Oncology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL USA
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Kamel MH, Bissada N, Warford R, Farias J, Davis R. Organ Sparing Surgery for Penile Cancer: A Systematic Review. J Urol 2017; 198:770-779. [DOI: 10.1016/j.juro.2017.01.088] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Mohamed H. Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Nabil Bissada
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Renee Warford
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Judy Farias
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
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Chipollini J, Tang DH, Sharma P, Spiess PE. National Trends and Predictors of Organ-sparing for Invasive Penile Tumors: Expanding the Therapeutic Window. Clin Genitourin Cancer 2017; 16:e383-e389. [PMID: 28967504 DOI: 10.1016/j.clgc.2017.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/19/2017] [Accepted: 09/03/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to analyze contemporary trends and predictors in the use of organ-sparing treatment (OST) for low-stage invasive penile tumors as well as to ascertain its impact on overall mortality (OM) in those with high-risk (pT2) disease. PATIENTS AND METHODS The National Cancer Data Base was queried for patients with clinically nonmetastatic penile cancer and available pathologic tumor (pT) and treatment data from 1998 to 2012. Independent predictors for performance of OST were analyzed. Multivariable Cox proportional hazard regression was used to identify factors of OM in a subset of patients with pT2 disease. RESULTS A total of 4231 patients with ≤ pT2cN0cM0 primary penile cancer were identified over a median follow-up of 39.6 months. Approximately 49% of patients received OST over the study period (P = .009). Older age, Hispanic ethnicity, urban counties, academic facilities, and pT2 disease were negative predictors for OST (all P < .05), whereas grade and years of diagnosis where associated with increased performance (P < .01). In subgroup analysis of pT2 patients, older age, black race, comorbidity, node status, and grade were associated with higher OM (all P < .05). When compared with radical penectomy, partial penectomy was associated with decreased OM (hazard ratio, 0.67; 95% confidence interval, 0.52-0.87; P = .002), whereas organ-sparing did not affect survival (hazard ratio, 0.83; 95% confidence interval, 0.52-1.31; P = .419) in these patients. CONCLUSION Ethnic and socioeconomic differences exist in the local management of penile tumors. No impact on OM was observed for those with high-risk cases treated with organ-sparing at intermediate follow-up. More studies are needed to evaluate oncologic efficacy of organ-sparing in carefully selected invasive penile tumors.
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Affiliation(s)
- Juan Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
| | - Dominic H Tang
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Science Center, Lubbock, TX
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
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Need for Evidence and Consensus on Laser Treatment for Management of Select Primary Penile Tumors. Eur Urol 2017; 72:4-6. [DOI: 10.1016/j.eururo.2017.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/13/2017] [Indexed: 11/15/2022]
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Laser Ablation for Cancer: Past, Present and Future. J Funct Biomater 2017; 8:jfb8020019. [PMID: 28613248 PMCID: PMC5492000 DOI: 10.3390/jfb8020019] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 12/27/2022] Open
Abstract
Laser ablation (LA) is gaining acceptance for the treatment of tumors as an alternative to surgical resection. This paper reviews the use of lasers for ablative and surgical applications. Also reviewed are solutions aimed at improving LA outcomes: hyperthermal treatment planning tools and thermometric techniques during LA, used to guide the surgeon in the choice and adjustment of the optimal laser settings, and the potential use of nanoparticles to allow biologic selectivity of ablative treatments. Promising technical solutions and a better knowledge of laser-tissue interaction should allow LA to be used in a safe and effective manner as a cancer treatment.
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27
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Organ Preservation Surgery for Carcinoma Penis. Indian J Surg Oncol 2017; 8:59-63. [PMID: 28127184 DOI: 10.1007/s13193-016-0573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022] Open
Abstract
Carcinoma of the penis is not uncommon in India. A sizeable number of patients do not report to the doctors in fear of mutilation to the organ and hence subsequently end up with advanced disease. Many patients with T1 or T2 disease when carefully selected are amenable to organ-preserving penile procedures including surgery, topical therapy, laser, and radiation therapy. Identification of appropriate patients and institution of these treatments has been noted to produce oncologically comparable results to extirpative surgeries. In this article, we review the criteria to identify patients qualifying for organ-preserving treatments and also review outcomes with a variety of penile-preserving procedures.
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Sosnowski R, Kuligowski M, Kuczkiewicz O, Moskal K, Wolski JK, Bjurlin MA, Wysock JS, Pęczkowski P, Protzel C, Demkow T. Primary penile cancer organ sparing treatment. Cent European J Urol 2016; 69:377-383. [PMID: 28127454 PMCID: PMC5260461 DOI: 10.5173/ceju.2016.890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical treatment of penile cancer is usually associated with mutilation; alterations in self-esteem and body image; affecting sexual and urinary functions; and declined health-related quality of life. Recently, organ sparing treatment has appeared and led to limiting these complications. MATERIAL AND METHODS An extensive review of the literature concerning penile-preserving strategies was conducted. The focus was put on indications, general principles of management, surgical options and reconstructive techniques, the most common complications, as well as functional and oncological outcomes. RESULTS Analyzed methods, e.g.: topical chemotherapy, laser ablation therapy, radiotherapy, Moh's microscopic surgery, circumcision, wide local excision, glans resurfacing and glansectomy are indicated in low-stage tumors (Tis, Ta-T2). After glansectomy, reconstruction is also possible. CONCLUSIONS Organ sparing techniques may achieve good anatomical, functional, and psychological outcomes without compromising local cancer control, which depends on early diagnosis and treatment. Penile sparing strategies are acceptable treatment approaches in selected patients with low-stage penile cancer after establishing disease-risk and should be considered in this population.
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Affiliation(s)
- Roman Sosnowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marcin Kuligowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Olga Kuczkiewicz
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Moskal
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Jan Karol Wolski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marc A. Bjurlin
- Division of Urology, NYU Lutheran Medical Center, NYU Langone Health System, NYU School of Medicine, New York, USA
| | - James S. Wysock
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, New York USA
| | - Piotr Pęczkowski
- Department of Radiotheraphy, Maria Sklodowska-Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Chris Protzel
- Department of Urology, University of Rostock, Germany
| | - Tomasz Demkow
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
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Management of Penile Cancer. Urology 2016; 96:15-21. [DOI: 10.1016/j.urology.2015.12.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 12/17/2022]
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30
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Bozzini G, Provenzano M, Romero Otero J, Margreiter M, Garcia Cruz E, Osmolorskij B, Verze P, Pavan N, Sanguedolce F, Buffi N, Ferrucio GG, Taverna G. Role of Penile Doppler US in the Preoperative Assessment of Penile Squamous Cell Carcinoma Patients: Results From a Large Prospective Multicenter European Study. Urology 2016; 90:131-5. [DOI: 10.1016/j.urology.2016.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/28/2015] [Accepted: 01/05/2016] [Indexed: 11/29/2022]
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Lucky M, Murthy KV, Rogers B, Jones S, Lau MW, Sangar VK, Parr NJ. The treatment of penile carcinomain situ(CIS) within a UK supra-regional network. BJU Int 2014; 115:595-8. [DOI: 10.1111/bju.12878] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marc Lucky
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
| | | | - Beverley Rogers
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
| | - Stephen Jones
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
| | - Maurice W. Lau
- The Christie NHS Foundation Trust, Withington; Manchester UK
| | - Vijay K. Sangar
- The Christie NHS Foundation Trust, Withington; Manchester UK
| | - Nigel J. Parr
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
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Zukiwskyj M, Daly P, Chung E. Penile cancer and phallus preservation strategies: a review of current literature. BJU Int 2013; 112 Suppl 2:21-6. [PMID: 24127672 DOI: 10.1111/bju.12205] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Penile cancer is a rare malignancy in most developed nations but its management can have significant anatomical, functional and psychological effects in patients. Whilst total penectomy used to be widely practiced, it is associated with significant psychological consequences pertaining to body image and masculinity, with loss of sexual function and the ability to void upright. Recent advances in surgical techniques and technologies has allowed for many organ-sparing techniques with acceptable psychosexual and oncological outcomes. Factors to be considered in phallus preservation treatment include: local invasion, tumour stage and the ability to achieve complete oncological control. Topical chemotherapeutic agents, laser ablation, radiotherapy, Mohs micrographic surgery, glansectomy and partial penectomy have been frequently used to interfere as little as possible with functional anatomy without compromising local cancer control. The difficulty with these phallus-preserving techniques is the potential risk of disease recurrence both locally and distally. Providing that patients are suitable for penile-sparing therapy, have been informed adequately on risk of tumour recurrence and are willing to commit to rigorous close surveillance, good functional outcome as well as oncological control can be achieved.
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Affiliation(s)
- Marianna Zukiwskyj
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Richter S, Ruether JD, Wood L, Canil C, Moretto P, Venner P, Gingerich J, Emmenegger U, Eisen A, Zalewski P, Joshua A, Mukherjee SD, Heng D, Czaykowski P, Soulieres D, Blais N, Rendon R, Fleshner N, Crook JM, Sridhar SS. Management of carcinoma of the penis: Consensus statement from the Canadian Association of Genitourinary Medical Oncologists (CAGMO). Can Urol Assoc J 2013; 7:E797-811. [PMID: 24475001 PMCID: PMC3879728 DOI: 10.5489/cuaj.1794] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Suzanne Richter
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - J. Dean Ruether
- Medical Oncology, Southern Alberta Cancer Research Institute, Alberta Health Services, Calgary, AB
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Heath Sciences Centre, Halifax, NS
| | - Christina Canil
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre; and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - Patricia Moretto
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre; and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - Peter Venner
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - Joel Gingerich
- Division of Medical Oncology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Research Institute, Toronto, ON
| | - Andrea Eisen
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Research Institute, Toronto, ON
| | - Pawel Zalewski
- Division of Oncology, Lakeridge Health Centre, Toronto, ON
| | - Anthony Joshua
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | | | | | - Piotr Czaykowski
- Division of Medical Oncology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB
| | - Denis Soulieres
- Hematology and Medical Oncology Service, Department of Medicine, Centre Hospitalier de l’Universite de Montreal, Montreal, Montreal, QC
| | - Norman Blais
- Hematology and Medical Oncology Service, Department of Medicine, Centre Hospitalier de l’Universite de Montreal, Montreal, Montreal, QC
| | - Ricardo Rendon
- Department of Surgery, Dalhousie University, Halifax, NS
| | - Neil Fleshner
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - Juanita M. Crook
- BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, BC
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Van Poppel H, Watkin N, Osanto S, Moonen L, Horwich A, Kataja V. Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi115-24. [DOI: 10.1093/annonc/mdt286] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Abstract
OBJECTIVES To review the risk factors, prevention, treatment, and management of the patient with penile cancer. DATA SOURCES Publications; clinical experience. CONCLUSION Penile cancer is a rare malignancy in the United States, but is more common in developing countries. The disease is so uncommon in the United States that there are oncology nurses who have never cared for a patient with this diagnosis. IMPLICATIONS FOR NURSING PRACTICE With significant psychosocial implications for the patient with penile cancer and partner, it is important that the nurse have an understanding of the diagnosis, treatment, and care of these patients.
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Affiliation(s)
- Jeanne Held-Warmkessel
- Department of Nursing, 333 Cottman Ave., Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Abstract
The spectrum of conditions affecting the penile skin is varied and ranges from simple, benign dermatoses to premalignant and malignant conditions. Recently, improved understanding of the aetiology and natural history of these conditions has shaped new treatment paradigms and a functional knowledge of dermatology, urology and genitourinary medicine is required to successfully diagnose and treat these men. In this article, we explore the common precancerous states that can lead to penile carcinoma and review the recent advances with regards to the molecular basis for these dermatoses and the treatments that may be most effective for these men.
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Affiliation(s)
- Oliver Kayes
- Department of Andrology, University College London Hospital, UK.
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