Penile Cancer: Challenges and Controversies



Series: Cancer Etiology, Diagnosis and Treatments, Men’s Issues
BISAC: MED062000

Aims and Scope: Although penile cancer is uncommon in the industrialized world, it is highly prevalent in certain regions of the globe such as South America, Africa, and Southeast Asia. It is a highly aggressive malignancy which is often associated with a long delay until diagnosis. This is frequently attributed to shame, fear, and ignorance of the patient. In more advanced stages, it may require extensive amputative surgery that is devastating both physically and psychologically with enormous impact on quality of life, such as loss of conjugal intimacy and self-esteem. On the contrary, in the early stages surgical resection and subsequent disfigurement can be minimized and associated with good cosmetic results. Therefore, it is both patient’s and physician’s task to identify the disease early as the negative impact of the treatment is undoubtedly reduced. This fact emphasizes the importance of education of the patient, primary care physician and the
public in general, and should get the proper attention from both the medical and lay media. Simple routine habits like self-examination and desired hygiene will facilitate early diagnosis and prevention.

Although penile cancer has undergone significant advances in the field of diagnosis and multidisciplinary treatment in the past two decades, several challenges and controversies still remain unsolved. Diagnostic evaluation and management of less clinically evident disease requires better standardization of practice. Similarly, minimizing adverse sequelae related to interventions cannot be overemphasized. The implementation of multidisciplinary centers of excellence focused on the nuances inherent to an uncommon but aggressive disease will significantly aid to improve treatment outcomes and quality of life. Each chapter’s senior author was hand-selected
as a world class resource for the area of expertise and for their willingness to share their surgical insight and wisdom.

This book will have contributions from world-renowned experts in this field from different continents, providing an international flare and perspective on the recent developments in the field of diagnosis and treatment penile cancer as well as reconstruction of the devastating effects of penile mutilation, including the recent interest in phallic reconstruction and ultimately penile transplantation for the penile cancer survivor. This book will also highlight other current challenges and controversies surrounding this disease, especially those related to the management of locally advanced and metastatic involvement.

This book, with its multidisciplinary approach, is intended to provide a comprehensive discussion and benefit every reader, junior or senior, world over who is interested in and deals with patients afflicted by penile cancer, including the urologic oncologist, the radiation oncologist, the medical oncologist, the urology resident, and last but not least the primary care physician.
(Imprint: Nova Medicine and Health)

Table of Contents

Table of Contents


Chapter 1. Introduction
(Francisco E. Martins and Miroslav L. Djordjevic, Department of Urology, University of Lisbon, School of Medicine, CHULN, Lisbon, Portugal, and others)

Chapter 2. Epidemiology, Etiology, Natural History and Risk Factors
(Ryan W. Speir, Adam Calaway, and Timothy A. Masterson, Indiana University School of Medicine, Department of Urology, Indianapolis, IN, USA)

Chapter 3. Pathology, Precursor Lesions, Prognostic Indicators and Genetics
(Antonio L. Cubilla, and Alcides Chaux, Professor Emeritus of Pathology, Universidad Nacional de Asunción, Director, Instituto de Patología e Investigación. Asunción, Paraguay, and Department of Scientific Research, Norte University, Asunción, Paraguay)

Chapter 4. Clinical Evaluation, Imaging and Staging
(Natália Martins, MD, and Francisco E. Martins, MD, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal, and others)

Chapter 5. Management of Localized Disease: The Role of Penile-Preserving Surgery
(Mohamed Kamel, MD, and Nabil Bissada, MD, Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, and others)

Chapter 6. Surgical Management of Locally Advanced Disease (T3-T4)
(Patrick Teloken, and Eric Chung, University of Queensland, Department of Urology, Princess Alexandra Hospital, Brisbane QLD Australia, and Andro Urology Centre, Brisbane QLD Australia)

Chapter 7. Management of Overt Inguinal Lymph Node (Regional) Disease
(Grant Pollock, and Juan Chipollini, Department of Surgery, the University of Arizona College of Medicine, Tucson, AZ, USA)

Chapter 8. Role of Radiotherapy for Penile Cancer
(Juanita Crook, Department of Radiation Oncology, University of British Columbia, and BCCA Center for the Southern Interior, Kelowna, BC, Canada)

Chapter 9. Management of Metastatic Penile Cancer: The Role of Chemotherapy, Multimodal Therapy and Novel Systemic Therapies
(Jad Chahoud, MD, Department of Cancer Medicine, The University of Texas, Anderson Cancer Center, Houston, TX, USA)

Chapter 10. Follow-Up of Penile Cancer: Contemporary Recommendations for Primary Disease and Inguinal Lymph Nodes
(Lona Vyas, and Oliver Kayes, Leeds Teaching Hospitals NHS TRUST, Leeds, West Yorkshire, England)

Chapter 11. Organ Sparing Surgery and Functional Restoration of the Penis
(Vladimir Kojovic, MD, PhD, and Miroslav L. Djordjevic, School of Medicine, University of Belgrade, Belgrade, Serbia)

Chapter 12. The Role of Penile Transplantation after Penile Cancer Surgery
(Andre van der Merwe, Division of Urology, Department of Surgical Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa)

Chapter 13. Psycho-Sexual and Social Effects of Penile Cancer Therapies and Impact on Quality of Life
(Jorge Daza, and John P. Sfakianos, Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York)

Chapter 14. Penile Prosthesis Implantation Following Phalloplasty
(Ervin Kocjancic, and Jorge H. Jaunarena, Professor of Urology, Vice Chairman Department of Urology, College of Medicine, University of Illinois At Chicago, Chicago, IL, USA, and Associate Physician, Urology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina)

Chapter 15. Is Prevention and Early Diagnosis of Penile Cancer Possible?
(Dunford C., Vyas L., Tharu T., and Minhas S., Imperial College Healthcare, London, UK)

Chapter 16. Penile Cancer Management and Decision-Making by Stage: A Changing Field?
(Joren Vanthoor, MD, Hein Van Poppel, MD, PhD, and Maarten Albersen, MD, PhD, Department of Urology, University Hospitals Leuven, Leuven, Belgium)

Chapter 17. Management of the Clinically Negative (CN0) Groin Patient: Timing for Intervention, Morbidity and Benefits
(Mohamed Kamel, and Philippe Spiess, Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, and others)

Chapter 18. Minimally Invasive Technology in Groin Lymph Node Dissection: Impact on Morbidity
(Luis G. Medina, Akbar Ashrafi, and Rene Sotelo, University of Southern California, Institute of Urology, Los Angeles, CA, USA)

Chapter 19. Risks and Benefits of Penile Preservation
(Clare O’Connell, Gregory Nason, and Paul Hegarty, Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland, and others)

Chapter 20. Reconstructive Surgery for Penile Cancer Survivor: When, How, and by Whom?
(Marco Falcone, MD, PhD, and Giulio Garaffa, MD, PhD, Urology Clinic, Molinette Hospital, Città della Salute e della Scienza University of Turin, Turin, Italy, and others)

Chapter 21. Future Directions and Goals
(Francisco E. Martins, MD, and Philippe E. Spiess, MD, Department of Urology, University of Lisbon, School of Medicine, Santa Maria University Hospital, CHULN, Lisbon, Portugal, and others)



“In the Western world, squamous cell carcinoma of the penis is diagnosed in about 1/100.000-1.000.000 men annually. It accounts for 0.4-0.6% of all malignancies in the USA and Europe. The rarity of this complex disease makes it a diagnostic and therapeutic challenge for treating physicians, especially since many only manage a limited number of cases annually. Current management of the disease is predominantly based on retrospective data from a limited number of studies, indicating a lack of high level evidence due to the rarity of the disease and the difficulties in organizing prospective trials in this cohort of patients. The rare incidence of penile cancer in daily clinical practice combined with limited evidence based recommendations, and limited knowledge of physicians of the current guidelines frequently results in nonuniform and suboptimal management. Prof. Martins and Porf. Djordjevic have therefore assembled a panel of internationally renowned experts who have contributed chapters on various aspects of the disease, helping the physician manage penile cancer patients better and offering them the best of care. We highly recommend this comprehensive and contemporary book to all doctors interested in penile cancer, from junior doctors to those who have further advanced in their careers interested in further deepening their knowledge on the subject.” – <strong>Maarten Albersen MD, PhD and Hein Van Poppel MD, PhD, Department of Urology, University Hospitals Leuven, Belgium</strong>

“Penile cancer is a devastating malignancy. The disease and its management can lead to serious impairment in psychological and functional status. This led to great challenges and controversies in its management. This is also due to the fact that it is a rare cancer which has led to paucity of clinical trials with inability to recruit large number of patients. The purpose of this book is to comprehensively account for these challenges and controversies and provide the best possible evidence-based answers to these issues. By gathering thought leaders in the field of penile cancer management, the editors of this book, Drs Martins and Djordjevic have successfully presented all these issues and provided the best available answers to such important questions. In this book, the editors did not leave a stone, unturned in the management of penile cancer. Adding to the strength of this book , the chapters are well organized, easy-to-read, and with valuable summaries and take-home messages. The recommendations provided by the authors, all internationally renowned experts in penile cancer, will greatly help managing penile cancer patients. This book is a great asset to urologists, radiation oncologists, medical oncologists and all health care providers involved in the care of penile cancer.” – <strong>Nabil K. Bissada, M.D., F.A.C.S., Professor of Urology, Baylor College of Medicine, Houston, Texas, USA</strong>

“Drs. Martins and Djordjevic have put together a very comprehensive reference book on the challenges and controversies in the management of penile cancer. There is no question the care of penile cancer patients has significantly suffered from being the recipients of often heterogeneous and non-evidence-based treatment in large part resulting from the paucity of cases seen at many centers and failure of adoption of treatment standards or guidelines. Thought leaders on the subject matter who have contributed to this book demystify what are suitable and best practice standards versus questionable therapeutic approaches that jeopardize optimal treatment outcomes in terms of oncological and quality of life endpoints. In addition, contributing authors share clinical and surgical concepts and clinical pearls they have refined in their practices through critical assessment of their own results and techniques. It is without question that readers will benefit in reading this book and incorporating some of its concepts in their day to day practices as it relates to the care of penile cancer patients. After all, we owe it to our patients to continually strive to improve ourselves in terms of the knowledge and approaches we tailor and personalize to their care.” – <strong>Philippe E. Spiess, M.D., MS, FRCS(C), FACS, Senior Member, Department of GU Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida</strong>


This book with its multidisciplinary approach is intended to provide a comprehensive discussion and benefit every reader, junior or senior, world over who is interested in and deals with patients afflicted by penile cancer, including the urologic oncologist, the radiation oncologist, the medical oncologist, the urology resident, and, last but not least, the primary care physician.


Penile cancer, penile reconstruction, cancer survivorship

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