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Organ-Sparing Partial Glansectomy: An Alternative Surgical Management for Invasive Penile Carcinoma-Case Report - Beyond the Abstract

Penile cancer is a rare cancer with reports of fewer than 1% of cancers in men in the United States.1 Treatment management’s goal is to provide complete oncological control while providing acceptably good urinary and sexual function. Although management is heavily guided by the stage and grade of the cancer, shared decisions are of utmost importance for patients to understand the risks and benefits of treatment and how it will affect their quality of life. This case report describes a patient with pT2 squamous cell carcinoma (SCC) of the penis who underwent circumcision with left partial-glansectomy and en bloc resection of the preputial mass with excellent oncological control and no recurrence at 1 year follow-up while providing good urinary and sexual function.

The staging and grading for penile cancer internationally follow the American Joint Committee on Cancer (AJCC) clinical and pathological classification consisting of primary tumor, regional lymph nodes, and distant metastasis (TNM). However, management pathways differ between the National Comprehensive Cancer Network (NCCN) guidelines utilized in the United States and the European Association of Urology (EAU) guidelines. For our patient presented by Chan et al.2 NCCN guidelines recommend a partial or total penectomy or radiation or chemoradiation versus EAU guideline recommending a wide local excision, partial or total glansectomy with reconstruction, or radiotherapy.3,4 The patient was diagnosed with pT2 penile cancer, thus allowing us to discuss the less invasive approach of wide-excision in glans-sparing fashion. Ultimately, the careful discussion of treatment options and the patient’s goals and expectations is what dictated the treatment course.

Choosing a less aggressive treatment emphasizes the need for compliance with follow-up as, statistically, this approach has a higher chance of local recurrence compared to the more invasive partial or total penectomy. Parnham et al. reported a 9.3% local recurrence rate with a median follow-up of 41.4 months among 172 patients who underwent organ-sparing treatment.5

While partial and total penectomy allows for a higher chance of better oncological control, the psychosocial comorbidities that come along with this invasive approach can decrease the quality of life of patients. Studies have often reported genitourinary function with a successful surgical outcome while being able to preserve good urinary and sexual function following glansectomy and skin grafting, but the psychological effect of treatment pathways is a less studied domain.6-8 In a study by Veeratterpallay et al., authors have shown that organ-preserving surgery, such as what our patient had, can help decrease the psychosocial comorbidity that is usually associated with those who undergo partial or total penectomy.9

If pursuing partial glansectomy approach, the presence of negative margins is of paramount importance. During such surgery, careful intraoperative examination of the lesion ensuring the remaining glans are viable and functioning made this surgical approach possible. Additionally, obtaining proper frozen sections reassured of negative resection margins intraoperatively confirmed on final pathology.

The careful case selection determined by history, physical exam, duration of symptoms, location and extent of tumor, preoperative imaging, and surgeon expertise allows for the shared decision making to include less invasive approaches for treatment. Results from other studies and this patient’s case indicate that organ-sparing partial glansectomy with close postoperative follow-up surveillance can deliver not only acceptable oncological control in patients with pT2 penile cancer but also provide good urinary and sexual function with decreased psychosocial comorbidity that is often associated with partial or total penectomy.

Written by: Jennida Chan,1 Jennifer Espinales,1 David Valancy,1 Brooke R. Koltz,2 Firas G. Petros1


  1. Department of Urology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA.
  2. Department of Pathology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA.
References:

  1. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin 2023;73:17-48.
  2. Chan J, Espinales J, Valancy D, Koltz BR, Petros FG. Organ-sparing partial glansectomy: an alternative surgical management for invasive penile carcinoma-case report. Transl Androl Urol. 2024 Dec 31;13(12):2833-2839. doi: 10.21037/tau-24-512. Epub 2024 Dec 28. PMID: 39816219; PMCID: PMC11732307.
  3. Clark PE, Spiess PE, Agarwal N, et al. Penile cancer: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2013;11:594-615.
  4. Brouwer OR, Albersen M, Parnham A, et al. European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2023 Update. Eur Urol 2023;83:548-60.
  5. Parnham AS, Albersen M, Sahdev V, et al. Glansectomy and Split-thickness Skin Graft for Penile Cancer. Eur Urol 2018;73:284-9.
  6. Hatzichristou DG, Apostolidis A, Tzortzis V, et al. Glansectomy: an alternative surgical treatment for Buschke-Löwenstein tumors of the penis. Urology 2001;57:966-9.
  7. Pietrzak P, Corbishley C, Watkin N. Organ-sparing surgery for invasive penile cancer: early follow-up data. BJU Int 2004;94:1253-7.
  8. O'Kane HF, Pahuja A, Ho KJ, et al. Outcome of glansectomy and skin grafting in the management of penile cancer. Adv Urol 2011;2011:240824.
  9. Veeratterapillay R, Sahadevan K, Aluru P, et al. Organ preserving surgery for penile cancer: description of techniques and surgical outcomes. BJU Int 2012;110:1792-5.
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