#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Malignant Tumors of the Penis – Dia­gnostics and Therapy


Authors: B. Mrinakova 1;  M. Ondrušová 2;  M. Švantnerová 3;  D. Ondruš 1
Authors‘ workplace: I. onkologická klinika LF UK a Onkologického ústavu sv. Alžbety, Bratislava 1;  Pharm-In, spol. s r. o., Bratislava 2;  Klinika radiačnej onkológie SZU a Onkologického ústavu sv. Alžbety, Bratislava 3
Published in: Klin Onkol 2019; 32(1): 31-39
Category: Review
doi: https://doi.org/10.14735/amko201931

Overview

Background:

Penile cancer belongs to group of relatively rare malignancies. It represents, on average, 0.5–1% of all tumours in males globally and occurs predominantly in older individuals (> 65 years). The geographical distribution of malignant cancer of the penis is reported. A higher incidence is observed in less developed parts of the world, particularly in South America, Southeast Asia, and some areas of Africa (> 2.0/100,000). In Slovakia, there has been a recent increase in incidence (1.1/100,000 in 2011). Mortality has stabilized at 0.3/100,000 in recent years. Significant risk factors for malignant cancers include social and cultural habits and hygienic and religious practices. Important risk factors are inadequate hygiene of the foreskin sac, phimosis, human papillomavirus infection, sexual promiscuity, smoking, genital infections, and a low socio-economic and educational status.

Purpose:

The present paper provides an overview of pathology, symptomatology, diagnostic approaches, and classification of the extent of the disease. Treatment of the primary tumour depends on the extent of the disease and includes topical treatment, photodynamic treatment, cryoablation, laser photocoagulation, conservative surgical treatment, especially circumcision, and even radical treatment – penile amputation with perineal urethrostomy. An important part of the management of this malignancy is surgical treatment of metastases in inguinal lymph nodes. The article devotes more attention to non-surgical treatment modalities, in particular radiotherapy (external and brachytherapy) and systemic therapy (chemotherapy and biologic therapy), offering an overview of the indications and regimens in the adjuvant, neoadjuvant and palliative approaches, with and without concomitant chemoradiotherapy, and describes possible adverse effects of the treatments. 

Conclusion:

Patients with penile cancer should be concentrated in centres that have abundant experience in the diagnosis and treatment of this disease.

Key words

penile cancer – surgical treatment – radiotherapy – chemotherapy – biologic therapy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted: 12. 11. 2018

Accepted: 12. 12. 2018


Sources

1. Trabulsi EJ, Gomella LG. Cancer of the urethra and penis. In: DeVita VT Jr, Lawrence TS, Rosenberg SA (eds). DeVita, Hellman, and Rosenberg’s Cancer Principles & Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health / Lippincott Williams & Wilkins 2015: 981–987.

2. Hakenberg OW, Compérat EM, Minhas S et al. EAU guide­lines on penile cancer: 2014 update. Eur Urol 2015; 67(1): 142–150. doi: 10.1016/j.eururo.2014.10.017.

3. Bray F, Colombet M, Mery L et al (eds). Cancer incidence in five continents, Vol. XI. Lyon: IARC Scientific Publ 2017.

4. Trama A, Foschi R, Larrañaga N et al. Survival of male genital cancers (prostate, testis and penis) in Europe 1999–2007: results from EUROCARE-5 study. Eur J Cancer 2015; 51(15): 2206–2216. doi: 10.1016/j.ejca.2015.07.027.

5. Hlodáková V, Safaei-Diba C. (eds). Incidencia zhubných nádorov v Slovenskej republike 2011. Bratislava: NCZI 2018.

6. Bray F, Ferlay J, Soerjomataram I et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6): 394–424. doi: 10.3322/caac.21492.

7. Štatistický úrad SR. Obyvateľstvo a migrácia, príčiny smrti: nádory. Úmrtnostné tabuľky SR. [online]. Dostupné z: http://slovak.statistics.sk/wps/portal/ext/themes/demography/population/indicators/.

8. Dillner J, von Krogh G, Horenblas S et al. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol 2000; 205 (Suppl): 189–193.

9. Maden C, Sherman KJ, Beckmann AM et al. History of circumcision, medical conditions, and sexual activity, and risk of penile cancer. J Natl Cancer Inst 1993; 85(1): 19–24.

10. Bleeker MC, Heideman DA, Snijders PJ et al. Penile cancer: epidemiology, pathogenesis and prevention. World J Urol 2009; 27(2): 141–150. doi: 10.1007/s00345-008-0302-z.

11. Nagy V. Karcinóm penisu. In: Breza J et al (eds). Princípy chirurgie IV. Bratislava: Slovak Academic Press 2016: 269–282.

12. Moch H, Humphrey PA, Ulbright TM et al. WHO clasiffication of tumours of the urinary system and male genital organs. 4th ed. Lyon: IARC 2016.

13. Moch H, Cubilla AL, Humphrey PA et al. The 2016 WHO classification of tumours of the urinary system and male genital organs – part A: renal, penile, and testicular tumours. Eur Urol 2016; 70(1): 93–105. doi: 10.1016/j.eururo.2016.02.029.

14. Brierley JD, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. 8th ed. Oxford: John Wiley & Sons 2017.

15. Van Poppel H, Watkin NA, Osanto S et al. Penile cancer: ESMO clinical practice guidelines for dia­gnosis, treatment and follow-up. Ann Oncol 2013; 24 (Suppl 6): vi115–vi124. doi: 10.1093/annonc/mdt286.

16. Hora M, Trávníček I, Kalusová K et al. Penis šetřící metody léčby nižších kategorií karcinomu penisu. Ces Urol 2014; 18(3): 199–202.

17. NCCN. Clinical practice guidelines in oncology – penile cancer, version 2.2018. [online]. Available from: http://www.nccn.org/professionals/physician_gls/pdf/penile.pdf.

18. Pešl M. Dia­gnostika a léčba karcinomu penisu. Urol praxi 2018; 19(4): 176–180.

19. Korezniowski MA, Crook JM. Contemporary role of radiotherapy in the management of penile cancer. Transl Androl Urol 2017; 6(5): 855–867. doi: 10.21037/tau.2017.07.02.

20. Stankušová H. Onkologická léčba karcinomu penisu z pohledu radiačního onkologa. Ces Urol 2015; 19(1): 19–32.

21. Leone A, Diorio GJ, Pettaway C et al. Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 2017; 14(6): 335–347. doi: 10.1038/nrurol.2017.47.

22. Šlampa P et al. Radiační onkologie v praxi. 4. vyd. Brno: Masarykův onkologický ústav 2014.

23. Doležel M, Petera J, Odrážka K. Brachyterapie v léčbě karcinomu penisu. Urol List 2005; 3(4): 22–25.

24. Crook JM, Heie-Meder C, Demanes DJ et al. American Brachytherapy Society-Groupe Européen de Curiethérapie-European Society of Therapeutic Radiation Oncology (ABS-GEC-ESTRO) consensus statement for penile brachytherapy. Brachytherapy 2013; 12(3): 191–198. doi: 10.1016/j.brachy.2013.01.167.

25. Crook J. The role of radiotherapy in the management of penile cancer. Curr Probl Cancer 2015; 39(3): 158–165. doi: 10.1016/j.currproblcancer.2015.03.007.

26. Pimenta A, Gutierrez C, Mosquera D et al. Penile brachytherapy – retrospective review of a single institution. Brachytherapy 2015; 14(4): 525–530. doi: 10.1016/j.brachy.2015.01.005.

27. Hasan S, Francis A, Hagenauer A et al. The role of brachytherapy in organ preservation for penile cancer: a meta-analysis and review of the literature. Brachytherapy 2015; 14(4): 517–524. doi: 10.1016/j.brachy.2015.03.008.

28. Gambachidze D, Lebacle C, Maroun P et al. Long-term evaluation of urinary, sexual, and quality of life outcomes after brachytherapy for penile carcinoma. Brachytherapy 2018; 17(1): 221–226. doi: 10.1016/j.brachy.2017.09.006.

29. Delaunay B, Soh PN, Delannes M et al. Brachytherapy for penile cancer: efficacy and impact on sexual function. Brachytherapy 2014; 13(4): 380–387. doi: 10.1016/j.brachy.2013.06.001.

30. Crook J, Ma C, Grimard L. Radiation therapy in the man­agement of the primary penile tumor: an update. World J Urol 2009; 27(2): 189–196. doi: 10.1007/s00345-008-0309-5.

31. Crook J. Contemporary role of radiotherapy in the management of primary penile tumors and metastatic disease. Urol Clin North Am 2016; 43(4): 435–448. doi: 10.1016/j.ucl.2016.06.005.

32. Hakenberg OW, Nippgen JB, Froehner M et al. Cisplatin, methotrexate and bleomycin for treating advanced penile carcinoma. BJU Int 2006; 98(6): 1225–1227. doi: 10.1111/j.1464-410X.2006.06496.x.

33. Haas GP, Blumenstein BA, Gagliano RG et al. Cisplatin, methotrexate and bleomycin for the treatment of carcinoma of the penis: a Southwest Oncology Group study. J Urol 1999; 161(6): 1823–1825.

34. Pagliaro LC, Williams DL, Daliani D et al. Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. J Clin Oncol 2010; 28(24): 3851–3857. doi: 10.1200/JCO.2010.29.5477.

35. Pizzocaro G, Algaba F, Horenblas S et al. EAU penile cancer guidelines 2009. Eur Urol 2010; 57(6): 1002–1012. doi: 10.1016/j.eururo.2010.01.039.

36. Leijte JA, Kerst JM, Bais E et al. Neoadjuvant chemotherapy in advanced penile carcinoma. Eur Urol 2007; 52(2): 488–494. doi: 10.1016/j.eururo.2007.02.006.

37. Pizzocaro G, Piva L. Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 1988; 27(6b): 823–824.

38. Protzel C, Ruppin S, Milerski S et al. The current state of the art of chemotherapy of penile cancer: results of a nationwide survey of German clinics. Urologe A 2009; 48(12): 1495–1498. doi: 10.1007/s00120-009-2108-z.

39. Garnick MB, Skarin AT, Steele GD Jr. Metastatic carcinoma of the penis: complete remission after high dose methotrexate chemotherapy. J Urol 1979; 122(2): 265–266.

40. Shammas FV, Ous S, Fossa SD. Cisplatin and 5-fluorouracil in advanced cancer of the penis. J Urol 1992; 147(3): 630–632.

41. Dexeus FH, Logothetis CJ, Sella A et al. Combination chemotherapy with methotrexate, bleomycin and cisplatin for advanced squamous cell carcinoma of the male genital tract. J Urol 1991; 146(5): 1284–1287.

42. Theodore C, Skoneczna I, Bodrogi I et al. A phase II multicentre study of irinotecan (CPT 11) in combination with cisplatin (CDDP) in metastatic or locally advanced penile carcinoma (EORTC PROTOCOL 30992). Ann Oncol 2008; 19(7): 1304–1307. doi: 10.1093/annonc/mdn149.

43. Kattan J, Culine S, Droz JP et al. Penile cancer chemotherapy: twelve years‘ experience at Institut Gustave-Roussy. Urology 1993; 42(5): 559–562.

44. Joerger M, Warzinek T, Klaeser B et al. Major tumor regression after paclitaxel and carboplatin polychemotherapy in a patient with advanced penile cancer. Urology 2004; 63(4): 778–780. doi: 10.1016/j.urology.2003.12.026.

45. Hakenberg OW, Protzel C. Chemotherapy in penile cancer. Ther Adv Urol 2012; 4(3): 133–138. doi: 10.1177/1756287212441235.

46. Huang XY, Kubota Y, Nakada T et al. Intra-arterial infusion chemotherapy for penile carcinoma with deep inguinal lymph node metastasis. Urol Int 1999; 62(4): 245–248. doi: 10.1159/000030406.

47. Chiang PH, Chen CH, Shen YC. Intraarterial chemotherapy as the first-line therapy in penile cancer. Br J Cancer 2014; 111(6): 1089–1094. doi: 10.1038/bjc.2014.394.

48. Di Lorenzo G, Federico P, Buonerba C et al. Paclitaxel in pretreated metastatic penile cancer: final results of a phase 2 study. Eur Urol 2011; 60(6): 1280–1284. doi: 10.1016/j.eururo.2011.08.028.

49. Sonpavde G, Pagliaro LC, Buonerba C et al. Penile cancer: current therapy and future directions. Ann Oncol 2013; 24(5): 1179–1189. doi: 10.1093/annonc/mds635.

50. Carthon BC, Pettaway CA, Pagliaro LC et al. Epidermal growth factor receptor-targeted therapy in locally advanced or metastatic squamous cell carcinoma of the penis. BJU Int 2014; 113(6): 871–877. doi: 10.1111/bju.12450.

51. Necchi A, Nicolai N, Colecchia M et al. Proof of activity of anti-epidermal growth factor receptor-targeted therapy for relapsed squamous cell carcinoma of the penis. J Clin Oncol 2011; 29(22): e650–e652. doi: 10.1200/JCO.2011.34.8367.

52. Zhu Y, Li H, Yao XD et al. Feasibility and activity of sorafenib and sunitinib in advanced penile cancer: a preliminary report. Urol Int 2010; 85(3): 334–340. doi: 10.1159/000315432.

53. ClinicalTrials.gov. Nivolumab and ipilimumab in treating patients with rare tumors. U.S. National Library of Medicine. [online]. Available from: https://clinicaltrials.gov/ct2/show/NCT02834013.

54. ClinicalTrials.gov. Dacomitinib (PF-0029 9804) in advanced/metastatic squamous cell carcinoma of the penis (HER-Uro01). U.S. National Library of Medicine. [online]. Available from: https://clinicaltrials.gov/ct2/show/NCT01728233.

Labels
Paediatric clinical oncology Surgery Clinical oncology
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#