NEW ORLEANS, LA USA (UroToday.com) - In this presentation, Adam Feldman from Harvard Medical School presented data on penile-sparing surgery in penile cancer. Historically a 2cm margin was the gold standard from excision in penile cancer. More recent published data has demonstrated that a smaller margin is adequate and current EAU and NCCN guidelines report 5mm as an acceptable margin.
The goals of penile sparing surgery are maintaining normal urination and preserving maximum penile length to allow for normal sexual function. He then outlined treatment options for organ preservation. These include topical therapy (5-fluorouracil, imiquimod) for CIS, laser therapy for CIS and some select T1 cases, and Mohs surgery. Dr. Feldman reviewed 3 studies looking at penile-sparing surgery. Each of these studies demonstrated the feasibility of penile-sparing surgery with acceptable recurrence rates between 20-35%. Recurrent T1 disease was associated with worse survival in multiple studies. Dr. Feldman noted that recurrences could occur over 5 years after surgery and thus long-term follow up is necessary for these patients.
With regards to surgical technique, frozen sections are important to ensure that margins are negative. Closure of the defect after excision could be accomplished via primary closure, the use of an advancement or rotation flap, or skin grafting. He discussed that use of a flap allows for preservation of sensation. Use of a skin graft does not have the same maintenance of sensation, but results in an excellent cosmetic result. Dr. Feldman then presented several penile sparing cases.
He concluded by stating that use of penile-sparing surgery is feasible with acceptable oncologic outcomes in patients with CIS and T1 disease. Recurrent disease is most common in patients with T1 disease, and those patients with T1 disease who experience multiple recurrences should not continue to receive penile-sparing surgeries.
Presented by Adam Feldman, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Harvard Medical School, Boston, MA USA
Reported by Timothy Ito, MD, medical writer for UroToday.com