Our systematic review provides a comprehensive overview of the various PSS techniques, emphasizing both oncologic and functional outcomes.4 The review followed PRISMA guidelines and was registered on PROSPERO, ensuring a methodical and transparent approach. The literature search identified 47 studies, encompassing a total of 10,847 patients.
We categorized PSS techniques into five primary approaches: wide local excision (WLE), circumcision, laser ablation, glansectomy ± split skin graft, and glans resurfacing. Despite variations in patient populations, surgical techniques, and follow-up periods, favorable oncologic outcomes were reported, with cancer-specific mortality rates ranging from 0% to 18%. PSS techniques have primarily been applied to patients with Tis or T1 stage disease, with some exceptions—such as laser ablation in recurrent T3 cases and WLE and circumcision in selected T2 cases. However, detailed oncologic outcomes for these advanced cases were often not reported separately, limiting insights into the efficacy of PSS in more locally advanced stages.
Functional outcomes, particularly related to sexual function and aesthetic satisfaction, were generally positive but underreported in many studies. Intraoperative complication data were often lacking, while postoperative complications were generally low, especially with WLE, laser ablation, and circumcision. However, higher complication rates were observed with procedures such as glans resurfacing and glansectomy ± split skin graft, occasionally reaching up to 25% in some series.
The heterogeneity of the data and the absence of standardized study protocols among the included studies highlight a significant gap in the literature. The predominance of retrospective studies and a considerable risk of bias temper the strength of our conclusions. Furthermore, the absence of comparative studies precludes definitive conclusions regarding the superiority of any particular PSS technique.
By synthesizing evidence from a broad spectrum of studies, our review aims to provide clinicians with a nuanced understanding of the benefits and limitations of different surgical approaches, thereby enhancing informed decision-making. Clinically, the review underscores the potential of PSS techniques to achieve satisfactory tumor control while preserving sexual function and body image—critical factors for patients with penile cancer. The review also calls for prospective, comparative studies with standardized protocols to better clarify the long-term oncologic and functional outcomes of PSS techniques.
In conclusion, our systematic review supports PSS as a viable option for localized penile cancer, with promising oncologic and functional outcomes that align with current guideline recommendations.
Written by: Giuseppe Fallara,1 Giuseppe Basile,2 Adrian Poterek,3 Marco Tozzi,4 Karl H Pang,5 Omer Onur Çakir,6 Marco Bandini,7 Matteo Ferro,4 Gennaro Musi,4 Maria Satchi,8 Angelo Territo,9 Christian Fankhauser,10 Fabio Castiglione11
- Department of Urology, IRCCS European Institute of Oncology, Milan, Italy.
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland.
- Department of Urology, IRCCS European Institute of Oncology, Milan, Italy.
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong; Division of Surgery and Interventional Science, University College London, London, UK.
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK; King's College London, King's Health Partners, London, UK.
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
- Department of Urology, Cantonal Hospital Lucerne, Lucerne, Switzerland; University of Zurich, Zurich, Switzerland.
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, King's College Hospital NHS Foundation Trust, London, UK; King's College London, King's Health Partners, London, UK.
- Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran ATH, Rompuy A-SV, et al. Penile cancer. Nat Rev Dis Primers 2021;7:11.
- Elst L, Vreeburg M, Brouwer O, Albersen M. Challenges in Organ-sparing Surgery for Penile Cancer: What Are the Limits? European Urology Focus 2023.
- Brouwer OR, Tagawa ST, Albersen M, Ayres B, Crook J, Heijden MS van der, et al. EAU-ASCO Collaborative Guidelines on Penile Cancer 2024. Arnhem, the Netherlands: EAU Guidelines Office; n.d.
- Fallara G, Basile G, Poterek A, Tozzi M, Pang KH, Çakir OO, et al. Oncological and Functional Outcomes of Penile Shaft Sparing Surgery for Localised Penile Cancer: A Systematic Review. Eur Urol Focus 2024.