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. 2018 Sep 28;115(39):646-652.
doi: 10.3238/arztebl.2018.0646.

The Diagnosis and Treatment of Penile Cancer

Oliver Walther Hakenberg, Desiree Louise Dräger  1 , Andreas Erbersdobler, Carsten Maik Naumann, Klaus-Peter Jünemann, Chris Protzel
Affiliations

The Diagnosis and Treatment of Penile Cancer

Oliver Walther Hakenberg et al. Dtsch Arztebl Int. .

Abstract

Background: The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation.

Methods: This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE).

Results: 95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis.

Conclusion: Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.

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Figures

Figure 1
Figure 1
Glans resection with split-thickness skin graft closure
Figure 2
Figure 2
One year after glans resection for pT2G3 penile cancer with split-thickness skin graft repair and bilateral inguinal lymphadenectomy (pN1 bilaterally) and adjuvant chemotherapy
Figure 3
Figure 3
Extensive fixed inguinal lymph node metastases in penile cancer (N3)
See this image and copyright information in PMC

Comment in

  • Reconstructive Possibilities.
    Djedovic G, Sohn M, Rieger UM. Djedovic G, et al. Dtsch Arztebl Int. 2019 Jan 7;116(1-2):11. doi: 10.3238/arztebl.2019.0011. Dtsch Arztebl Int. 2019. PMID: 30782309 Free PMC article. No abstract available.

References

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