Recent developments and current management of penile cancer
Paul Hadway1, Varun Sahdev1, Manit Arya2 & Asif Muneer*,2
Practice Points Primary penile tumor section • A high clinical suspicion and a biopsy are required for the diagnosis of carcinoma in situ and invasive penile cancer. • Penile-preserving surgical techniques have been developed. These operations aim to achieve clear surgical margins while maintaining penile length and function. Many series have confirmed the oncological safety of surgery, but more data are needed on quality of life and measures of both sexual and urinary functional outcome operatively. • External beam radiotherapy is generally reserved for palliation of inoperable tumors. Brachytherapy as curative treatment appears promising in a few centers. No randomized controlled trials comparing surgery with brachytherapy have been performed to date.
1 Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Craven Road, Reading, RG1 5AN, UK 2 Department of Urology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK *Author for correspondence: asif.muneer@ uclh.nhs.uk
Management of lymph nodes • The presence of nodal disease is the most important prognostic factor for patients with penile squamous cell carcinomas. • Approximately half of men will have impalpable inguinal lymph nodes at presentation, of which 20% will harbor occult micro-metastases. Computed tomography–PET and MRI-PET appear promising at detecting metastases, but are not yet in routine practice. To reduce morbidity from unnecessary lymph node dissection (LND), dynamic sentinel lymph node biopsy has been widely accepted as a minimally invasive operation to aid detection of micrometastases, with a false-negative rate of
