EAU & ASCO: Penile Cancer 2023

See Original Guidelines

Background

• Penile cancer negatively impacts quality of life through
  • Physical and emotional changes
  • Feelings of mutilation
  • Loss of masculinity
  • Voiding and sexual dysfunction, which in turn can result in relationship breakdowns and withdrawal from society
  • Lymphedema

Epidemiology

• Uncommon in industrialized countries
• More common in South America, Southeast Asia, and parts of Africa
• Race
  • Highest incidence in white Hispanics, followed by Alaskans and Native American Indians, African Americans, white non-Hispanics.
• Increasing incidence in Western/developed countries most likely due to higher infection rates of HPV

Pathophysiology

Risk factors

• Human papilloma virus (HPV)
  • Most important risk factor
• Phimosis
• Chronic penile inflamatoin
• Lichen sclerosus
• Ultraviolet A phototherapy
• Low socio-economic status

Pathology

• >95% of penile cancers are squamous cell carcinomas (SCCs)

Penile Squamous Cell Carcinoma

• Usually arises from the epithelium of the inner prepuce or the glans
• Subtypes
  • HPV-independent
    • Usual (most common)
    • Pseudohyperplastic
    • Pseudoglandular
    • Verrucous
    • Caniculatum
    • Papillary
    • Sarcomatoid (Most aggressive and worse prognosis)
    • Mixed
  • HPV-associated
    • Basaloid
    • Warty
    • Clear cell
    • Lymphoepithelioma-like
    • Mixed

Prognosis

• Overall 5-year survival: 67%
  • Localized disease: 81%
  • Distant metastsis: 18%