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
- HPV-independent
Diagnosis and Evaluation
Management
Prognosis
- Overall 5-year survival: 67%
- Localized disease: 81%
- Distant metastsis: 18%