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
- Most frequent HPV genotypes: HPV16 followed by HPV6
- Risk of penile cancer is increased in patients with condyloma acuminata
- Female sexual partners of patients with penile cancer have not been found to have an increased incidence of cervical cancer
- No general recommendation (except in a few countries) for HPV vaccination in males because of the different HPV-associated risk patterns in penile- and cervical cancer
- Since up to 50% of invasive penile carcinomas and 80% of preneoplastic lesions are HPV-associated, HPV vaccination is encouraged
- Phimosis
- Strongly associated with invasive penile cancer, due to associated chronic infections
- Smegma is not a carcinogen
- Neonatal circumcision reduces the incidence of penile cancer, but does not reduce the risk of Penile Intraepithelial Neoplasia
- Chronic penile inflammation
- Lichen sclerosus
- Ultraviolet A phototherapy
- Cigarette smoking
- Low level of education
- Low socio-economic status
Pathology
- >95% of penile cancers are squamous cell carcinomas (SCCs)
- Other malignant lesions of the penis
- Melanoma
- Mesenchymal tumors
- Lymphomas
- Metastases
- Penile metastases are frequently of prostatic, urinary bladder or colorectal origin
- Sarcoma
Penile Squamous Cell Carcinoma
- Usually arises from the epithelium of the inner prepuce or the glans
- Subtypes
- HPV-independent
- Usual
- Pseudohyperplastic
- Pseudoglandular
- Verrucous
- Caniculatum
- Papillary
- Sarcomatoid (Most aggressive and worse prognosis)
- Mixed
- HPV-associated
- Basaloid (most common among HPV-associated penile carcinomas)
- Warty
- Clear cell
- Lymphoepithelioma-like
- Mixed
- HPV-independent
- Penile intraepithelial neoplasia is considered the precursor lesion of penile SCC
- Clinical terms such as ‘Erythroplasia of Queyrat, Bowenoid papulosis and Bowen’s disease’ are discouraged
- Penile intraepithelial neoplasia is also classified as HPV-independent and HPV-associated
Diagnosis and Evaluation
Management
Prognosis
- Overall 5-year survival: 67%
- Localized disease: 81%
- Distant metastasis: 18%