Testicular, Penile, and Rare GU Malignancies

Penile cancer (PC) is  a rare malignancy with an incidence estimated less than 1/100 000 per year in the Western World^1-3

Historically, demolitive surgical approaches, such as total or partial penile amputation, were the most commonly used. Indeed, demolitive options were deemed to be necessary in order to respect a macroscopic surgical margin of at least 2 cm.^3-4 If the oncological outcomes of these approaches demonstrated to be satisfactory, they significantly affected aesthetic outcomes, as well as sexual and urinary functions.^5-12 

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• Written by: Mirko Preto, Federica Peretti, Marco Falcone
• References:
  1. Backes DM, Kurman RJ, Pimenta JM, Smith JS. Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes Control 2009;20:449–57.
  2. Chaux A, Netto GJ, Rodriguez IM, et al. Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma. World J Urol 2013; 31:861–7.
  3. Albersen M, Parnham A, Joniau S, Sahdev V, Christodoulidou M, Castiglione F, Nigam R, Malone P, Freeman A, Jameson C, Minhas S, Ralph DJ, Muneer A. Predictive factors for local recurrence after glansectomy and neoglans reconstruction for penile squamous cell carcinoma. Urol Oncol. 2018 Apr;36(4):141-146
  4. Das S. Penile amputations for the management of primary carcinoma of the penis. Urol Clin North Am. 1992 May;19(2):277-82
  5. Kieffer JM, Djajadiningrat RS, van Muilekom EA, et al. Quality of life in patients treated for penile cancer. J Urol 2014;192:1105-10.
  6. D’Ancona CA, Botega NJ, De Moraes C et al. Quality of life after partial penectomy for penile carcinoma. Urology 1997;50:593-6. 
  7. Romero FR, Romero KR, Mattos MA, et al. Sexual function after partial penectomy for penile cancer. Urology 2005;66:1292-5.
  8. Opjordsmoen S, Fosså SD. Quality of life in patients treated for penile cancer. A follow-up study. Br J Urol 1994;74:652-7.
  9. Sedigh O, Falcone M, Ceruti C, Timpano M, Preto M, Oderda M, Kuehhas F, Sibona M, Gillo A, Gontero P, Rolle L, Frea B. Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results? Can Urol Assoc J. 2015 Jul-Aug;9(7-8):E423-7
  10. Parnham AS, Albersen M, Sahdev V, Christodoulidou M, Nigam R, Malone P, Freeman A, Muneer A. Glansectomy and Split-thickness Skin Graft for Penile Cancer. Eur Urol. 2018 Feb;73(2):284-289.
  11. Maddineni SB, Lau MM, Sangar VK. Identifying the needs of penile cancer sufferers: a systematic review of the quality of life, psychosexual and psychosocial literature in penile cancer. BMC Urol 2009;9:8.
  12. Smith Y, Hadway P, Biedrzycki O, et al. Reconstructive surgery for invasive squamous carcinoma of the glans penis. Eur Urol 2007;52:1179–85.
  13. Hoffman MA, Renshaw AA, Loughlin KR. Squamous cell carcinoma of the penis and microscopic pathologic margins: How much margin is needed for local cure? Cancer 1999;85:1565-8.
  14. Minhas S, Kayes O, Hegarty P, et al. What surgical resection margins are required to achieve oncological control in men with primary penile cancer? BJU Int 2005;96:1040-3.
  15. Agrawal A, Pai D, Ananthakrishnan N, et al. The histological extent of the local spread of carcinoma of the penis and its therapeutic implications. BJU Int 2000;85:299-301.
  16. Lindegaard JC, Nielsen OS, Lundbeck FA, Mamsen A, Studstrup HN, von der Maase H. A retrospective analysis of 82 cases of cancer of the penis. Br J Urol 1996;77:883–90.
  17. Philippou P, Shabbir M, Malone P, et al. Conservative surgery for squamous cell carcinoma of the penis: resection margins and longterm oncological control. J Urol. 2012;188:803–808.
  18. Bracka A. Glans resection and plastic repair. BJU Int 2009;105:136–144.
  19. Burnett AL. Penile preserving and reconstructive surgery in the management of penile cancer. Nat Rev Urol 2016;13:249–57.
  20. Beech BB, Chapman DW, Rourke KF. Clinical outcomes of glansectomy with split-thickness skin graft reconstruction for localized penile cancer. Can Urol Assoc J. 2020 Oct;14(10):E482-E486.
  21. Garaffa G, Shabbir M, Christopher N, et al. The surgical management of lichen sclerosus of the glans penis: our experience and review of the literature. J SexMed 2011 Apr;8(4):1246–1253.
  22. Scarberry K, Angermeier KW, Montague D, et al. Outcomes for organ-preserving surgery for penile cancer. Sex Med 2015;3:62-6.
  23. Morelli G, Pagni R, Mariani C, et al. Glansectomy with split-thickness skin graft for the treatment of penile carcinoma. Int J Impot Res 2009;21:311–4.
  24. Joseph P, Christopher C. Skin Grafting - StatPearls - NCBI Bookshelf 2020.
  
  

It’s now been 3.5 years since I last wrote anything about testicular germ cell tumors and ongoing clinical trials.¹  Although we still cure most men afflicted with this disease, we have not made any major new therapeutic advancements since I wrote that last article.  Approximately, 15-20% of patients with metastatic germ cell tumors will relapse following initial chemotherapy.  Even in this situation, approximately 50% can still be cured with salvage treatments, either with more conventional cisplatin-based chemotherapy or with high-dose chemotherapy and autologous stem cell rescue.^2-4

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