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Penile Cancer
Organ-preserving Surgery for Penile Cancer
Maarten Albersen
1,2
and Steven Joniau
2
1. Basic Research Fellow, Department of Urology, University of California, San Francisco; 2. Urologist, Department of Urology, University Hospitals Leuven
Abstract
Penile cancer is a rare malignancy with a prevalence of one in 100,000 men in developed countries. The traditional treatment of this cancer
consists of either partial or total penile amputation. These procedures are inherently disfiguring and have a profound impact on sexual and
urinary function, body image and quality of life. Following the publication of important histopathological analyses of the spreading pattern of
penile cancer, less radical organ-preserving surgical approaches have gained popularity. These organ-preserving techniques are cold-knife
excision, laser surgery and Mohs micrographic surgery. Although no prospective trials are available due to the rarity of the disease,
contemporary literature consists of multiple retrospective reports showing excellent oncological control with organ-preserving surgery for
penile cancer. Local recurrence is a frequent issue in organ-preserving surgery, although it does not appear to affect disease-specific survival.
We reviewed the current literature on organ-preserving surgical techniques for penile cancer and in this article provide an overview of the
background, indications and outcome of these treatment modalities.
Keywords
Organ-preserving surgery, penile cancer, laser, Mohs micrographic surgery, glansectomy, penis
Disclosure: The authors have no conflicts of interest to declare.
Received: 18 November 2009 Accepted: 6 January 2010
steven.joniau@uzleuven.be
Penile cancer is a rare malignancy in developed countries. In the US contemporary review. Other penile-preserving treatments that use
and Europe, penile cancer occurs in fewer than one in 100,000 males, radio- and chemotherapy are beyond the scope of this review and are
and it accounts for fewer than 1% of all male cancers.
1–4
In developing elegantly discussed elsewhere.
7
countries, incidence rates reach 4.4 in 100,000, and penile cancer
accounts for up to 10% of all malignancies in certain South American, Patient Selection and Tumour, Node,
African and Asian countries. This geographical variation is believed to Metastases Classification
be the result of socioeconomic, hygienic and religious differences.
2,3
The primary lesion is best assessed by physical examination, which can
be complemented by imaging modalities such as magnetic resonance
Although traditional treatment of penile cancer by either partial or total imaging (MRI) and ultrasound.
5
The same general rule applies for inguinal
penile amputation has been proved to result in excellent oncological examination. The selection of patients eligible for organ-preserving
control, these surgeries are inherently mutilating and compromise the strategies depends on various factors, including tumour stage, tumour
sexual function and body image of the patient to a considerable grade and compliance of patients with regular follow-up visits. Generally
extent. For this reason, authors have sought to treat penile cancer less speaking, patients with low-stage and low-grade lesions are eligible for
radically, resulting in surgical techniques that preserve penile tissue organ-preserving surgery, while tumours infiltrating the corpus
and function.
5,6
Ninety-five per cent of all penile malignancies are cavernosum and high-grade lesions are more suitable for traditional
squamous cell carcinomas (SCCs), which in the majority of cases have partial or total penectomy.
8
Specific indications for each technique will
their origin in the squamous epithelium lining the glans, coronal sulcus be discussed in more detail in the sections on the various modalities.
and prepuce and thus are frequently distally located, making them
potentially suitable for organ-preserving resection.
2
Although the tumour, node, metastases (TNM) classification is
designed to guide treatment decisions based on prognostic
Because of the rare nature of the disease, only limited data are differences between the TNM stages, an exception to this rule
available to confirm the equality of the organ-preserving techniques appears to be the distal (meatal) T3 lesion. A superficial tumour that
to conventional partial or total penectomy, although in recent years grows into the urethra is currently staged as T3, even if there is no
multiple retrospectively conducted studies have shown acceptable infiltration into the erectile tissue. However, this group of patients can
oncological outcomes in combination with preservation of sexual be treated with penile-preserving methods with a good prognosis. The
function, upright voiding and quality of life. Various techniques have same applies for patients with corpus spongiosum invasion, who are
been investigated, including local excision, Mohs micrographic suitable for conservative surgery, as opposed to those who have a
surgery and laser ablation, all of which will be discussed in this tumour that shows corpus cavernosum invasion. Nonetheless, in the
© TOUCH BRIEFINGS 2009
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