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Challenges and controversies in the management of penile cancer

Nature Reviews Urology volume 11, pages 702–711 (2014)Cite this article

Subjects

Key Points

  • Advances in the understanding of penile cancer are hampered by the rarity of this condition and poor awareness among the public and clinicians results in delays in diagnosis and treatment

  • A change in public education, attitude and awareness is essential to increase early detection of penile cancer

  • Preventive strategies, such as neonatal circumcision and human papillomavirus vaccination in men, are difficult to justify for penile cancer alone but become attractive considering the wide-ranging health benefits they confer

  • Penile-preserving surgery (PPS) is associated with best oncological, functional and cosmetic outcomes and increased use of PPS is not associated with a rise in recurrence rates or disease-specific mortality

  • Dynamic sentinel lymph node sampling has transformed management of cN0 disease, but disease involving pelvic nodes still has poor prognosis and its management remains uncertain

  • Establishment of supraregional centres results in improved knowledge and together with organizations such as the International Rare Cancer Initiative forms a good basis for future collaborative studies

Abstract

Penile cancer is a rare disease, accounting for ∼1% of all malignancies in men. Poor awareness of the condition among the public and clinicians often causes long delays in diagnosis and treatment, which may result in the development of advanced disease that might require extensive and emasculating surgery. In the UK, the development of supraregional penile cancer centres has pooled resources and expertise, which has led to considerable improvements in our understanding and management of this rare condition over the past decade. However, significant gaps in our knowledge still exist. Several areas of diagnosis and management remain areas of controversy, ranging from preventive strategies and treatment of premalignant disease to the assessment of lymph node involvement and the management of advanced disease.

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Figure 1: Total glans resurfacing: intraoperative and immediate postoperative appearance.
Figure 2: Glansectomy: intraoperative and immediate postoperative appearance.

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Authors and Affiliations

  1. Department of Urology, Guy's Hospital, SE1 9RT, London, UK

    Majid Shabbir

  2. Department of Urology, St James's University Hospital, LS9 7TF, Leeds, UK

    Oliver Kayes

  3. Department of Urology, University College Hospital, NW1 2BU, London, UK

    Suks Minhas

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  1. Majid Shabbir
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  2. Oliver Kayes
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  3. Suks Minhas
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M.S. researched data and wrote the article. All authors made substantial contributions to the discussion of content and reviewed/edited the manuscript before submission.

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Correspondence to Majid Shabbir.

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Shabbir, M., Kayes, O. & Minhas, S. Challenges and controversies in the management of penile cancer. Nat Rev Urol 11, 702–711 (2014). https://doi.org/10.1038/nrurol.2014.307

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