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O'Kelly JA, Browne E, Daly P, Keane J, Shah N, Shilling C, Cullen IM. Penile cancer in younger men-A more aggressive disease? Urol Oncol 2023; 41:329.e11-329.e15. [PMID: 37225633 DOI: 10.1016/j.urolonc.2023.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Penile cancer (PC) in men under 45 is very rare with an incidence of 0.1 to 0.8/100,000. There is little published data on disease characteristics and outcomes of PC in younger men. Herein, we evaluate the disease characteristics and outcomes of penile cancer in younger men compared to an older cohort. METHODS This study included all men diagnosed with PC at our institution from 2016 to 2021. Primary outcomes included overall survival, cancer-specific survival, and disease-free survival. Secondary outcomes included disease characteristics and surgical management. Men aged ≤45 years (Group A) were compared with men aged >45 years (Group B) at diagnosis. RESULTS There were 90 patients treated for invasive PC over the study period. The median age at diagnosis was 64 (26-88). The mean length of follow-up was 27 (±18) months. There were 12 (13%) in Group A, and 78 (87%) patients in Group B. Group A had a worse cancer-specific survival compared to Group B (39 months vs. not reached, HR 0.1 (95%CI 0.02-0.85, P = 0.03). There was no significant difference in overall or disease-free survival between both groups. More men in Group A had lymph node metastases at the time of diagnosis (58% vs. 19%, P < 0.001). There was no significant difference in histopathological features including tumor subtype, grade, T stage, p53 status or presence of lymphovascular or perineural invasion. CONCLUSION In our study, younger men were more likely to have nodal involvement at time of diagnosis and had a worse cancer-specific survival.
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Affiliation(s)
- John A O'Kelly
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland.
| | - Eva Browne
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland; Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - John Keane
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Nigam Shah
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Christine Shilling
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Ivor M Cullen
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland; Royal College of Surgeons in Ireland, Dublin, Republic of Ireland; Department of Urology, Beaumont Hospital, Dublin, Republic of Ireland
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Scornajenghi CM, Asero V, Bologna E, Basile G, De Angelis M, Moschini M, Del Giudice F. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review. Curr Opin Urol 2023; Publish Ahead of Print:00042307-990000000-00098. [PMID: 37377374 DOI: 10.1097/mou.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Penile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1-2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. RECENT FINDINGS Patient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SUMMARY OSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.
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Affiliation(s)
- Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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Ngweso S, Nzenza T, McMillan K, Sofield D, Lozinskiy M, Hayne D. Current trends in penile cancer survivorship amongst remote patients and Aboriginal people in Western Australia. ANZ J Surg 2023; 93:534-540. [PMID: 36478516 DOI: 10.1111/ans.18177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/27/2021] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Penile cancer is a rare urological malignancy, accounting for less than 1% of all cancers in males. Given its rarity, few studies exist reporting survival outcomes. The primary objective of this project was to review the mortality of patients diagnosed with penile cancer in Western Australia between 1992 and 2017 and to determine if Aboriginal and Torres Strait Islander people and patients in rural and remote regions experience discrepancies in survival outcomes. METHODS All cases of penile cancer recorded within the Western Australia Cancer Registry between 1992 and 2017 were reviewed. Analysis was performed using chi-squared test of association, binomial logistic regression and survival analysis was conducted using Kaplan Meier and Cox Regression analysis. RESULTS One hundred eighty-six cases of penile cancer were identified; 62 patients (33%) were from regional or remote locations and nine patients (4.8%) were Aboriginal. 13 of the regional or remote patients and 5 of the Aboriginal patients died from penile cancer. Patients who were Aboriginal (HR 6.512, CI 2.123-19.968; P = 0.001) or from regional or remote Western Australia (HR 2.382, CI 1.050-5.401; P = 0.038) were at an increased risk of penile cancer-specific mortality. CONCLUSIONS Aboriginal people with penile cancer and men from regional and remote Western Australia experience worse penile cancer-specific survival outcomes.
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Affiliation(s)
- Simeon Ngweso
- Department of Urology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group
| | - Tatenda Nzenza
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin McMillan
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David Sofield
- Department of Urology, Bethesda Hospital, Claremont, Western Australia, Australia
- Department of Urology, St John of God Hospital, Subiaco, Western Australia, Australia
| | | | - Dickon Hayne
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Urology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Clinicopathological characteristics of carcinoma penis over 10 years in a tertiary-level oncology center in Nepal: a retrospective study of 380 cases. Int Urol Nephrol 2023; 55:589-596. [PMID: 36454449 DOI: 10.1007/s11255-022-03427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This study was done to find out the clinicopathological characteristics of carcinoma penis in Nepali population and to evaluate various risk factors that predict its inguinal lymph node metastasis. METHODS A retrospective cross-sectional study was carried out at the Urology Unit, Department of Surgical Oncology at BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Case notes of biopsy-proven penile cancer, from January 2012 to December 2021, who underwent some form of surgical intervention were included. RESULTS A total of 380 patients were included in the study. The mean age of the patients was 55.92 ± 13.81 years. At presentation, 78.5% had clinically node-positive disease. The most common treatment for the primary tumor was partial amputation of the penis (74.2%). Bilateral inguinal lymph node dissections were done in 370 cases. The most common histology was the usual SCC in 94.2% of cases and 69% were well differentiated. T3 was the most common staging in 49.4% cases. Pathologically nodal negative status was found in 58% cases. In univariate analysis, factors like duration of symptoms (≥ 6 months), high-risk histopathology (basaloid/sarcomatoid variant), increased T-stage, poorly differentiated tumor, and the presence of PNI or LVI were significantly associated with lymph node metastasis. CONCLUSIONS Penile cancer is a common cancer in developing countries such as Nepal. The majority of the patients present late. Early recognition and prompt treatment are required to improve the overall outcome.
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Santos RDS, Hirth CG, Pinheiro DP, Bezerra MJB, Silva-Fernandes IJDL, Paula DSD, Alves APNN, Moraes Filho MOD, Moura ADAA, Lima MVA, Pessoa CDÓ, Furtado CLM. HPV infection and 5mC/5hmC epigenetic markers in penile squamous cell carcinoma: new insights into prognostics. Clin Epigenetics 2022; 14:133. [PMID: 36284309 PMCID: PMC9597985 DOI: 10.1186/s13148-022-01360-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Penile cancer is one of the most aggressive male tumors. Although it is preventable, the main etiologic causes are lifestyle behaviors and viral infection, such as human papillomavirus (HPV). Long-term epigenetic changes due to environmental factors change cell fate and promote carcinogenesis, being an important marker of prognosis. We evaluated epidemiological aspects of penile squamous cell carcinoma (SCC) and the prevalence of HPV infection using high-risk HPV (hrHPV) and p16INK4A expression of 224 participants. Global DNA methylation was evaluated through 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC). RESULTS The incidence of HPV was 53.2% for hrHPV and 22.32% for p16INK4a. hrHPV was not related to systemic or lymph node metastasis and locoregional recurrence, nor influenced the survival rate. P16INK4a seems to be a protective factor for death, which does not affect metastasis or tumor recurrence. Lymph node and systemic metastases and locoregional recurrence increase the risk of death. An increased 5mC mark was observed in penile SCC regardless of HPV infection. However, there is a reduction of the 5hmC mark for p16INK4a + (P = 0.024). Increased 5mC/5hmC ratio (> 1) was observed in 94.2% of penile SCC, irrespective of HPV infection. Despite the increase in 5mC, it seems not to affect the survival rate (HR = 1.06; 95% CI 0.33-3.38). CONCLUSIONS P16INK4a seems to be a good prognosis marker for penile SCC and the increase in 5mC, an epigenetic mark of genomic stability, may support tumor progression leading to poor prognosis.
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Affiliation(s)
- Renan da Silva Santos
- grid.8395.70000 0001 2160 0329Drug Research and Development Center, Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Brazil
| | | | - Daniel Pascoalino Pinheiro
- grid.8395.70000 0001 2160 0329Drug Research and Development Center, Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Dayrine Silveira de Paula
- grid.8395.70000 0001 2160 0329Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Ana Paula Negreiros Nunes Alves
- grid.8395.70000 0001 2160 0329Drug Research and Development Center, Postgraduate Program in Translational Medicine, Federal University of Ceará, Fortaleza, Brazil ,grid.8395.70000 0001 2160 0329Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Manoel Odorico de Moraes Filho
- grid.8395.70000 0001 2160 0329Drug Research and Development Center, Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Brazil ,grid.8395.70000 0001 2160 0329Drug Research and Development Center, Postgraduate Program in Translational Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Marcos Venício Alves Lima
- Laboratory of Pathology, Cancer Institute of Ceará, Fortaleza, Brazil ,Laboratory of Molecular Biology and Genetics, Cancer Institute of Ceará, Fortaleza, Brazil
| | - Claudia do Ó Pessoa
- grid.8395.70000 0001 2160 0329Drug Research and Development Center, Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Brazil
| | - Cristiana Libardi Miranda Furtado
- grid.8395.70000 0001 2160 0329Drug Research and Development Center, Postgraduate Program in Translational Medicine, Federal University of Ceará, Fortaleza, Brazil ,grid.412275.70000 0004 4687 5259Experimental Biology Center, University of Fortaleza, Fortaleza, Brazil
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Fu L, Tian T, Yao K, Chen XF, Luo G, Gao Y, Lin YF, Wang B, Sun Y, Zheng W, Li P, Zhan Y, Fairley CK, Grulich A, Zou H. Global Pattern and Trends in Penile Cancer Incidence: Population-Based Study. JMIR Public Health Surveill 2022; 8:e34874. [PMID: 35793140 PMCID: PMC9301560 DOI: 10.2196/34874] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/01/2022] [Accepted: 05/26/2022] [Indexed: 12/16/2022] Open
Abstract
Background
Penile cancer is a relatively rare genital malignancy whose incidence and mortality are rising in many countries.
Objective
This study aims to assess the recent incidence and mortality patterns and incidence trends of penile cancer.
Methods
The age-standardized incidence and mortality rates (ASIR and ASMR, respectively) of penile cancer in 2020 were estimated from the Global Cancer Registries (GLOBOCAN) database. Incidence trends of penile cancer from 1973 to 2012 were assessed in 44 populations from 43 countries using the Cancer Incidence in Five Continents plus (CI5plus) and the Nordic Cancer Registries (NORDCAN) databases. Average annual percentage change was calculated to quantify trends in ASIR using joinpoint regression.
Results
Globally, the estimated ASIR and ASMR of penile cancer were 0.80 (per 100,000) and 0.29 (per 100,000) in 2020, equating to 36,068 new cases and 13,211 deaths in 2020, respectively. There was no significant correlation between the ASIR (P=.05) or ASMR (P=.90) and Human Development Index. In addition, 15 countries saw increasing ASIR for penile cancer, 13 of which were from Europe (United Kingdom, Lithuania, Norway, Estonia, Finland, Sweden, Cyprus, Netherlands, Italy, Croatia, Slovakia, Russia, and the Czech), and 2 from Asia (China and Israel).
Conclusions
Although the developing countries still bear the higher incidence and mortality of penile cancer, the incidence is on the rise in most European countries. To mitigate the disease burden resulting from penile cancer, measures to lower the risk for penile cancers, including improving penile hygiene and male human papillomavirus vaccination, may be warranted.
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Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tian Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kai Yao
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiang-Feng Chen
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Shanghai Human Sperm Bank, Shanghai, China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Peiyang Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuewei Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Morris BJ, Katelaris A, Blumenthal NJ, Hajoona M, Sheen AC, Schrieber L, Lumbers ER, Wodak AD, Katelaris P. Evidence-based circumcision policy for Australia. JOURNAL OF MEN'S HEALTH 2022; 18:132. [PMID: 36034719 PMCID: PMC9409339 DOI: 10.31083/j.jomh1806132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim was (1) to perform an up-to-date systematic review of the male circumcision (MC) literature and (2) to determine the number of adverse medical conditions prevented by early MC in Australia. Searches of PubMed using "circumcision" with 39 keywords and bibliography searches yielded 278 publications meeting our inclusion criteria. Early MC provides immediate and lifetime benefits, including protection against: urinary tract infections, phimosis, inflammatory skin conditions, inferior penile hygiene, candidiasis, various STIs, and penile and prostate cancer. In female partners MC reduces risk of STIs and cervical cancer. A risk-benefit analysis found benefits exceeded procedural risks, which are predominantly minor, by approximately 200 to 1. It was estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. An increase in early MC in Australia to mid-1950s prevalence of 85% from the current level of 18.75% would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort. Survey data, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation indicate that MC has no detrimental effect on sexual function, sensitivity or pleasure. US studies found that early infant MC is cost saving. Evidence-based reviews by the AAP and CDC support early MC as a desirable public health measure. Although MC can be performed at any age, early MC maximizes benefits and minimises procedural risks. Parents should routinely be provided with accurate, up-to-date evidence-based information in an unbiased manner early in a pregnancy so that they have time to weigh benefits and risks of early MC and make an informed decision should they have a son. Parental choice should be respected. A well-trained competent practitioner is essential and local anaesthesia should be routinely used. Third party coverage of costs is advocated.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia
| | - Athos Katelaris
- Department of Urology, St George Hospital, Sydney, NSW 2217, Australia
| | - Norman J. Blumenthal
- Department of Obstetrics and Gynaecology, SAN Clinic, Wahroonga, NSW 2076, Australia
| | - Mohamed Hajoona
- Victoria Circumcision Clinic, The Regent Medical Group, Preston, VIC 3072, Australia
| | | | - Leslie Schrieber
- Department of Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Pregnancy and Reproduction Program, Hunter Medical Research Institute, New Lambton Heights; Priority Research Centre for Reproductive Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex D. Wodak
- St Vincent’s Hospital, Australian Tobacco Harm Reduction Association and Australia21, Darlinghurst, NSW 2010, Australia
| | - Phillip Katelaris
- Katelaris Urology, North Shore Private Hospital, St Leonards, NSW 2065, Australia
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When Shall I Ask for a Second Opinion in Specialized Centers and How Can I Find Them? Do I Need a Medical Therapy in My Disease Course? Semin Oncol Nurs 2022; 38:151287. [DOI: 10.1016/j.soncn.2022.151287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision? Int J Impot Res 2022; 35:256-263. [PMID: 34997197 DOI: 10.1038/s41443-021-00502-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 01/02/2023]
Abstract
Non-therapeutic circumcision refers to the surgical removal of part or all of the foreskin, in healthy males, where there is no medical condition requiring surgery. The arguments for and against this practice in children have been debated for many years, with conflicting and conflicted evidence presented on both sides. Here, we explore the evidence behind the claimed benefits and risks from a medical and health-related perspective. We examine the number of circumcisions which would be required to achieve each purported benefit, and set that against the reported rates of short- and long-term complications. We conclude that non-therapeutic circumcision performed on otherwise healthy infants or children has little or no high-quality medical evidence to support its overall benefit. Moreover, it is associated with rare but avoidable harm and even occasional deaths. From the perspective of the individual boy, there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold informed consent himself. We feel that the evidence presented in this review is essential information for all parents and practitioners considering non-therapeutic circumcisions on otherwise healthy infants and children.
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Affiliation(s)
| | - Gordon Muir
- Urology Department, King's College Hospital, London, UK.
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10
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Anderson E, Yao HH, Chee J. Optimal surgical margin for penile‐sparing surgery in management of penile cancer—Is 2 cm really necessary? BJUI COMPASS 2021; 2:281-285. [PMID: 35475297 PMCID: PMC8988642 DOI: 10.1002/bco2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Classical teaching of a 2 cm macroscopic surgical margin for surgical treatment of primary penile cancer is overly aggressive. Contemporary evidence suggests narrow but clear margins have similar survival outcomes for localized disease. This study aims to determine the oncological outcome of using a risk‐adapted algorithm to selection of macroscopic surgical margin based on biopsy grade of disease: 5 mm margin for grade 1, 10 mm margin for grade 2, and 20 mm margin for grade 3. Methods This is a retrospective case series of patients who underwent penile‐sparing surgery for biopsy‐proven penile SCC by a single surgeon from May 2010 through to January 2019. Clinicopathological data were extracted from medical records. Primary outcome was the positive margin rate. Secondary outcomes were overall survival (OS), cancer‐specific survival (CSS), metastasis‐free survival (MFS), and local recurrence‐free survival (RFS). Kaplan‐Meier survival analysis was used to determine survival outcomes. Results A total of 21 patients were included in this study. The median age was 65. Pre‐operative biopsy grade was grade 1 in 19.1% of patients, grade 2 in 47.6%, and grade 3 in 33.3%. The median size of tumor on examination was 20 mm. Using a grade‐stratified algorithm for macroscopic surgical margin, only one patient (4.8%) had a positive margin. This patient had G1T3 disease and proceeded to have a total penectomy for oncological clearance. The median margin clearance was 7 mm. The 12‐month OS, CSS, MFS, and local RFS were 94.6%, 94.6%, 81.0%, and 92.3%, respectively. Conclusion This study suggests that using a grade‐stratified approach to aim for a narrower macroscopic surgical margin does not appear to significantly alter the oncological outcome, with a negative margin rate of 95.2% in our this series. This enables more men to be eligible for organ preserving surgery and thereby improve their quality of life in the urinary function and sexual function domain. Larger prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Elliot Anderson
- Department of Urology Western Health Melbourne VIC Australia
- Department of Urology Alfred Health Melbourne VIC Australia
| | - Henry Han‐I Yao
- Department of Urology Western Health Melbourne VIC Australia
- Eastern Health Clinical School Monash University Melbourne VIC Australia
| | - Justin Chee
- Department of Urology Western Health Melbourne VIC Australia
- Eastern Health Clinical School Monash University Melbourne VIC Australia
- Department of Urology Alfred Health Melbourne VIC Australia
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11
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Abstract
Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.
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Affiliation(s)
- Henry Han-I Yao
- Department of Urology, Eastern Health, Melbourne, Australia.,Department of Urology, Western Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia.,Department of Urology, Alfred Health, Melbourne, Australia
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12
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Qi F, Wei X, Zheng Y, Ren X, Li X, Zhao E. Incidence trends and survival outcomes of penile squamous cell carcinoma: evidence from the Surveillance, Epidemiology and End Results population-based data. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1428. [PMID: 33313173 PMCID: PMC7723588 DOI: 10.21037/atm-20-1802] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background To provide the latest incidence trends and explore survival outcomes of penile squamous cell carcinoma (PSCC) patients with or without a previous primary malignancy. Methods Patients diagnosed with PSCC between 1975 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively included. Then, we calculated the age-adjusted incidence rates (IRs) and annual percentage changes (APCs). Multivariate Cox analysis and Kaplan-Meier (KM) survival curves were conducted to investigate prognostic variables for cancer-specific survival (CSS). Results A total of 6,122 PSCC patients were enrolled, 1,137 of whom had a prior malignancy. The age-adjusted IR for the general population in men declined before 1987, fluctuated slightly between 1987 and 1997, and showed an upward trend after 1997, which was basically consistent with that in patients without a previous primary malignancy. The incidence trend of PSCC in the general population was similar with that in those without a previous malignancy. However, the IRs of PSCC in men with a previous malignancy have been increasing since 1975 regardless of race. Furthermore, age at diagnosis, pathological grade, extent of disease, marital status, the administration of surgery and presence of previous primary malignancy were identified to be significantly related to CSS. Conclusions The IRs of PSCC have been increasing in recent years. Several independent prognostic factors for CSS were identified, allowing surgeons to assess the individualized risk in advance.
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Affiliation(s)
- Feng Qi
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xiyi Wei
- First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yuxiao Zheng
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohan Ren
- First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Xiao Li
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Erkang Zhao
- Department of Urology, Donghai County Hospital of Traditional Chinese Medicine, Lianyungang, China
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13
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What are the unmet supportive care needs of men affected by penile cancer? A systematic review of the empirical evidence. Eur J Oncol Nurs 2020; 48:101805. [DOI: 10.1016/j.ejon.2020.101805] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/11/2020] [Accepted: 07/16/2020] [Indexed: 01/23/2023]
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14
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Sosnowski R, Wolski JK, Zi Talewicz U, Szyma Ski M, Baku A R, Demkow T. Assessment of selected quality of life domains in patients who have undergone conservative or radical surgical treatment for penile cancer: an observational study. Sex Health 2020; 16:32-38. [PMID: 30532994 DOI: 10.1071/sh17119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/06/2018] [Indexed: 11/23/2022]
Abstract
Background Surgery is the standard treatment for organ-restricted penile cancer, but it is also a disfiguring procedure that can profoundly affect quality of life. Using a survey, in this study we assessed the effect of different surgical invasiveness on satisfaction in selected life domains of patients who underwent penile-sparing surgery and partial penectomy. METHODS Forty patients who underwent penile-sparing surgery (n=13) or partial penectomy (n=27) were enrolled in the study. The response rate was 71%. Information was obtained after surgery on sexuality, self-esteem, masculinity and partner relationships using the International Index of Erectile Function, the Self-Esteem Scale and the Conformity to Masculinity Norms Inventory questionnaires. We evaluated the effect of primary surgery type on selected domains of quality of life and correlations between study variables after surgery. RESULTS High self-esteem, satisfactory erectile function and masculinity results in both groups were comparable to those in the published literature. Men who underwent less disfiguring treatment had a significantly higher sense of masculinity than those who underwent partial penectomy (P=0.05). No significant differences were observed in erectile dysfunction and self-esteem. The level of aggressiveness of a surgical procedure was a predictor of sense of masculinity (P=0.01), but was not associated with self-esteem and sexual dysfunction (P=0.28 and P=0.55 respectively); 83% of patients were able to satisfactorily maintain partner relationships. CONCLUSIONS Disfiguring treatments for penile cancer significantly interfere with the sense of masculinity, but sexual functioning and self-esteem do not differ according to the type of surgical procedure. Most men maintained stable partner relationships after surgery, regardless of surgery type.
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Affiliation(s)
- Roman Sosnowski
- Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Street, 02-781 Warsaw, Poland
| | - Jan Karol Wolski
- Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Street, 02-781 Warsaw, Poland
| | - Urszula Zi Talewicz
- Faculty of Psychology, Department of Health Psychology and Rehabilitation, University of Warsaw, Stawki 5/7 Street, 00-183 Warsaw, Poland
| | - Micha Szyma Ski
- Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Street, 02-781 Warsaw, Poland
| | - Robert Baku A
- Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Street, 02-781 Warsaw, Poland
| | - Tomasz Demkow
- Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Street, 02-781 Warsaw, Poland
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15
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Bladder, penile, renal pelvis and testis cancers: A population based analysis of incidence and survival 1977-2013. Cancer Epidemiol 2020; 65:101692. [DOI: 10.1016/j.canep.2020.101692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 01/03/2023]
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16
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Lagacé F, Ghazawi FM, Le M, Savin E, Zubarev A, Powell M, Moreau L, Sasseville D, Popa I, Litvinov IV. Penile Invasive Squamous Cell Carcinoma: Analysis of Incidence, Mortality Trends, and Geographic Distribution in Canada. J Cutan Med Surg 2019; 24:124-128. [PMID: 31722549 DOI: 10.1177/1203475419888869] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Penile invasive squamous cell carcinoma (SCC) is a rare disease with several known risk factors. However, few studies have assessed its incidence, mortality, and temporal trends. OBJECTIVE Our objectives are to analyze the epidemiology of penile SCC in Canada and to examine patient distribution with this cancer across Canada in order to elucidate population risk factors. METHODS Three independent cancer registries were used to retrospectively analyze demographic data from Canadian men diagnosed with penile invasive SCC between 1992 and 2010. The Canadian Census of Population was used to calculate incidence and mortality rates at the province and Forward Sortation Area levels. RESULTS The overall age-adjusted incidence rate was 6.08 cases per million males. Four provinces with statistically significantly higher incidence rates were identified. The national crude incidence rates increased linearly between 1992 and 2010, whereas the age-adjusted incidence rates showed no significant increase during this time period. The overall age-adjusted mortality rate was 1.88 deaths per million males per year. The province of Saskatchewan had significantly higher mortality rates. There was no increase in crude or age-adjusted mortality rates between 1992 and 2010. There was a significant positive correlation between incidence rates and obesity, Caucasian ethnicity, and lower socioeconomic status. CONCLUSION This study was able to establish geographic variation for this malignancy at the provincial level. Although there are many established risk factors for penile SCC, our results suggest that the increase in crude incidence rates observed is largely due to the aging population.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | | | - Michelle Le
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Evgeny Savin
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Andrei Zubarev
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Mathieu Powell
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Linda Moreau
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Ioana Popa
- Division of Urological Surgery, Université de Montréal, QC, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montreal, QC, Canada
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17
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Wang Y, Wang K, Chen Y, Zhou J, Liang Y, Yang X, Li X, Cao Y, Wang D, Luo L, Li B, Li D, Wang L, Liang Z, Gao C, Wang Q, Lv Q, Li Z, Shi Y, Niu H. Mutational landscape of penile squamous cell carcinoma in a Chinese population. Int J Cancer 2019; 145:1280-1289. [PMID: 31034097 DOI: 10.1002/ijc.32373] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/04/2019] [Accepted: 04/18/2019] [Indexed: 01/07/2023]
Abstract
Penile squamous cell carcinoma (PSCC) is a malignancy that affects the skin and tissues of the penis, but the knowledge of pathogenesis and carcinogenesis is limited. Here, we characterize the PSCC genomic landscape using whole-exome sequencing. Of the 30 paired blood and tumor samples, we identified recurrent mutations in 11 genes; confirmed previous findings for FAT1 (4/30), HRAS (4/30), NOTCH1 (4/30), TP53 (3/30) and PIK3CA (3/30); and revealed novel candidate driver genes [CASP8 (4/30), SLITRK2 (3/30), FLG (3/30) and TRRAP (3/30)]. Our in vitro experiments suggested CASP8 was involved in mediating TRAIL-induced apoptosis of penile cancer cell lines. We also observed the frequently altered pathways for potential therapeutic implications: alterations in the Notch (30% of sample altered), RTK-RAS (26.7% altered) and Hippo (23.3% altered) pathways accounted for over 50% of tumors. The frequently altered genes (>10%) in these pathways were proved to be expressed in penile tumors by immunohistochemistry assay. These findings provide new insight into the mutational and pathway landscapes of PSCC and suggest potential novel therapeutic opportunities for this malignancy.
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Affiliation(s)
- Yonghua Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ke Wang
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), the Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanbin Chen
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Juan Zhou
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), the Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China
| | - Ye Liang
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuecheng Yang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoqi Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), the Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China
| | - Yanwei Cao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dong Wang
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), the Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Luo
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Li
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dan Li
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Liping Wang
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhijuan Liang
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengwen Gao
- The Affiliated Hospital of Qingdao University & The Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Qifeng Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lv
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqiang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), the Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China.,The Affiliated Hospital of Qingdao University & The Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China.,Institute of Social Cognitive and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, China.,Institute of Neuropsychiatric Science and Systems Biological Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongyong Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), the Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China.,The Affiliated Hospital of Qingdao University & The Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China.,Institute of Social Cognitive and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, China.,Institute of Neuropsychiatric Science and Systems Biological Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Psychiatry, First Teaching Hospital of Xinjiang Medical University, Urumqi, China
| | - Haitao Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.,Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, China
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18
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Prabhakaran S, Ljuhar D, Coleman R, Nataraja RM. Circumcision in the paediatric patient: A review of indications, technique and complications. J Paediatr Child Health 2018; 54:1299-1307. [PMID: 30246352 DOI: 10.1111/jpc.14206] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/25/2018] [Accepted: 07/29/2018] [Indexed: 01/15/2023]
Abstract
Circumcision is one of the most commonly performed surgical procedures in the world. Despite this, the practice of paediatric circumcision remains highly controversial, and continues to generate ongoing debate. This debate has become more relevant recently with the provisional guidelines from the Centers for Disease Control and Prevention recommending a change of practice. In this review article, we provide an overview of the history and incidence of circumcision, normal preputial development, types of phimosis, the absolute and relative indications for circumcision as well as the evidence base for its use as a preventative measure. Our aim is to provide paediatricians with a greater understanding of this common surgical procedure and the conditions it treats, to guide their clinical practice and parent counselling.
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Affiliation(s)
- Swetha Prabhakaran
- Department of Paediatric Surgery and Urology, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Damir Ljuhar
- Department of Paediatric Surgery and Urology, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Robert Coleman
- Department of Paediatric Surgery and Urology, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery and Urology, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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19
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Ritch CR, Soodana-Prakash N, Pavan N, Balise RR, Velasquez MC, Alameddine M, Adamu DY, Punnen S, Parekh DJ, Gonzalgo ML. Racial disparity and survival outcomes between African-American and Caucasian American men with penile cancer. BJU Int 2018; 121:758-763. [DOI: 10.1111/bju.14110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chad R. Ritch
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | | | - Nicola Pavan
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Raymond R. Balise
- Division of Biostatistics; Department of Public Health Sciences; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Maria Camila Velasquez
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mahmoud Alameddine
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Desmond Y. Adamu
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Sanoj Punnen
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Dipen J. Parekh
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mark L. Gonzalgo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
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20
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Abstract
PURPOSE OF REVIEW As patients with HIV infection are living longer with their disease, we have seen the evolution of skin cancer in this population. Cancer registries have not documented the incidence and prevalence of these cancers but we do have relevant data from cohorts. This article attempts to bring to light the extent to which skin cancer is an issue in HIV disease both domestically and internationally. RECENT FINDINGS Squamous cell cancer is increasing in incidence in the United States and elsewhere. The anatomic locations of skin cancer vary according to demographics, host factors, and environment. In this review, squamous cell cancer will be contrasted to the other skin cancers namely, melanoma, and basal cell cancers. SUMMARY As our HIV population ages, clinicians should be informed as to the relevant risk factors for development of skin cancer. With the increasing incidence of these cancers in the modern era of HIV, clinicians and researchers will be informed with regard to prevention and treatment strategies.
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21
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Campbell RA, Slopnick EA, Ferry EK, Zhu H, Kim SP, Abouassaly R. Disparity between pre-existing management of penile cancer and NCCN guidelines. Urol Oncol 2017; 35:531.e9-531.e14. [PMID: 28363474 DOI: 10.1016/j.urolonc.2017.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/13/2017] [Accepted: 03/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the locoregional management of penile cancer before the introduction of NCCN guidelines and how much shift in practice patterns is required to meet the guidelines. METHODS The National Cancer Data Base was queried to identify 6,396 patients with squamous cell carcinoma of the penis diagnosed between 2004 and 2013. The cohort was divided into management groups based on the NCCN guidelines: cTa and cTis (cTa/is), pT1 low grade (T1LG), pT1 high grade (T1HG), and pT2 or greater (T234). These groups were analyzed to determine if management of locoregional disease complies with the 2016 NCCN guidelines and logistic regression analyses were performed to determine factors associated with adherence. RESULTS Nationwide management of the primary tumor closely follows the NCCN guidelines, with 96.9% adherence for cTa/is, 91.4% for T1LG, and 94.2% for T234. Management of regional lymph nodes (LNs) was inadequate with only 62.9% of patients with clinical N1 or N2 disease undergoing regional LN dissection (LND). The percentage of patients with known LN metastases who received regional LND increased over time (46.2% in 2004 to 69.4% in 2013, P = 0.034). Patients treated at community cancer programs (odds ratio [OR] = 0.26, 95% CI: 0.19-0.35), comprehensive community cancer programs (OR = 0.34, 95% CI: 0.29-0.41), and integrated network cancer programs (OR = 0.36, 95% CI: 0.25-0.52) were significantly less likely to receive LND compared with patients treated at academic comprehensive cancer programs. CONCLUSIONS Before the introduction of NCCN guidelines, national practice patterns for the management of the primary tumor were consistent with the recommendations. However, the management of regional LNs deviated from the guidelines, reflecting an area for improvement.
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Affiliation(s)
- Rebecca A Campbell
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Emily A Slopnick
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Elizabeth K Ferry
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Hui Zhu
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Simon P Kim
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Robert Abouassaly
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.
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22
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Trends in incidence, mortality and treatment of penile cancer before and after centralisation of penile cancer services in England (1990–2009). JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816676740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Penile cancer services were centralised in England in 2002. Has this had an impact on treatments for penile cancer and survival? Patients and methods: All cases of penile cancer from 1990 to 2009 were identified from national cancer registry data. Mortality data were obtained from the Office for National Statistics and survival data were extracted from a national population-based database, the Cancer Information System. Socioeconomic deprivation was calculated using a national income deprivation score and surgical treatments were obtained from Hospital Episode Statistics (HES) data. Results: The number of penile cancer cases recorded rose from 300 to 400 per year during the early period of centralisation. There was a significant rise in the age-standardised incidence of penile cancer from 1.2 per 100,000 to 1.4 per 100,000 during this period. Mortality remained stable at 0.3 per 100,000. One-year and five-year relative survival remained stable after centralisation at 88% and 72% respectively. The incidence and mortality of penile cancer was significantly higher in the most deprived quintile of the population. Following centralisation, the number of total penile amputations was low at 11% but only 39% of men were recorded as having lymph node surgery, although this may reflect poor compliance with coding rather than true practice. Conclusions: The incidence of penile cancer in England is rising, but mortality and survival remains stable. Incidence and mortality is higher in more deprived areas, and greater public awareness of this disease and its risk factors are needed. By 2009, rates of penile amputation were low but potentially the proportion of lymph-node surgery remained low. This may change with the uptake of inguinal sentinel lymph-node sampling.
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23
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Patel MI, Yuminaga Y, Bang A, Lawrentschuk N, Skyring T, Smith DP. Volume-outcome relationship in penile cancer treatment: a population based patterns of care and outcomes study from Australia. BJU Int 2016; 118 Suppl 3:35-42. [DOI: 10.1111/bju.13626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Manish I. Patel
- Discipline of Surgery; Westmead Hospital; University of Sydney; Sydney Australia
- Department of Urology; Westmead Hospital; Westmead Australia
| | - Yuigi Yuminaga
- Department of Urology; Westmead Hospital; Westmead Australia
| | - Albert Bang
- Cancer Research Division; NSW Cancer Council; Sydney Australia
| | - Nathan Lawrentschuk
- University of Melbourne; Department of Surgery/Olivia Newton-John Cancer Research Institute; Austin Health and Department of Surgical Oncology; Peter MacCallum Hospital; Melbourne Australia
| | - Timothy Skyring
- Department of Urology; Wollongong Hospital; Wollongong Australia
| | - David P. Smith
- Cancer Research Division; NSW Cancer Council; Sydney Australia
- Sydney Medical School; The University of Sydney; Sydney Australia
- Menzies Health Institute Queensland; Griffith University; Gold Coast Australia
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24
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Sharma P, Zargar-Shoshtari K, Pettaway CA, Schabath MB, Giuliano AR, Spiess PE. Disparities in Penile Cancer. Cancer Control 2016; 23:409-414. [DOI: 10.1177/107327481602300412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Although penile cancer is a rare malignancy in developed nations, racial and socioeconomic differences exist in the incidence of the disease and its associated survival-related outcomes. Methods A search of the literature was performed for research published between the years 1990 and 2015. Case reports and non—English-language articles were excluded, instead focusing specifically on large, population-based studies. Results The incidence of penile cancer is higher in Hispanic and African American men compared with whites and Asians. Men with penile cancer also appear to have a distinct epidemiological profile, including lower educational and income levels, a history of multiple sexual partners and sexually transmitted infections, and lack of circumcision with the presence of phimosis. African American men presented at a younger age with a higher stage of disease and worse survival rates when compared with white men. Rates of cancer-specific mortality increased with age, single marital status, and among those living in regions of lower socioeconomic status. Conclusions An understanding of sociodemographical differences in the incidence and survival rates of patients with penile cancer can help advance health care policy changes designed to improve access and minimize disparities in cancer care for all men alike.
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Affiliation(s)
- Pranav Sharma
- Departments of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Urology at Texas Tech University Health Sciences Center in Lubbock, Texas
| | - Kamran Zargar-Shoshtari
- Departments of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Curtis A. Pettaway
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew B. Schabath
- Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Anna R. Giuliano
- Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Philippe E. Spiess
- Departments of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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