- Clinical science
Primary carcinoma of the penis is a rare tumor disease that mainly occurs in older men. It is associated with several risk factors including (untreated) phimosis, infection with human papillomavirus, and smoking. Patients present with a lump or an ulcerative lesion of the penis. Palpation of the groin and physical examination may reveal enlarged inguinal lymph nodes. Excisional biopsy is performed for histopathological confirmation of the tumor while MRI of the penis and CT of the pelvis are part of the tumor staging. The primary treatment is usually surgical and depends on the extent of the local and regional disease; options include local excision and partial or radical penectomy. Regional lymph node dissection may be necessary if the inguinopelvic nodes are involved. Metastatic disease is rare at inital presentation, but chemotherapy may be a palliative option. The overall prognosis is determined by the presence and extent of regional lymph node involvement.
- Rare type of malignancy in industrialized countries
- More common in developing countries in Africa, South America, and Asia
- Peak incidence: 60 years of age
Epidemiological data refers to the US, unless otherwise specified.
- Chronic inflammation of the penis
- Risk factors
- Protective factor: occurence of penile cancer in men who were circumcised before adulthood is rare.
Palpable painless lump or ulcerative lesion of the penis
- The glans and the foreskin are the most common locations.
- A concurrent phimosis may conceal the lesion
- Surface of the lesion may be exophytic, flat, or ulcerated
- Chronic penile rash or subtle burning sensation
- Voiding and sexual function typically remain unimpaired
- Swollen inguinal lymph nodes
Excisional biopsy (gold standard)
- ∼ 95% of all penile cancers are squamous cell carcinoma (SCC): atypical squamous cells with varying degrees of mitotic activity
- Tumor staging
Treatment depends on the TNM-stage of the disease and the risk of recurrence, but the initial approach is typically surgical.
Small (< 3cm) primary tumors
- Limited local excision with or without circumcision
- Laser ablation
- Radiation therapy
- Invasive or bulky primary tumors
- Recurrent or metastatic disease: penectomy or palliative chemotherapy
- Prognosis is determined primarily by the presence and the extent of inguinal lymph node involvement.
- Recurrence is approximately 28% for squamous cell carcinomas
- 5-year overall survival rates for locally-confined tumors and advanced tumors: 85% and < 60%