Penile carcinoma: Multi-options possible requirements

Organ preservation in the treatment of penile cancer: To cut or not to cut

MP61-01 EXPLORING THE GENETIC LANDSCAPE OF SOMATIC VARIANTS IN PENILE CANCER PATIENTS

Background: Penile cancer is a rare and aggressive disease. The incidence in India, Africa, and South America ranges from 2.3 to 8.3 per 100,000. No data regarding incidence rates in Indonesia. The etiological factors include poor genital hygiene, phimosis, tobacco use, multiple sex partners, human papillomavirus (HPV) infection, and chronic inflammatory states. Squamous cell carcinoma (SCC) represents 95% of penile cancers. Progression and treatment of the disease cause devastating consequences and morbidity such as disfiguring penile amputation. This study aimed to assess the epidemiological characteristics of penile cancer in the city of Bandung, its associated risk factors, clinical manifestations, and compare the results with previous studies. Methods: This was a descriptive study conducted at Hasan Sadikin Hospital Bandung from January 2010 to 2019. The study included all penile cancer patients that came to Urology Department. Variables such as age, history of circumcision, phimosis, HPV infection, marital status, smoking habit, educational level, age of onset, operation, histopathological results, history of multiple sex partners, location of the tumor, comorbidities, and staging are collected from the medical record and analyzed. Results: A total of 13 penile cancer patients were involved with the age range from 28 to 67 years and 50.69 years on average. Most of them were smokers (69.2%) and uncircumcised (53.8%). All of the patients came at an advanced stage, and penectomy was done. Histopathologically, 84.6% were SCC. One of our patients was consulted by a haemato-oncologist for adjuvant chemotherapy (6 cycles of cisplatin and 5-fluorouracil). Conclusions: Penile cancer is a rare neoplasm in Bandung, West Java. The characteristics of penile cancer patients found in our hospitals were on average 50.7 years old, and the most risk factors found were smoking and uncircumcised. Histopathologically, most of them were SCC. All patients came to seek medical treatment at an advanced stage and had undergone surgical penectomy.

To study the patterns of care of penile cancer diagnosed in the state of New South Wales (NSW) over a 10year period and determine factors that are associated with differences in survival. All invasive penile cancer diagnosed between 2001 and 2009 in NSW, Australia, were identified from the Central Cancer Registry. Records of treatment from the Admitted Patient Data Collection and deaths from the Registry of Births Deaths and Marriages were electronically linked. Predictors of receiving an inguinal lymph node dissection (ILND) were analysed using multivariable logistic regression. Survival analyses were performed with Kaplan-Meier and Cox proportional hazards models. A total of 220 men were diagnosed with penile cancer over the 10years from 69 centres. The median number of penile operations performed over 10years was <4. Radical penile surgery (partial or total penectomy) was performed in 70% of the cases and the proportion of patients receiving radical surgery increased over time (P = 0.015). Only 53/220 men with invasive penile cancer received an ILND. Younger age and higher stage were the only factors that predicted whether ILND was performed. Overall survival (OS) was predicted by age, stage, marital status and co-morbidity status. Low centre volume decreased OS by 37% (HR 0.63 [95% CI: 0.40-0.97]). For men who received ILND, low centre volume decreased OS by 60% (HR 0.40 [95% CI: 0.19-0.85]). There is a decreasing trend for the use of conservative penile surgery and median centre volumes for penile cancer surgery in NSW are low. A decrease in overall survival is observed in men treated in lower volume surgery centres.

MP61-05 WHAT ARE THE CAUSES OF DEATH AMONG MEN TREATED FOR PENILE CANCER?

Analysis of Suicide Risk in Patients with Penile Cancer and Review of the Literature.

Inguinal lymph node dissection (ILND) plays a crucial role in the oncological management of patients with melanoma, penile, and vulvar cancer. This study aims to systematically evaluate perioperative adverse events (AEs) in patients undergoing ILND and its reporting. A systematic review was conducted according to PRISMA. PubMed, MEDLINE, Scopus, and Embase were queried to identify studies discussing perioperative AEs in patients with melanoma, penile, and vulvar cancer following ILND. Our search generated 3.469 publications, with 296 studies meeting the inclusion criteria. Details of 14.421 patients were analyzed. Of these studies, 58 (19.5%) described intraoperative AEs (iAEs) as an outcome of interest. Overall, 68 (2.9%) patients reported at least one iAE. Postoperative AEs were reported in 278 studies, combining data on 10.898 patients. Overall, 5.748 (52.7%) patients documented ≥1 postoperative AEs. The most reported ILND-related AEs were lymphatic AEs, with a total of 4.055 (38.8%) events. The pooled meta-analysis confirmed that high BMI (RR 1.09; p = 0.006), ≥1 comorbidities (RR 1.79; p = 0.01), and diabetes (RR 1.81; p = < 0.00001) are independent predictors for any AEs after ILND. When assessing the quality of the AEs reporting, we found 25% of studies reported at least 50% of the required criteria. ILND performed in melanoma, penile, and vulvar cancer patients is a morbid procedure. The quality of the AEs reporting is suboptimal. A more standardized AEs reporting system is needed to produce comparable data across studies for furthering the development of strategies to decrease AEs.

Penile squamous cell carcinoma is a rare malignancy that poses a significant concern to those affected due to its aggressive nature and profound impact on patients' quality of life. This review examines the evidence on the impact of penile cancer and its various treatments on the sexual health of patients. Men's post-surgical sexual functioning has mainly been assessed with the International Index of Erectile Functioning. Some studies asked men to report retrospectively on pre-surgical sexualfunctioning or compared surgical techniques with non-randomized samples. Studies on patient's perspectives on sexual sensations and appearance are emerging, however reliable assessments of sexual wellbeing are missing. Penile cancer significantly impacts patients' sexual activity, sexual function, sexual sensations, cosmesis and sexual wellbeing. Considerable proportions of patients resume sexual activity following treatments, including organ-sparing procedures, partial or total penectomy, and adjuvant therapies. While organ-sparing surgeries can largely preserve sexual functioning, more invasive treatments like partial or total penectomy result in greater declines, with the impact on sexual wellbeing remaining underexplored. Rigorous prospective studies assessing valid and reliable patient reported outcome measures for sexual wellbeing besides sexual functioning are needed in order to fullyunderstand and address the impact of penile cancer treatment on sexual health.

ObjectiveSimple or radical trachelectomy are accepted fertility sparing therapies for patients diagnosed with cervical cancer ≤2 cm. In patients with larger tumors a fertility sparing concept is considered experimental. The...

There have been few published case series of penile squamous cell carcinoma (SCC) removed with Mohs micrographic surgery (MMS). Of these case series, the published cure rates are between 68% and 74%. To report 30 years of experience removing penile SCCs with MMS. Retrospective record review of 42 patients with 44 penile SCCs. There was one recurrence of the 19 primary SCCs in situ, resulting in a cure rate of 94.7%. There were no recurrences among the 10 primary invasive SCC. Of the 6 recurrent invasive SCCs, 2 recurred, resulting in an initial cure rate of 66.7%. These 2 recurrences were re-treated with MMS with no evidence of recurrence at 5 years. There were 4 patients with SCC in situ of the glans with extension down the urethra. While all 4 patients required urethral dilation postoperatively secondary to urethral stricture, none of these tumors recurred and normal function was restored in each case. In conclusion, MMS may be preferred for patients with penile carcinoma by providing a high cure rate and tissue conservative alternative to partial or total penectomy and does not need to be limited to low-grade, small, superficial tumors.

Background: Penile cancer is a rare malignant tumor characterized by invasive growth and early metastasis. Several risk factors related to penile cancer have been identified, such as human papillomavirus status (HPV), circumcision status, smoking, poor hygiene. Current scientific evidence and guidelines on the management and treatment of penile cancer are rarely updated. In particular, there is insufficient evidence for targeted therapy and immunotherapy for penile cancer. Here, we analyzed features of gene profiling of penile cancer and some biomarkers of immunotherapy such as tumor mutation burden (TMB), PD-L1 expression, and status of microsatellite. Methods: Totally 26 tumor samples of Chinese patients with penile cancer were consecutively collected in China from January 2018 to June 2020, Next generation sequencing (NGS) was used to detect gene mutation, microsatellite instability (MSI) or microsatellite stable (MSS), and tumor mutational burden (TMB) analyzed by a 733 gene panel by 3D Medicines, a laboratory accredited by College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA). PD-L1 expression detected by using Dako PD-L1 IHC 22C3 pharmDx, Tumor Proportion Score (TPS) was used to determine expression of PD-L1. TPS was arranged into the following intervals: strong positive ≥50%, moderate positive ≥5% and &amp;lt;50%, weak positive ≥1% and &amp;lt;5%, and negative &amp;lt;1%. Results: Among these 26 samples, 20 samples were available for TMB analysis and MSI/MSS analysis, and 15 samples were available for analysis of PD-L1 expression. The average TMB level of these penile cancer was 7.4 mutants/Mb, and 85% (17/20) of them with TMB level under 10 mutants/Mb. Analysis of PD-L1 expression results showed that 26.7% (4/15) with PD-L1 negative, 6.7% (1/15) weak positive, 53.3% (8/15) moderate positive, 13.3%(2/15) with PD-L1 strong positive. In addition, none of these sample were MSI. Furthermore, NGS results show that a total of 176 gene mutations have been identified in these 26 Chinese patients with penile cancer, and 43.2% (73/176) were germline mutation. The main mutated gene were TP53 (65.4%,17/26), CDKN2A (50.0%,13/26), AKT (46.2%,12/26), FAT1 (38.5%,10/26), PIK3CA/MSH2/POLD1/VEGFA (34.6%, 9/26), BRIP1/MDM2/ATM/XPC/TERT (30.8%,8/26). The top ten of germline mutated genes were AKT (42.3, 11/26), XPA (38.5%,10/26), POLD1 (34.6%, 9/26), ERCC2/TP53/RAC1/MSH2/MSH3/ATM/VEGFA/PRKDC/MGMT/BLM/MDM2/BRIP1/PRSS1/ERCC5 (30.5%,8/26). Conclusion: Patients with penile cancer have rich spectrum of gene mutations, especially, high percentage of germline mutation was displayed in penile cancer, it may suggest that genetic/Familial high-risk should be put into consideration in the management of penile cancer. What's more, immunotherapy may also have certain potential because of the expressing of PD-L1. Citation Format: Bin Zhao, Hushan Zhang, Guoying Zhang, Jian Xu, Maolin Yang. Analysis of oncologic characteristics of penile cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2193.

BACKGROUND: The incidence of penile carcinoma in Paraguay is among the highest worldwide (4/100,000 inhabitants). Penile cancer has been related to environmental factors, including human papillomavirus (HPV) infection. This study was designed to generate epidemiological data to guide future studies and design a cancer control program. MATERIAL &amp; METHODS: A questionnaire was administered prospectively to 103 penile cancer cases referred to a Penile Cancer Center in Paraguay between 1993 and 2007. This questionnaire obtained information on: age, residence (urban, suburban/rural), education, income, smoking, hygiene and sexual habits, and history of sexually transmittable diseases. Medical record abstraction collected the following information: tumor site (glans, foreskin or coronal sulcus) and foreskin features including phimosis. All cases were pathologically proven invasive penile carcinomas. RESULTS: Median age was 62 years. Tumors were large, involving glans, foreskin and coronal sulcus in 56% of cases. Tumors exclusive of glans, foreskin or skin of the shaft were less frequent (32%, 11%, and 1%). Phimosis was detected in 57% of cases. The major cause of phimosis was lichen sclerosus, present in 74% of such patients. Patients lived in either semirural or rural regions (83%) and were typically moderate to heavy smokers (76%). A history of sexually transmitted disease was present in 74% of the patients; 58% of the patients had more than 10 lifetime female sexual partners. Minimal education and poverty were characteristic (91% and 75%). Histologically, 102 cases were squamous cell carcinomas (SCC) and 1 case was a clear cell carcinoma; 1 case of usual SCC originated on a giant condyloma. Sixty-seven percent of carcinomas showed an associated lichen sclerosus. Evidence of HPV infection (evaluated by SPF-10 PCR in formalin-fixed, paraffin-embedded tissues in 86% of all cases) was found in 36% of tumors. Twenty-four percent of all patients received inguinal dissection and nodal metastasis was present in 72% of such cases. CONCLUSIONS: Penile cancer patients in Paraguay are poorly educated smokers of low socio-economic conditions, living in semi-rural or rural areas of the country. They frequently report a history of sexually transmitted diseases and a high number of female partners. Phimosis and lichen sclerosus are prevalent. Tumors are typically large and locally advanced, with a high regional metastatic rate. These data may guide planning of a penile cancer public health control program in Paraguay.

Human Papillomavirus Type 16 Integration Analysis by Real-time PCR Assay in Associated Cancers

To review recent developments in the diagnosis and treatment of penile cancer, we reviewed the medical literature from 1 May 2002 to 1 June 2003 on the incidence, aetiology, staging, diagnosis and treatment of penile cancer by a Medline search. The diagnostic tools and treatment modalities for penile cancer are still controversial. Recently developed diagnostic and therapeutic modalities should help urologists in the management of the disease. Our review of the recent literature provides an update on diagnostic and therapeutic opinion on penile cancer.

Introduction The American Cancer Society estimates that 2,200 men develop penile cancer annually and 440 men will die from the disease. Partial penectomies (PP) and total penectomies (TP) are both performed for penile cancer in the United States. Compared to TP, PP is performed more frequently to preserve functional urinary outcomes. Objective To date TP and PP outcomes have not been compared, in this study we compared clinical characteristics and post-operative outcomes between TP and PP conducted between 2006-2016. Methods We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010-2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Results Partial penectomy patients were less likely to be transferred patients (7.3% vs 20.9%, p=0.002), less likely to be suffering from diabetes (25.9% vs 40.3%, p=0.026), and were more likely to have preoperative laboratory values within normal limits. TP was associated with increased preoperative white blood cell count x109, preoperative white blood cell count &amp;gt; 7.5x109 (p&amp;lt;0.001), preoperative hematocrit (p&amp;lt;0.001). PP patients were, in contrast, shown to have higher pre-operative creatinine levels (p=.037) and lower platelet levels than TP patients (p=.045). PP patients had shorter operation times (78.8 vs 145.5 min, p&amp;lt;0.001). PP patients also had decreased levels of inpatient stay length (1.67 vs 4.31, p&amp;lt;0.001), any 30-day post-surgery complication (7% vs 31%, p&amp;lt;0.001), deep incisional surgical site infection (0.5% vs 6% p=0.017), wound disruption (0.5% vs 6.0%p=0.017), intraoperative or postoperative transfusion (1.6% vs 7.5%, p=0.029), and sepsis (0.5% vs 7.5%, p=0.005), when compared to patients who underwent TP. TP patients displayed a significantly greater number of concurrent surgical procedures (p&amp;lt;0.001), when compared to PP patients. There was no information on urinary, sexual, and erectile outcomes in the database. Conclusions PP is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures. Total penectomy is associated with a greater proportion of patients suffering from comorbid conditions, suggesting that TP patients are at higher risk for post-surgical complications and longer hospital stays. There is a gap in reported data pertaining to post-operative sexual function and erectile outcomes for PP at a national level. Disclosure No.