Therapeutic and Surgical Indications for Patients with Penile Cancer in the COVID-19 era

Abstract

Purpose: The aim of this work is to review and synthesize the existing evidence and recommendations regarding to the therapeutic and surgical indications as well as monitoring of patients with Penile Cancer in COVID-19 era and to propose an action protocol to facilitate decision-making. Material and Methods: A non-systematic review of the literature regarding the management of penile cancer during the COVID-19 pandemic was performed until April 30, 2020. We propose our recommendations based on this evidence. Results: Penile cancer is an uncommon but aggressive disease. Prognosis is determined by several characteristics, being the most important the presence of lymph nodes, in which case, treatment should not be delayed. For these reasons, an initial evaluation is mandatory. Priority classifications, based on the oncological outcomes when treatment is delayed, have been made in order to separate deferrable disease from the one that needs high priority treatment. In penile cancer with low risk of progression, surgical treatment can be delayed, but other options must be considered, like topical treatment or laser therapy. In cases with intermediate risk of progression, surgical treatment may be delayed up to three months, but we must consider radiation therapy and brachytherapy as effective options. When feasible, follow-up should by telemonitoring. Conclusions: In the COVID 19 era, initial evaluation of the patient is mandatory. Histological diagnosis with local staging is necessary before offering any therapeutic option. In case of superficial non-invasive disease, topical treatment is effective in absence of lymph node involvement. In selected patients, radiotherapy is an organpreserving approach with good results. Non-deferrable surgical treatment must be performed by an experienced surgeon and as an outpatient procedure when possible. When indicated, iLND should not be delayed since it is decisive for patient survival. Follow-up should be by telemonitoring.

Impact of the COVID‐19 pandemic on urological cancers: The surgical experience of two cancer hubs in London and Milan

“…It has been reported that topical treatment is effective and should be the first option in the absence of lymph node involvement, while radiotherapy has had good results in more advanced lesions. 30 As previously mentioned for testicular cancer, there is limited information on the effects of delaying surgical treatment due to COVID‐19. However, a recent review reported that testicular cancer patients would benefit from minimised delays and their treatment should be prioritised.…”

“…Moreover, the decline in the number of penile cancer surgery is also in line with published studies. It has been reported that topical treatment is effective and should be the first option in the absence of lymph node involvement, while radiotherapy has had good results in more advanced lesions 30 . As previously mentioned for testicular cancer, there is limited information on the effects of delaying surgical treatment due to COVID‐19.…”

Cancer management during the COVID-19 pandemic: Choosing between the devil and the deep blue sea

“…Several articles have provided insight into how practitioners should approach this difficult dilemma accordingly to each cancer histology. Suggestions and guidelines are available for head and neck, sino-nasal, spinal, breast, upper tract urothelial, cervical, penile, testicular, pancreatic, kidney, gastric, colorectal, skin, adrenal, liver, prostate, ovarian, endometrial, bladder and endocrine cancer ( Cohen et al, 2020 ; Baumann et al, 2020 ; Werner et al, 2020 ; Tarantola et al, 2013 ; Catanese et al, 2020 ; Vecchione et al, 2020 ; Turri-Zanoni et al, 2020 ; de C. Zequi and Abreu, 2020 ; Gravas et al, 2020 ; O’Leary et al, 2020 ; Casco et al, 2020 ; Katims et al, 2020 ; Berjano et al, 2020 ; Kapuria et al, 2020 ; P. March 25 and 2020, 2021 ; Tachibana et al, 2020 ; Loveday et al, 2020 ; Jones et al, 2020 ; Villani et al, 2020 ; Fligor et al, 2020 ; Sanchez et al, 2020 ; Wallis et al, 2020 ; Topf et al, 2020 ; Matsuo et al, 2020 ; Colombo et al, 2020 ; Campi et al, 2020 ; Raghavan et al, 2020 ).…”

More Aggressive Cancer Behaviour in Thyroid Cancer Patients in the Post-COVID-19 Pandemic Era: A Retrospective Study

“…[6][7][8] Severe anxiety and depression were observed among those patients. 9 Although a three-month delay in cancer treatment was deemed tolerable in some studies and recommendations, 10,11 such advice must be adopted with great caution. Obviously, cancers originating from different tissues need to be handled according to their severity and aggressiveness.…”