The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh's micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump.
To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options.
The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included.
The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh's micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being.
Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods.
We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh's micrographic surgery could be used for smaller lesions.
European urology open science. 2022 May 02*** epublish ***
Vasileios I Sakalis, Riccardo Campi, Lenka Barreto, Herney Garcia Perdomo, Isabella Greco, Łukasz Zapala, Mithun Kailavasan, Tiago Antunes-Lopes, Jack David Marcus, Kenneth Manzie, John Osborne, Benjamin Ayres, Luc M F Moonen, Andrea Necchi, Juanita Crook, Pedro Oliveira, Lance C Pagliaro, Chris Protzel, Arie S Parnham, Maarten Albersen, Curtis A Pettaway, Philippe E Spiess, Scott T Tagawa, R Bryan Rumble, Oscar R Brouwer
Department of Urology, Agios Pavlos General Hospital, Thessaloniki, Greece., Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy., Department of Urology, University Hospital Nitra, Nitra, Slovakia., Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad Del Valle, Cali, Colombia., Department of Urological Minimally Invasive and Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, Medical University of Warsaw, Warsaw, Poland., Royal Derby Hospital, Derby, UK., Department of Urology, Hospital de S. João, Porto, Portugal., Multicancer Fighter Patient Advocate, Us TOO, New York, NY, USA., Patient Advocate, ORCHID, UK., Department of Urology, St George's University Hospitals NHS Foundation Trust, London, UK., Department of Radiotherapy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., University of British Columbia, British Columbia Cancer Agency, Kelowna, British Columbia, Canada., Department of Urology, The Christie NHS Foundation Trust, Manchester, UK., Department of Oncology, Mayo Clinic, Rochester, MN, USA., Helios Clinics Schwerin, Schwerin, Germany., Department of Urology, University Hospitals Leuven, Leuven, Belgium., The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA., American Society of Clinical Oncology, Alexandria, VA, USA., The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.