Surgical treatment of penile cancer

Aim of the Study: Penile cancer (PC) is an uncommon malignant tumor, with an overall incidence of around 1/100,000 males in Europe and the USA. The incidence of penile cancer increases with age, with a peak in the sixth decade but it does occur in younger men. The aims of the treatment of the primary tumour are complete tumour removal with as much organ preservation as possible, without compromising oncological control. Local treatment modalities for localised PC include excisional surgery, external beam radiotherapy (EBRT), brachytherapy and laser ablation. However, treatment choice depends on tumour size, histology, stage and grade, localisation (especially relative to the meatus) and patient preference. Glansectomy with distal corporectomy and reconstruction or partial amputation with reconstruction are recommended for disease invading the corpora cavernosa and/or urethra (T3). We report two cases of patients undergoing partial penectomy and total penectomy with perineal urrthrostomy. Year of production: 2018. Materials and Methods: The first patient (61 years) came to our attention with a hard, swelling and necrotic lesion involving the glans and the distal portion of the penis, in association with bilateral lymphadenopathy. Ulrtrasonographic and magnetic resonance investigations confirmed the invasion of the right corpus cavernosum. The patient underwent partial penectomy and bilateral lymphadenectomy. The second patient (75 years) presented with a big necrotic lesion involving the glans and the foreskin, that appeared fused together. Ultrasonographic and magnetic resonance imaging confirmed the invasion of the glans, with dubious involment of corpora cavernosa. Total penectomy, bilateral orchidectomy and perineal urethrostomy was performed, in association with fine needle aspiration cytology to the lymphnodes. Results: In the first case histopathological diagnosis was squamous cell carcinoma involving the glans, the corpus spongiosum and urethra. Marginal involving of the corpora cavernosa. Lymphnodes resulted free from desease. (TNM Classification: pG2.C2.T3.N0.Pn1). The histopathological diagnosis in the second case was squamous cell carcinoma with verrucoid aspects involving the glans and the corpus spongiosum, with corpora cavernosa and urethral margin free from desease (TNM Classification: pG2.C2.T2.R0.Nx). Discussion: As PC can be a morbid and disfiguring ailment, every effort must be made to preserve penile length and functionality, while attaining adequate cancer control. Although maximal penile preservation would be ideal, proper cancer control remains the primary goal of treatment and therefore must be pursued in the management plan for each individual patient with adapted techniques to minimize recurrence and improve functional outcomes.