Therapeutic strategies in treatment of penile cancer

Between 1968 and 1995, 78 patients were treated for squamous cell carcinoma of the penis at the Departments of Urology of the Universities of Marburg and Heidelberg. In 22 patients the primary lesion was treated by penis preserving procedures like laser beam, circumcision, tumor excision and irradiation. A total of 56 patients underwent radical procedures like partial or total penectomy. Following partial or total penectomy no patient with T1-tumor had local recurrence or inguinal lymph node metastasis. For those patients receiving penis preserving therapy for T1-carcinomas, 9/17 (53%) developed local recurrence, of the 9,3 (33%) had simultaneous groin metastases as well. In contrast, no patient with a T1-tumor had a local recurrence or simultaneous inguinal lymph node metastasis after partial or total penectomy For T2 stages, local recurrence rate was 100% after penis preserving therapy versus 21 % in the penectomy group. Primary inguinal lymphadenectomy was performed in 29 patients. Histologically proven groin metastases were found in 52 %. No patient with T1-tumor had simultaneous inguinal lymph node metastases. The five-year survival rate for N1-carcinomas was 67 %, for NZ-carcinomas 29%. Partial or total penectomy is the therapy of choice in treatment of penile cancer even for T1-tumors. Primary inguinal lymphadenectomy is not necessary for patients with T1-tumors. In patients with tumor-stage T2-T4, however, primary inguinal lymphadenectomy should be performed. Multicenterstudies are necessary to evaluate further data about this rare neoplasm.