(UroToday.com) At the 2021 American Urological Association (AUA) Summer School session on the updates in the management of penile cancer, Dr. Philippe Spiess from the Moffitt Cancer Center started the course with an introduction and highlighting the global impact of penile cancer in 2021. Dr. Spiess notes that in 2021, there will be an estimated 2,210 new cases of penile cancer diagnosed in the United States. Additionally, there will be 460 suspected deaths secondary to penile cancer, although penile cancer accounts for only 0.4-0.6% of all malignancies in the United States and Europe. As follows is a global summary of the incidence of penile cancer:1
The most recent eighth edition of the TNM staging classification for urologic cancers (published in 2018) made important changes to the penile cancer staging, as highlighted by Dr. Spiess. Most notably, a T3 penile lesion does not have to have urethral involvement exclusively, as now tumors invading the corpus cavernosum are also staged as T3 disease. Also important to prognosis are the histologic variations of penile tumors:
- Verrucous: verrucous carcinoma, pseudohyperplastic carcinoma, and carcinoma cuniculatum have the best prognosis
- Warty: warty and papillary carcinoma, as well as not otherwise specified are of intermediate prognosis
- Basaloid: basaloid and sarcomatoid carcinomas have the worst prognosis
In an unpublished survey from Dr. Spiess’ group regarding practice patterns among members of the Society of Urologic Oncology, the majority of respondents (49%) noted that they only perform 1-2 inguinal lymph node dissections per year, followed by 30% performing 3-5 dissections per year. When presented with a <=2 cm lymph node, 45% would go straight to inguinal lymph node dissection, 36% would proceed with biopsy first, and 17% would prescribe a trial of antibiotics. With regards to prophylactic anticoagulation, 78% of respondents note that they use anticoagulation, with 60% using it in the pre-and perioperative setting until the patient is ambulating.
Disappointingly, Dr. Spiess emphasized that the temporal 5-year relative survival trend over the past 3 decades has not improved substantially for penile cancer, based on data from the SEER and the EUNICE databases:
In an epidemiological study combining data from pN positive patients (n=330) from the Moffitt Cancer Center and San Raffaele in Milan, the majority of pN2/pN3 patients (67%) were treated with neoadjuvant systemic chemotherapy, while most pN1patients (65%) were treated with surgery alone.2 Of the 128 patients treated with surgery alone, 79 (61.7%) were alive at last follow-up with reported 5-year PFS, CSS, and OS of 54.8%, 58.9%, and 54.8%, respectively. Finally, on multivariate analysis, no peri-operative treatment was associated with improvement in CSS or OS.
Dr. Spiess concluded his presentation noting that there are ongoing immunotherapy and HPV-directed clinical pathways in penile cancer:
Presented by: Philippe E. Spiess, MD, MS, FRCS(C), FACS, Moffitt Cancer Center, Tampa, FL
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the AUA2021 May Kick-off Weekend May 21-23.
References:
- Thomas A, Necchi A, Muneer A, et al. Penile cancer. Nat Rev Dis Primers. 2021 Feb 11;7(1):11.
- Chipollini J, Necchi A, Spiess PE. Outcomes for patients with node-positive penile cancer: Impact of perioperative systemic therapies and the importance of surgical intervention. Eur Urol 2018 Aug;74(2):241-242.