Update on organ preserving surgical strategies for penile cancer

Emmanuel, Anthony; Watkin, N.

doi:10.1016/j.urolonc.2021.01.012

Cited by 6 publications

(8 citation statements)

References 38 publications

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“…Conservative treatments are usually reserved for patients with localized tumors (c ≤ T2) with the aim of eradicating the entire cancer, obtaining free margins of excision and sparing the organ [6]. In this scenario, urologists are increasingly favoring penile-sparing approaches due to their remarkable functional outcomes and significant preservation of patients' physical and psychosexual wellbeing [7]. Interestingly, Maddineni et al evaluated the effects of PC and its treatment on psychosexual, social, and QoL experiences, concluding that PC had a negative impact on wellbeing in up to 40% of patients; almost 50% of men that underwent radical surgeries show symptoms of a psychiatric illness and up to two thirds experience an impairment of sexual function [8].…”

Section: Introductionmentioning

confidence: 99%

Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer

Cilio,

Tufano,

Pezone

et al. 2023

Current Oncology

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Background: Men with localized invasive penile cancer (PC) can be treated with organ-sparing treatments with different functional and aesthetical outcomes. Thus, the aim of this study is to investigate sexual outcomes in patients with PC confined to the glans that underwent wide local excision (WLE) vs. glansectomy with urethral glanduloplasty. Methods: Complete data from 60 patients with PC were analyzed at our institution from 2017 to 2022. Patients were asked for personal habits and clinical features. PC was assessed with a clinical visit and imaging techniques. At the outpatient follow-up visit or phone call, all patients compiled the Changes in Sexual Function Questionnaire (CSFQ) and the International Index of Erectile Function in its short 5-item form (IIEF-5). Erectile function (EF) impairment was categorized using Cappelleri’s criteria. Results: Overall, 34 patients with PC confined to the glans (c ≤ T2N0) were included. Of those, 12 underwent WLE and 22 underwent glansectomy with urethral glanduloplasty. Using multivariable logistic regression, glansectomy (OR: 3.49) and diabetes (OR: 2.33) were associated with erectile disfunction (IEEF < 22). Meanwhile, using multivariable linear regression analysis, younger patients (Coeff: −2.41) and those that underwent glansectomy (Coeff: −7.5) had a higher risk of sexual function impairment, according to the CSFQ. Conclusions: Patients with PC ≤ T2N0 that underwent WLE have better outcomes in terms of sexual functioning than the patients who underwent glansectomy and uretheral gladuloplasty. Further research is needed to clarify the outcomes of penile-sparing surgery, to inform patients in pre-surgical counseling more comprehensively, and to meet their post-operative expectations more effectively.

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Section: Introductionmentioning

confidence: 99%

Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer

Cilio,

Tufano,

Pezone

et al. 2023

Current Oncology

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“…The surgical management of penile cancer has shifted from radical ablative surgery to organ-preserving techniques, with closer surgical margins, which provide good oncological, psychological and functional outcomes ( 7 , 8 ). Traditionally, the tumour-free margin of partial penectomy is recommended to be at least 20 mm ( 7 , 9 ). Agrawal et al ( 10 ) suggested a 10-mm surgical margin for grade 1 or 2 and a 15-mm surgical margin for grade 3 penile cancer.…”

Section: Introductionmentioning

confidence: 99%

Venous thrombosis, multiple carcinomatous foci and differences in metastatic pathways of penile carcinoma

Li³

et al. 2023

Oncol Lett

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The aim of the present study was to explore the life-threatening complications and metastatic pathways of penile squamous cell carcinoma (SCC), as numerous patients with penile cancer are relatively young, are of good general health and have no visceral metastasis, yet have poor survival rates. A total of 94 patients with SCC of the penis who were surgically treated were included in the current study. The coagulation parameters, including prothrombin time (PT), fibrinogen and D-dimer, were analyzed. The patients' age ranged from 25 to 95 years (mean ± standard deviation, 53.3±1.4 years). A total of 77 patients (81.9%) underwent partial penectomy and 17 (18.1%) underwent radical penectomy. The PT was significantly different between patients whose tumour invaded the corpora cavenosum and those whose tumour had not invaded, and between patients with and without pelvic lymph node metastasis. A negative correlation was obtained between PT and pelvic lymph node metastasis. In addition, six typical SCC cases and one metastatic penile carcinoma case manifested with multiple carcinomatous foci, embolisms and evidence of a metastatic pathway occurring simultaneously with tumour progression were presented. The present study indicated that venous thrombosis is one of the life-threatening complications of advanced penile cancer. Furthermore, multiple carcinomatous foci were detected in histological images. Of note, direct clinical evidence for different metastatic pathways of primary and secondary penile carcinoma was provided.

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“…(1) Increased understanding of the minimum clear surgical margin required, has allowed surgeons to push the boundaries of PSS. (2) The centralisation of care to centres with multidisciplinary expertise. (3) Multiinstitutional collaboration -allowing the combining of data and the evaluation of these patients in larger cohorts, yielding greater power in research.…”

Section: Introductionmentioning

confidence: 99%

“…We also consider future areas of research and direction of work. Full information on the indications and methods of PSS are discussed in detail elsewhere [1,2]. Table 1 summarises the main PSS techniques, including their advantages and disadvantages [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Update on penile sparing surgery for penile cancer

Anastasiadis

Ayres²,

Watkin³

2021

Current Opinion in Urology

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Purpose of reviewPenile sparing surgery (PSS) is considered the standard of care in penile cancer where appropriate, as preservation of the penis may enable the patient to maintain urinary and sexual function. This review will focus on the latest developments over the past two years. Recent findingsIn this review, we discuss the latest findings in oncological outcomes in PSS, specifically glansectomy. We also introduce technology that may be useful in improving the precision of surgical resection margins in PSS. Finally, we consider the value of patient-reported outcome measures (PROMs) and consider how research in this area can be improved. SummaryA recent study has found a correlation between local recurrences (LR) and worse overall and cancerspecific survival in glansectomy, which challenges the belief that LR do not confer worse oncological outcomes. Despite numerous studies evaluating PROMs in penile cancer/PSS, few of these studies provide quality evidence of the 'supportive care needs'. A shift in research is required to identify those men at most risk of distress and to identify ways to support men diagnosed with penile cancer.

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Update on organ preserving surgical strategies for penile cancer

Cited by 6 publications

References 38 publications

Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer

Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer

Venous thrombosis, multiple carcinomatous foci and differences in metastatic pathways of penile carcinoma

Update on penile sparing surgery for penile cancer

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