San Francisco, CA—Penile cancer is not very common in the United States, but it can be potentially fatal and appropriate treatment is crucial. A new, large population-based study showed that the management of patients with penile cancer in the United States is often not in line with current guidelines, including the 2013 National Comprehensive Cancer Network (NCCN) clinical guidelines for the management of penile cancer. These findings were presented at the 2014 Genitourinary Cancers Symposium by lead investigator Elizabeth Kate Ferry, MD, Urology Resident, Case Western Reserve University/University Hospitals Urology Institute, Cleveland, OH.
In the United States, approximately 1570 new cases of penile cancer are reported annually, as well as 310 deaths. In Africa, Asia, and South America, the incidence approaches 10%.
The results of this study show that patients with late-stage, potentially fatal penile cancers are being undertreated, whereas those with more benign, early-stage penile cancers are being overtreated, according to Dr Ferry. These findings further indicate that urologists managing patients with this type of cancer, as well as surgical oncologists, need to raise their level of awareness to updated guidelines and what treatments are actually recommended for what stage of penile cancer.
The study was based on the National Cancer Data Base, and included data on diagnosis and first-course surgery by disease stage in all US hospitals, including comprehensive cancer centers, community hospitals, and teaching research hospitals, between the years 2000 and 2010. The data were grouped into no surgery, penile-sparing surgery, and radical surgery.
First-course surgeries were performed in 1405 patients in community hospitals, 3930 in comprehensive cancer center hospitals, and 3667 in teaching research hospitals during the study period. No change in the patterns of surgical management was observed during the study period in patients with high-risk or low-risk penile cancers, even though clinical guidelines have been updated.
Parallel with this observation, there has been no change in survival trends among patients with penile cancer, according to Dr Ferry and colleagues.
The data revealed that surgeons are not following NCCN guidelines for penile cancer. Undertreatment was seen in variable but high rates of penile-sparing surgery, which were performed in patients with advanced penile cancers at all types of hospitals; undertreating this population places these patients at an increased risk for cancer-related death.
By contrast, the investigators found a persistent pattern of overtreatment for patients with stage I penile cancer, using radical surgery, an inappropriate type of surgery for this stage of cancer; the overtreatment trend was evident again at all hospitals.
Advances in Penile Cancer Management
Also at the meeting, Derek Raghavan, MD, PhD, President, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, reviewed the progress in treating penile cancer over the past century.
The most important advances in the recent century related to penile cancer management, according to Dr Raghavan, are:
- The use of Mohs surgery for carefully selected patients with superficial penile cancer
- Combination chemotherapy with cisplatin, methotrexate, and bleomycin
- The discovery that human papillomavirus infection in men is linked to an increased risk for penile cancer.
“The biggest challenge in moving the field forward is the paucity of cases to allow completion of randomized, definitive trials of chemotherapy,” Dr Raghavan emphasized.