An update on treatment of penile cancer

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.

Sexuality in penile cancer survivors: A rarely discussed problem in uro‐oncology

“…Penile cancer is a very rare neoplasm that mainly affects high-income countries, with a rate of less than 1 case per 100 000 men in the United States and an average annual notification of 2000 new cases. 12 By the year 2020, an average of 36 000 new cases of penile cancer and an average of 13 200 deaths per year were recorded, 9 with a mortality rate close to 37%, being the highest among genitourinary cancer cases. The region with the most cases is the Asian continent with 20 315 cases, followed by Europe with 6762 cases, Latin America, and the Caribbean with 4988 cases, Africa with 2060 cases and finally North America with 1741 cases.…”

“…Penile cancer is a very rare neoplasm that mainly affects high‐income countries, with a rate of less than 1 case per 100 000 men in the United States and an average annual notification of 2000 new cases 12 . By the year 2020, an average of 36 000 new cases of penile cancer and an average of 13 200 deaths per year were recorded, 9 with a mortality rate close to 37%, being the highest among genitourinary cancer cases.…”

“…Although penile cancer is the least frequent type of urological cancer of all, its psychological and sexual performance impact is more profound, having severe consequences in patients, especially in heterosexual men, but repercussions have also been observed in men who have sex with other men 1 . This is because the treatment can be a total or partial penectomy, in which there is a complete or partial removal of the penis, respectively 12 . Loss of the penis has multiple consequences on the sexual health and quality of life of patients, such as loss of sexual interest, decreased sexual activity, loss of the ability to have orgasms, decreased frequency of masturbation, triggering of partner loss, divorce and marital problems 13 .…”

“…1 This is because the treatment can be a total or partial penectomy, in which there is a complete or partial removal of the penis, respectively. 12 Loss of the penis has multiple consequences on the sexual health and quality of life of patients, such as loss of sexual interest, decreased sexual activity, loss of the ability to have orgasms, decreased frequency of masturbation, triggering of partner loss, divorce and marital problems. 13 It is estimated that at least 56% of these patients do not receive any guidance from the treating urologist, 3 which limits their ability to regain an active and safe sex life, increasing the likelihood of significant mental consequences.…”

Efficacy of indocyanine green fluorescence‐guided inguinal lymph node dissection for penile cancer: a randomised trial

“…Accurate surgical staging of ILNs aids comprehensive evaluation and treatment and is recommended for selected patients with penile cancer (T1b-T4N0 or N1-3) [4]. Moreover, increasing the number of dissected ILNs might contribute to improved survival outcomes in patients who receive an ILND [5]. However, the possibility of complications after ILND is generally high, which may worsen patients' quality of life and overall survival [6].…”