Therapeutic strategies in treatment of penile cancer

Between 1968 and 1995, 78 patients were treated for squamous cell carcinoma of the penis at the Departments of Urology of the Universities of Marburg and Heidelberg. In 22 patients the primary lesion was treated by penis pres erving procedures like laser beam, circumcision, tumor excision and irradia tion. A total of 56 patients underwent radical procedures like partial or t otal penectomy. Following partial or total penectomy no patient with T1-tum or had local recurrence or inguinal lymph node metastasis. For those patien ts receiving penis preserving therapy for T1-carcinomas, 9/17 (53%) develop ed local recurrence, of the 9,3 (33%) had simultaneous groin metastases as well. In contrast, no patient with a T1-tumor had a local recurrence or sim ultaneous inguinal lymph node metastasis after partial or total penectomy F or T2 stages, local recurrence rate was 100% after penis preserving therapy versus 21 % in the penectomy group. Primary inguinal lymphadenectomy was p erformed in 29 patients. Histologically proven groin metastases were found in 52 %. No patient with T1-tumor had simultaneous inguinal lymph node meta stases. The five-year survival rate for N1-carcinomas was 67 %, for NZ-carc inomas 29%. Partial or total penectomy is the therapy of choice in treatmen t of penile cancer even for T1-tumors. Primary inguinal lymphadenectomy is not necessary for patients with T1-tumors. In patients with tumor-stage T2- T4, however, primary inguinal lymphadenectomy should be performed. Multicen terstudies are necessary to evaluate further data about this rare neoplasm.