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Penile cancer

Nature Reviews Disease Primers volume 7, Article number: 11 (2021) Cite this article

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Abstract

Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1–1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.

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Fig. 1: Penile cancer incidence and mortality.
Fig. 2: Molecular pathways in HPV-associated penile carcinogenesis.
Fig. 3: Clinical appearance of penile cancer.
Fig. 4: Imaging in penile cancer diagnosis.
Fig. 5: Histology of penile carcinomas.
Fig. 6: Organ-sparing surgical options for penile cancer.
Fig. 7: Surgical staging and treatment of the groins in penile cancer.

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Acknowledgements

The authors thank a patient who kindly contributed with his disease experience to this article. M.A. holds a mandate of the Foundation Against Cancer.

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Authors and Affiliations

  1. Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Anita Thomas & Maarten Albersen

  2. Department of Urology, University Hospitals Leuven, Leuven, Belgium

    Anita Thomas & Maarten Albersen

  3. Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany

    Anita Thomas

  4. Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy

    Andrea Necchi

  5. Department of Urology, University College London Hospitals, London, UK

    Asif Muneer

  6. National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals, London, UK

    Asif Muneer

  7. Division of Surgery and Interventional Science, University College London, London, UK

    Asif Muneer

  8. Section of Urologic Oncology, Department of Urology, ABC Medical School, Instituto do Cancer Vieira de Carvalho, São Paulo, Brazil

    Marcos Tobias-Machado

  9. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK

    Anna Thi Huyen Tran

  10. Department of Pathology, University Hospitals Leuven, Leuven, Belgium

    Anne-Sophie Van Rompuy

  11. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Philippe E. Spiess

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  1. Anita Thomas
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Contributions

Introduction (M.A., A.Th. and A.-S.V.R.); Epidemiology (M.A. and A.Th.); Mechanisms/Pathophysiology (M.A., A.Th. and P.E.S.); Diagnosis, screening and prevention (M.A., A.Th., A.M. and A.-S.V.R.); Management (M.A., A.Th., A.N., A.M., M.T.-M. and A.Tr.); Quality of life (M.A., A.Th. and A.M.); Outlook (M.A., A.Th., A.N. and A.M.).

Corresponding author

Correspondence to Maarten Albersen.

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Competing interests

M.A.: eUROGEN clinical lead on rare urogenital cancer workstream (WS3); Nature Reviews Urology advisory board member; European Urology Associate Editor; EAU Scientific Office member; EAU–ASCO penile cancer guideline panel member. A.Th.: EUSP scholar. A.M.: eUROGEN research lead on rare urogenital cancer workstream (WS3); ESMO penile cancer guideline panel member; editorial board BJU International. A.N.: EAU–ASCO penile cancer guideline panel member, penile cancer research funding to institute by Ipsen and Pfizer. P.E.S.: NCCN penile cancer guideline discussion writing committee member; EAU–ASCO penile cancer guideline panel member; Nature Reviews Urology advisory board member. M.T.-M.: coordinator of Penile Cancer Collaborative Coalition – Latin America. All other authors declare no competing interests.

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Informed consent

The authors affirm that human research participants provided informed consent for publication of the images in Figure 3 and Figure 6.

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Nature Reviews Disease Primers thanks O. Brouwer, J. Crook, O. Hakenberg, G. Netto, F. Zhou and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Thomas, A., Necchi, A., Muneer, A. et al. Penile cancer. Nat Rev Dis Primers 7, 11 (2021). https://doi.org/10.1038/s41572-021-00246-5

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