eMedicine Specialties > Urology > Cancer, Bladder, Penis, and Urethra

Penile Cancer: Follow-up

Author: Stanley A Brosman, MD, Clinical Professor, Department of Urology, University of California at Los Angeles Medical School
Contributor Information and Disclosures

Updated: Dec 3, 2008

Outcome and Prognosis

The prognosis of penile cancer is primarily related to the presence or absence of inguinal node metastasis. Untreated patients with inguinal metastases rarely survive 2 years. Of those with clinically palpable adenopathy and histologically proven metastases, 20-50% are alive at 5 years following inguinal lymphadenectomy. The results are even better when the extent of the nodal involvement is considered. An 82-88% 5-year survival rate has been reported when only 1-3 lymph nodes are involved. Lont et al reported that patients with 1-2 involved inguinal nodes that do not contain poorly differentiated cancer have a 90% 5-year survival rate. When the nodes are positive, the overall recurrence rate is 80%, and the 5-year survival rate is 10%-15%.24

Radiation therapy in a select group of patients with small superficial lesions has been successful in a large number of patients. Control rates of 90-100% have been reported. In a group of 10 patients treated at Memorial Sloan-Kettering Cancer Center by electron beam therapy, all were effectively treated as determined by negative findings on posttreatment biopsy specimens. The most common complication was urethral stricture, which occurred in 4 patients. Nine of the patients retained sexual function.

In 2001, Novak and Dvoaeek used interstitial brachytherapy with iridium wires to treat 28 patients with squamous cell carcinoma. Six patients had Tis, 11 had T1N0, and 4 had T2N0. The prescribed dose of 0.6-0.65 Gy was delivered in 2-7 days. Local tumor control was evident in all patients at a mean follow-up of 65 months. Cancer has not recurred.26

Hegarty et al reported on a prospective series of 100 patients treated at one institution according to EAU guidelines. Of men with palpable nodes, 72% had metastatic disease, but 18% of those who did not have palpable adenopathy also had metastases. The tumor grade was more predictive for nodal disease and survival than T stage. The 3-year disease-specific survival rates for N0, N1, and N2 disease were 100%, 100%, and 73%, respectively. The survival rate associated with N3 disease was 67%, and the overall survival rate was 92%. The median survival rate among those with metastases was 3 months. The EAU guidelines were deemed limited in their ability to predict micrometastatic disease. Although early lymphadenectomy was beneficial in those with nodal disease, 82% of patients underwent unnecessary prophylactic lymphadenectomy.27

Current techniques, such as intensity-modulated radiation therapy, will probably become more effective and produce fewer adverse effects.

Future and Controversies

The major controversy regarding penile cancer is the indication and extent of inguinal lymphadenectomy. Patients with clinically palpable or radiologically demonstrable lymph nodes after an adequate course of antibiotic therapy should undergo surgery. Depending on the size and extent of the apparent nodal involvement, a decision must be made regarding a superficial node dissection, which is associated with less morbidity, or a full inguinal node dissection, which includes the nodes in the femoral triangle.

In patients with clinically negative nodes, an argument can be made for observation. Because up to 80% of patients with inguinal node metastases can be cured with lymphadenectomy, monitoring patients and withholding surgery until metastases become evident may be possible with patient compliance. However, experience indicates that superficial dissections in patients with microscopic metastases result in few complications and limited morbidity.

In 2001, Slaton et al examined a group of 78 patients with squamous cell carcinoma in an effort to identify prognostic factors that would help predict extranodal metastases and select candidates for adjuvant therapy.28

They identified 78 patients who had undergone inguinal lymphadenectomy, 42 of whom had nodal metastases. They found that the presence of bilateral nodal metastases, which occurred in 16 (38%) of 42 patients, and extranodal extension, which was found in 25 (60%) of 42 patients, were independent predictors for progression. They suggested that such patients be considered candidates for adjuvant therapy.

In the future, patients with superficial penile cancers can expect effective treatment with either surgery or radiation therapy and can expect to retain a functioning penis. Those requiring more extensive resections or penectomy can undergo penile reconstruction, which has produced acceptable results. The techniques available to identify and remove the sentinel nodes, as well as using a modified lymphadenectomy, should eliminate the need for observation, reduce the need for extensive inguinal lymph node dissection, and decrease the morbidity of this procedure.

The ability to effectively manage metastatic disease with chemotherapy has been disappointing, but the results of studies using molecular targeting agents in combination with chemotherapy offers hope.

 


More on Penile Cancer

Overview: Penile Cancer
Workup: Penile Cancer
Treatment: Penile Cancer
Follow-up: Penile Cancer
References
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Further Reading

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Keywords

penile cancer, penile carcinoma, penis cancer, penile malignancies, cancer of the penis, carcinoma of the penis, squamous cell carcinomas, SCCs, penile tumor, penis tumor, warty growth, exophytic growth, smegma, human papilloma virus, human papillomavirus, penile autoamputation, pearly penile papules, hirsute papillomas, coronal papillae, balanitis xerotica obliterans, leukoplakia, condyloma acuminata, venereal warts, Kaposi sarcoma, Buschke-Lowenstein tumor, penile carcinoma in situ, penile CIS, erythroplasia of Queyrat, Bowen disease, complete penectomy, partial penectomy, radical penectomy

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Contributor Information and Disclosures

Author

Stanley A Brosman, MD, Clinical Professor, Department of Urology, University of California at Los Angeles Medical School
Stanley A Brosman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, American Urological Association, Association of Clinical Research Professionals, International Society of Urological Pathology, Société Internationale d'Urologie (International Society of Urology), Society for Basic Urologic Research, Society of Surgical Oncology, Society of Urologic Oncology, and Western Section American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Gamal Mostafa Ghoniem, MD, FACS, Fellowship Program Director, Clinical Professor of Surgery, Head, Section of Voiding Dysfunction, Female Urology and Reconstruction, Cleveland Clinic Florida
Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Society for Urology and Engineering, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Associate Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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