Penile cancer: a case for guidelines

Introduction: Aspects of the management of penile cancer remain controversi al. In the management of early TI NO disease, treatments are divided betwee n amputation and a variety of penis conserving techniques (PCT); local exci sion, laser techniques, chemotherapy and radiotherapy. We report on a retro spective series of patients with penile cancer. Patients and Methods: Thirty-seven patients were diagnosed between 1987-199 6. All patient records were retrieved. Data recorded included TNM stage, hi stological grade and treatment. The end-points were death, nodal progressio n and local recurrence. Results: Median survivor follow-up of 42 months was obtained. Twenty-six pa tients (70%) presented with T1 disease, 7 (19%) T2 and 4 (11%) T3 or T4. In guinal nodal disease was seen in 11 (30%). The mean age was 63 years. Overa ll, 13 penile amputations were performed, 13 underwent radiotherapy, 6 were locally excised in combination with radiotherapy and 3 underwent local exc ision alone. Two patients were unsuitable for treatment. Of the total (37 p atients) 15 have died; 12 from penile cancer. Ten have suffered disease pro gression and 12 remain alive with no evidence of disease. Twenty-three pati ents presented with early T1 NO disease. They were treated with radiotherap y (12), local excision (2), combined radiotherapy and excision (2) and part ial amputation (4). Outcome was not significantly related to treatment moda lity. Spread to the inguinal nodes or local recurrence has occurred in 10, of whom 2 have died. Only 13 (57%) appear disease-free. Conclusions: The characteristics of the patients and the disease in this se ries are similar to published series in Europe and North America. There is significant variability in the modalities of treatment used within this ser ies. Local recurrence and disease progression occurs in 43% of T1 NO lesion s. There would seem to be some room for improvement. International data are retrospective and inconclusive with regard to best practice. There is an u rgent requirement for randomised controlled trials to improve the outcome o f these patients.