Results and 10-Year Follow-Up in Patients with Squamous Cell Carcinoma of the Penis

Abstract

Penile malignancies are infrequent but represent a diagnostic and therapeutic challenge as patients tend to disregard early asymptomatic lesions of the disease. Due to the lack of studies involving large patient numbers, the therapeutic concepts for different stages of the disease could not be defined by prospective studies. Long-term results are rare. We present the therapeutic concepts and the 10-year results of our experience with 42 cases of penile carcinoma treated at our institution between 1973 and 1986. Therapy included radical circumcision in 10 cases, local excision of the tumor in 4, partial or total glandular resection in 6 patients, partial penectomy in 20, and total penectomy in 2 cases. Inguinal lymphadenectomy was performed initially in 14 cases with positive histology in 7 patients (50%). Complications included meatal stenosis in 8 cases (19%), urethral stricture in 1 case, death due to fulminant pulmonary embolism in 1 case and local infections in 2 cases. Follow-up of patients with initially nonmetastatic disease showed a progression to death in 4 of 35 patients (11.6%) with a mean survival of 30 (range 11.5–56) months, in patients with initial lymph node metastases progression to death occurred in 5 of 7 patients (71.4%) with a mean survival of 9.76 months (range 9 days to 24 months). Stage-related disease-specific 10-year survival rates are 100% for stages 0 and 1, 90.9% for stage 2, and 20% for stage 3, while no patient in stage 4 survived for 5 years. From our data we conclude that the single most important prognostic factor in the treatment of carcinoma of the penis is lymph node involvement. Therefore increased attention has to be paid to the recognition of early stages of this potentially curable disease.

Predicting Cancer Progression in Patients with Penile Squamous Cell Carcinoma: The Importance of Depth of Invasion and Vascular Invasion

“…Inguinal lymphadenectomy, in addition to being potentially curative, also provides the pathologic lymph node status, the most important prognostic information in penile squamous cell carcinoma (14). The criteria for selection of patients for ilioinguinal lymphadenectomy remain controversial.…”

“…This approach has been successful (8,14,21,(23)(24). Lopes found that superficially invasive (1 to 5 mM) grade 1 or 2 tumors infrequently rarely metastasized (1 of 24) while deeply invasive ( more than 5 mM) and Grade 3 tumors usually metastasized (43 of 52) (24).…”

Local Treatment ofPenile Squamous Cell Carcinoma

“…The exceptional occurrence of squa- Emasculation is selectively performed in patients with large tumours infiltrating surrounding structures (T4). After radical surgery, the local recurrence rate ranges from 0 to 14% of cases, with mean values up to 4-5% (table 1) [7][8][9][10][11][12][13][14][15]. Considering the classical criteria of oncological radicality, the issue about the compromise of the penile anatomic and functional integrity inevitably arises, causing a high rate of sexual, psychological and social repercussions.…”

Functional imaging in penile cancer: PET/computed tomography, MRI, and sentinel lymph node biopsy

“…Lymph nodes, however, frequently undergo reactive enlargement in primary penile cancer [1,21]. This may explain the relatively high rate of false-positive lymph node findings [7,22]. The advantage of crosssectional imaging, particularly CT and MRI, over physical examination is that the former can help to detect deep lymph nodes and masses in the pelvis and retroperitoneum [6].…”