AUA 2017: Oncological Outcomes And Patterns Of Recurrence Of Penile Sparing Approaches For Carcinoma Of The Penis: A Retrospective, Multicenter Cohort Analysis

Boston, MA (UroToday.com) Penile cancer remains a rare cancer, particularly in Europe and the United States. As such, multi-institutional studies are required to generate enough data for substantive research. In that spirit, the authors of this study completed a retrospective, multi-institutional assessment of penile sparing surgery (PSS), defined broadly as circumcision, partial/total glansectomy, laser ablation, or wide local excision (WLE), and its oncologic outcomes.

Radical penectomy can be a disfiguring operation, and while necessary in certain conditions, it should be avoided if feasible. By partially preserving the penis, the patient is able to preserve functional status, which is important for quality of life. However, oncologic outcome should be balanced against functional preservation.

In this study, the authors evaluated 1303 consecutive patients who underwent PSS over a 15-year period at 5 different institutions. Patients were stratified by the type of PSS they underwent, and oncologic outcomes were assessed.

Table 1 (not shown) highlighted the demographics of each of the cohorts. As can be expected, there were more advanced pathology and higher rates of local/distant recurrence in the patients with more aggressive interventions. As a result, they also had lower rates of 1, 2 and 5-year recurrence-free survival.

Of note, however, at a median follow up of 43 months. Unfortunately, the group updated their data at the time of the presentation, but in the new data, they note that WLE and laser therapy had worse RFS than glansectomy patients. Circumcision had the best RFS data.

In Table 2 (not shown), multivariable analysis found tumor grade (HR = 1.5, p <0.001) and corporal invasion (HR = 1.4, p = 0.05) to be significant, independent predictors for disease recurrence. These results are not surprising.

Figure 1 demonstrated RFS based on treatment type. WLE and Laser ablation had the lowest RFS of the treatment modalities; glansectomy was slightly better, while circumcision was the best.

Limitations / Discussion Points:
1. WLE and Laser therapy patients had worst recurrence outcomes, which is concerning. In these patients, glansectomy may be better.
2. It would have been nice to separate RFS curves based on T-stage, to help better guide clinicians re: optimal management for specific stage disease.
3. Importantly, margin status was only available for 21% of patients.

The moderators note that 13% of patients with pT2 disease underwent laser therapy. This highlights the fact that penile sparing therapy should be reserved for patients with appropriate pathology and should be done at centers of excellence. Inappropriate PSS can compromise a patient’s chance for cure.

Presented by: Juan Chipollini

Co-Authors: Adam Baumgarten, Dominic Tang, Sylvia Yan, Sarah Ottenhof, Yao Zhu, Ding-wei Ye, Chris Protzel, Simon Horenblas

Institution(s): International, multi-institutional

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto
Twitter: @tchandra_uromd

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
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