OBJECTIVES: To review outcomes of the treatment of carcinoma in situ of the penis at a large supra-regional penile cancer network, where centralisation has permitted greater experience with treatment outcomes, and suggest treatment strategies.
MATERIALS AND METHODS: The network penile cancer database which details presentation, treatment and complications was analysed from 2003-10, identifying patients with CIS, with minimum follow up of 2 years, looking at treatments administered and outcomes.
RESULTS: Fifty-seven patients with mean age 61yr (range:34-91yr) were identified. Eighteen were treated by circumcision (CIRC) only, 20 by CIRC and local excision (LE) and 19 by CIRC and 5-flurouracil (5FU). Mean follow up was 3.5yr (2-8). Of those treated by CIRC none subsequently developed CIS on the glans. For those who underwent CIRC+LE, 5/20 developed recurrence requiring further treatment. Of those treated by CIRC+5FU, 14/19 (73.7%) completely responded (CR). Of incomplete responders (IR, n=5), 2 showed focal invasive malignancy at repeat biopsy. One IR underwent glansectomy and 4 grafting. No CR relapsed. Complications of 5FU included significant inflammatory response in 7 (36.8%), with 2 requiring hospital admission and 1 neo-phimosis (5.3%).
CONCLUSION: This study suggests that patients undergoing circumcision for isolated CIS and complete responders to 5FU may require only short term follow up, as recurrence is unlikely, whereas longer follow up is required for all other patients. However numbers in this study are small and larger studies are needed to support this. Incomplete response to 5FU dictates immediate re-biopsy as it carries a significant chance of previously undetected invasive disease.
Written by:
Lucky M, Murthy K, Rogers B, Jones S, Lau M, Sangar V, Parr N. Are you the author?
Wirral University Teaching Hospital NHS Foundation Trust.
Reference: BJU Int. 2014 Jul 25. Epub ahead of print.
doi: 10.1111/bju.12878
PubMed Abstract
PMID: 25060513
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