Studies Evaluate Trends in the Surgical Management of Penile Cancer


Key Points

  • A large nationwide study shows that surgical management of penile cancer has not changed since the year 2000.
  • In general, high-risk penile cancers were undertreated with penile-sparing surgery, while stage I cancers were overtreated with radical surgery.
  • These findings were consistent across community hospitals, comprehensive cancer center hospitals, and teaching research hospitals.

A large retrospective population-based study shows that potentially fatal penile cancers are surgically undertreated in the United States and more benign penile cancers are surgically overtreated. Even though penile cancer is rare in the United States, accounting for about 1,570 new cases in 2013 and 310 deaths, the study has implications for health-care delivery, according to the investigators.

“We know that survival trends have not changed for penile cancer since 1990. Our study showed that surgical management trends have not changed either. Contrary to NCCN [National Comprehensive Cancer Center] guidelines, penile-sparing surgery continues to be performed in all types of hospitals for higher-stage penile cancers, which may represent undertreatment of potentially fatal penile cancers. We also found a persistent pattern of overtreatment of stage I penile cancer,” stated lead author Elizabeth K. Ferry, MD, of Case Western Reserve University/University Hospitals Urology Institute, Cleveland.

Study Details

The study, which was presented as a poster session at the 2014 Genitourinary Cancers Symposium (Abstract 379), was based on the National Cancer Database (NCDB) and included data on diagnosis and first-course surgery by stage in all U.S. hospitals (community hospitals, comprehensive cancer centers, and teaching research hospitals) from 2000 to 2010. Data were divided into no surgery, penile-sparing surgery, and radical surgery groups.

First-course surgeries were documented in 1,405 patients treated in community hospitals, 3,930 treated in comprehensive cancer center hospitals, and 3,667 in teaching research hospitals from 2000 to 2010.

No change in patterns of surgical management was observed over the study period in high-risk or low-risk penile cancers.

Radical surgery was overused in stage I cancers in all hospitals. Among all hospital types, variable but nevertheless high rates of penile-sparing surgery were observed over the study period.

These trends suggest that surgeons are not following the 2013 NCCN Clinical Practice Guidelines for the treatment of penile cancer. The study suggests that oncologists should be aware of the recommendations and follow them.

Modest Increase in Multimodal Therapy Use

A separate study by the same authors, also presented at a poster session, documented trends in multimodality therapy for more advanced penile cancer based on the NCDB (Abstract 370). From 2000 to 2011, 1,028 and 440 men were diagnosed with stage III and IV penile cancer, respectively, and were treated with surgery alone, surgery with radiation, or surgery with chemoradiation.

The addition of radiation therapy was variable but low. The addition of chemotherapy gradually increased over time, and the increase was most robust in stage III. Surgery with chemotherapy was the most common multimodal therapy. The authors stated that further study is needed to determine whether these trends will affect mortality.

The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.