EAU & ASCO: Penile Cancer 2023

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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

Diagnosis and Evaluation

Management

Prognosis

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

References