ABSTRACT: The risk of lymph node (LN) metastasis in G2T1 penile cancer has been previously reported as 0-50% and is classified as "intermediate" in the European Association of Urology (EAU) guidelines. The management of impalpable regional nodes in this cohort of patients remains contentious and varies among treatment centres depending on tumour factors and local resources.
To establish the risk of LN metastasis in G2T1 disease.
We interrogated the databases of two referral centres for penile cancer.
Out of 902 patients, 117 (13%) patients were identified with G2T1 cancers. Those with palpable inguinal nodes (cN1) underwent early inguinal LN dissection (iLND). Those with clinically node negative (cN0) inguinal basins were either observed or surgically staged with iLND or by dynamic sentinel LN biopsy (DSLNB). Median follow-up was 44 mo, with minimum follow-up of 6 mo.
Fifteen of 117 (13%) patients with G2T1 cancer had LN metastasis at initial staging or during follow-up. Six of 12 (50%) cN1 patients had histologically proven LN metastasis on iLND. One hundred five patients were cN0 at presentation. Ten cN0 patients had prophylactic iLND, none of which yielded LN metastasis; 5 of 64 (8%) cN0 patients who had DSLNB had tumour-positive LNs, and 4 of 31 (13%) cN0 patients who were observed developed LN metastasis during follow-up. In cN0 patients, the risk of LN metastasis at initial staging or during surveillance was 9%.
We consider that in cN0 patients with G2T1 penile cancer, the risk of developing metastases during surveillance warrants surgical and potentially curative staging. However, the morbidity of prophylactic bilateral iLND is too great to justify a detection rate of 9%. Less morbid alternatives such as DSLNB are advisable in G2T1 disease.
European urology 08/2009; 57(4):688-92. · 7.67 Impact Factor
ABSTRACT: To report our initial experience of total glans resurfacing (TGR), as premalignant lesions of the glans penis have conventionally been treated by local excision, topical chemotherapy, laser or cryotherapy, but these techniques are frequently associated with high local failure rates and unsightly scarring that can make monitoring by gross inspection difficult.
TGR involves removing the glans and subcoronal epithelial and subepithelial tissues down to the corpus spongiosum of the glans and Buck's fascia at the coronal sulcus. The denuded glans penis is then covered with an extra-genital skin graft. Ten patients underwent TGR: six had recurrent erythroplasia of Queyrat after 5% 5-fluorouracil (5-FU) therapy; one had no clinical response to 5-FU or imiquimod; one had a severe allergic reaction and therefore could not tolerate 5-FU; and two had extensive glans hyperkeratosis and severe dysplasia.
There were no postoperative complications. All skin grafts took successfully, and the cosmetic results were excellent. In all cases, pathological resection margins were clear. To date, there has been no evidence of disease recurrence on follow-up (median 30 months, range 7-45).
TGR is a successful surgical alternative for managing intractable premalignant penile lesions. It has the potential to restore normal anatomy and minimize the risk of local recurrence by replacing diseased epithelium and subepithelial tissues with healthy extra-genital skin.
BJU International 10/2006; 98(3):532-6. · 2.84 Impact Factor
ABSTRACT: To determine the incidence of balanitis xerotica obliterans (BXO) in a consecutive series of penile carcinomas in one centre, as BXO is a common penile disease that usually involves the prepuce and glans, and there have been sporadic case reports of the association between BXO and penile carcinoma, although it is uncertain if there is a specific causal relationship.
The reported incidence of penile carcinoma in patients with BXO is 2.6-5.8%, leading some to advocate circumcision in all cases, with close follow-up in those with persistent glanular disease. We prospectively analysed all cases of penile cancer referred to the unit over a 54-month period, to determine the prevalence of BXO.
In all, 155 patients with penile malignancy were reviewed, 44 of whom had BXO (28%). This group included 34 men with squamous cell carcinoma and 10 with carcinoma in situ; in 39, BXO and malignancy presented synchronously. In three other cases, cancer occurred in the background of chronic persistent BXO; in two cases penile cancer was truly metachronous. The tumours with associated BXO tended to be of lower stage and grade, and the patients presented when younger, but this was not statistically significant.
A significant proportion of patients with penile malignancy have a histological diagnosis of BXO. We think that patients presenting with long-standing BXO and those in whom BXO has not resolved after circumcision warrant biopsies and a careful follow-up.
BJU International 08/2006; 98(1):74-6. · 2.84 Impact Factor