Penile Cancer Guidelines

Updated: Jan 10, 2018
  • Author: Stanley A Brosman, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines

Guidelines Summary

The following organizations have published guidelines for the diagnosis and management of penile cancer:

  • 2017 National Comprehensive Cancer Network (NCCN) [55]
  • 2013 European Society of Medical Oncology (ESMO) [56]
  • 2014 European Association of Urology (EAU) [13]

Risk Factors

The  NCCN guidelines delineate the following risk factors for the development of penile cancer [55] :

  • Phimosis
  • Balanoposthitis 
  • Chronic penile inflammation
  • Penile trauma
  • Lichen sclerosus
  • Smoking
  • HIV or HPV infection
  • Poor hygiene
  • Lack of neonatal circumcision

Diagnosis

All three guidelines concur that diagnosis begins with a complete physical exam that records the morphological and physical characteristics of the lesion, including the following:

  • Diameter of the lesion(s) or suspicious areas
  • Location(s) on the penis
  • Number of lesions
  • Whether the lesion(s) are papillary, nodular, ulcerous, or flat
  • Relationship with other structures, including submucosal, urethra, corpora spongiosa, and/or corpora cavernosa.

Accurate histological diagnosis with a punch, excisional, or incisional biopsy and staging of both the primary tumour and regional nodes are required before the appropriate therapy can be selected. [13, 55, 56]

Treatment

The treatment recommendations from all three guidelines are outlined in the table below. [13, 55, 56]

 

Table. Summary of Guideline Treatment Recommendations (Open Table in a new window)

   

Level of Evidence

Stage

Treatment

NCCN

[55]

ESMO

[56]

EAU

[13]

Tis or Ta

Penile-preserving techniques:

  • Topical therapy (5% 5-fluorouracil and 5% imiquimod cream)

2A

IVC

3C

  • Laser therapy using CO2 or Nd:YAG laser

2B

IIIC

3C

  • Circumcision and wide local excision

2A

IVC

3C

  • Glansectomy

2B

 

3C

  • Partial/total glans resurfacing
 

IIIC

3C

         

T1G1-2

Penile-preserving techniques:

  • Wide local excision plus reconstructive surgery with split-thickness skin graft (STSG) or full-thickness skin graft (FTSG)

2A

IIIC

3C

  • Laser therapy

2B

IVC

3C

  • Radiotherapy delivered as EBRT or brachytherpay

2B

IVC

3C

       

T1G3-4

Wide local excision

2A

IIIB

3C

Glansectomy

2A

IIIB

3C

Partial penectomy

2A

IIIB

 

Total penectomy

2A

IIIB

 

Radiotherapy

2B

IIIC

3C

Chemoradiotherapy

3

IIIC

 
       

T2 or greater

Partial penectomy

2A

IIIB

3C

Total penectomy

2A

IIIB

3C

Radiotherapy

2B

IIID

3C

Chemoradiotherapy

3

IIID

 
       

Non-palpable lymph nodes

Surveillance:

  • Low- risk (Tis, Ta, T1a)
  • Intermediate Risk (T1G2 without lymphovascular invasion)

2A

 

B

B

2aB

Dynamic sentinel node biopsy (DSNB):

  • Low- risk (Tis, Ta, T1a)
  • Intermediate Risk (T1bG1-2)
  • High Risk (T1bG3-4 or greater)

2A

2A

2A

 

B

B

 

2aB

2aB

Inguinal lymph node dissection (ILND):

  • Intermediate Risk (T1bG1-2)
  • High Risk (T1bG3-4 or greater)
  • If positive nodes found on DSNB
  • IF DSNB unavailable

2A

2A

IIIB

IVC

 

 

 

2aB

2aB

       

Palpable inguinal nodes

Inguinal lymph node dissection (ILND):

  • If 0-1 nodes are positive: Surveillance
  • If ≥2 nodes are positive: Consider adjuvant radiotherapy, chemoradiotherapy or chemotherapy

2A

IIIC