EAU & ASCO: Penile Cancer 2023: Difference between revisions
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** '''Involvement of surrounding structures''' | ** '''Involvement of surrounding structures''' | ||
** '''Anticipated skin and soft tissue defects (as well as plastic surgical consultation (as appropriate))''' | ** '''Anticipated skin and soft tissue defects (as well as plastic surgical consultation (as appropriate))''' | ||
* '''Organ-sparing''' | * '''<span style="color:#ff0000">Organ-sparing''' | ||
** '''Options''' | ** '''<span style="color:#ff0000">Options''' | ||
*** '''Circumcision''' | *** '''<span style="color:#ff0000">Circumcision''' | ||
**** '''Standard treatment for foreskin/preputial penile cancer''' | **** '''<span style="color:#ff0000">Standard treatment for foreskin/preputial penile cancer''' | ||
**** '''Facilitates follow-up in patients treated with topical treatment, laser therapy or brachytherapy, facilitates follow-up examinations''' | **** '''<span style="color:#ff0000">Facilitates follow-up in patients treated with topical treatment, laser therapy or brachytherapy, facilitates follow-up examinations''' | ||
*** '''Wide local excision''' | *** '''<span style="color:#ff0000">Wide local excision''' | ||
*** '''Glansectomy''' | *** '''<span style="color:#ff0000">Glansectomy''' | ||
*** '''Glans resurfacing''' | *** '''Glans resurfacing''' | ||
**** '''Consists of full thickness removal of the glandular epithelium followed by reconstruction with a graft''' | **** '''Consists of full thickness removal of the glandular epithelium followed by reconstruction with a graft''' | ||
**'''Indications''' | **'''<span style="color:#ff0000">Indications''' | ||
***'''Lesions confined to the glans and prepuce (PeIN, Ta, T1–T2) and patient willing to comply with strict follow-up''' | ***'''<span style="color:#ff0000">Lesions confined to the glans and prepuce (PeIN, Ta, T1–T2) and patient willing to comply with strict follow-up''' | ||
* '''Amputative surgery''' | * '''<span style="color:#ff0000">Amputative surgery''' | ||
** '''Partial penectomy''' | ** '''<span style="color:#ff0000">Partial penectomy''' | ||
*** '''Indications''' | *** '''<span style="color:#ff0000">Indications''' | ||
***# '''Invasion of the corpora cavernosa (T3)''' | ***# '''<span style="color:#ff0000">Invasion of the corpora cavernosa (T3)''' | ||
***# '''Patient not willing to undergo organ-sparing surgery or not willing to comply with strict follow-up.''' | ***# '''<span style="color:#ff0000">Patient not willing to undergo organ-sparing surgery or not willing to comply with strict follow-up.''' | ||
***Efficacy | ***Efficacy | ||
****Risk of local recurrence ≈4–5% | ****Risk of local recurrence ≈4–5% | ||
**'''Total penectomy with perineal urethrostomy''' | **'''<span style="color:#ff0000">Total penectomy with perineal urethrostomy''' | ||
***'''Indications''' | ***'''<span style="color:#ff0000">Indications''' | ||
****'''Large invasive tumours not amenable to partial amputation''' | ****'''<span style="color:#ff0000">Large invasive tumours not amenable to partial amputation''' | ||
* '''With surgical treatment, negative surgical margins for invasive carcinoma must be obtained.''' | * '''With surgical treatment, negative surgical margins for invasive carcinoma must be obtained.''' | ||
** Perform intra-operative frozen section analysis of resection margins in cases of doubt on the completeness of resection. | ** Perform intra-operative frozen section analysis of resection margins in cases of doubt on the completeness of resection. | ||
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==== Treatment of superficial non-invasive disease (PeIN, Ta) ==== | ==== Treatment of superficial non-invasive disease (PeIN, Ta) ==== | ||
*'''Options''' | *'''<span style="color:#ff0000">Options''' | ||
** '''Non-surgical''' | ** '''<span style="color:#ff0000">Non-surgical''' | ||
*** '''Topical therapies''' | *** '''<span style="color:#ff0000">Topical therapies''' | ||
**** '''Imiquimod''' | **** '''<span style="color:#ff0000">Imiquimod''' | ||
**** '''5-fluorouracil''' | **** '''<span style="color:#ff0000">5-fluorouracil''' | ||
****'''Insufficient responses and recurrences may signify underlying invasive disease, hence, if topical treatment fails, it should not be repeated''' | ****'''Insufficient responses and recurrences may signify underlying invasive disease, hence, if topical treatment fails, it should not be repeated''' | ||
***'''Laser ablation''' | ***'''<span style="color:#ff0000">Laser ablation''' | ||
**'''Surgical''' | **'''<span style="color:#ff0000">Surgical''' | ||
***'''Circumcision''' | ***'''<span style="color:#ff0000">Circumcision''' | ||
****'''Should be the primary surgical option''' | ****'''<span style="color:#ff0000">Should be the primary surgical option''' | ||
***** Following circumcision, the glans mucosa keratinizes over a period of 3–6 months and any residual PeIN or lichen sclerosus may resolve. Close monitoring before starting additional therapy has been advocated | ***** Following circumcision, the glans mucosa keratinizes over a period of 3–6 months and any residual PeIN or lichen sclerosus may resolve. Close monitoring before starting additional therapy has been advocated | ||
***'''Local excision''' | ***'''<span style="color:#ff0000">Local excision''' | ||
**** Extensive PeIN, residual PeIN in resection margins or recurrent disease after ablative or topical therapy, can be treated by surgical excision | **** Extensive PeIN, residual PeIN in resection margins or recurrent disease after ablative or topical therapy, can be treated by surgical excision | ||
**** Glans resurfacing | **** Glans resurfacing | ||
* '''Despite treatment, penile intra-epithelial neoplasia can progress to invasive lesions in 2.6–13% of patients''' | * '''<span style="color:#ff0000">Despite treatment, penile intra-epithelial neoplasia can progress to invasive lesions in 2.6–13% of patients''' | ||
==== Treatment of invasive disease confined to the glans (cT1/T2) ==== | ==== Treatment of invasive disease confined to the glans (cT1/T2) ==== | ||
* Treatment choice depends on tumour size, histology, stage and grade, localisation and patient preference. | * <span style="color:#ff0000">Treatment choice depends on tumour size, histology, stage and grade, localisation and patient preference. | ||
** When feasible, small and localised invasive lesions should receive organ-sparing treatment. | ** <span style="color:#ff0000">When feasible, small and localised invasive lesions should receive organ-sparing treatment. | ||
*** Organ-sparing surgery associated with higher recurrence rates than amputative surgery | *** <span style="color:#ff0000">Organ-sparing surgery associated with higher recurrence rates than amputative surgery | ||
* Foreskin tumours | * <span style="color:#ff0000">Foreskin tumours | ||
** Treated by ‘radical’ circumcision. | ** <span style="color:#ff0000">Treated by ‘radical’ circumcision. | ||
* For glandular and coronal lesions | * <span style="color:#ff0000">For glandular and coronal lesions | ||
** Surgical options | ** <span style="color:#ff0000">Surgical options | ||
*** Wide local excision | *** <span style="color:#ff0000">Wide local excision | ||
*** Partial glansectomy | *** <span style="color:#ff0000">Partial glansectomy | ||
*** Total glansectomy with reconstruction | *** <span style="color:#ff0000">Total glansectomy with reconstruction | ||
** Non-surgical options | ** <span style="color:#ff0000">Non-surgical options | ||
*** External beam radiotherapy and brachytherapy | *** <span style="color:#ff0000">External beam radiotherapy and brachytherapy | ||
*** Laser therapy of small lesions has been reported but the risk of invasive disease must be | *** Laser therapy of small lesions has been reported but the risk of invasive disease must be recognized, and the recurrence risk is high, possibly as a result of the limited tissue penetration depth of laser ablation. | ||
* Width of negative surgical margins | * Width of negative surgical margins | ||
** Macroscopic margins can indeed be minimal, specifically in smaller and less aggressive lesions | ** Macroscopic margins can indeed be minimal, specifically in smaller and less aggressive lesions | ||