Maximum 12-Month Follow-Up Suffices in More than Half of Men with Surgically-Treated Invasive Penile Cancer

In men with primary squamous cell carcinoma of the penis who have undergone surgery that removed all glanular epithelium and who have nodal (N) stage 0/1, a maximum 12-month follow-up period is recommended, provided that patients are recurrence-free throughout the first year of the surveillance period, according to United Kingdom researchers.

Importantly, they noted, this subgroup accounts for 54% of all patients with invasive penile cancer. “We recommend a maximum follow-up of one disease-free year in this population, which is far less than the five-year surveillance period recommended by the EAU,” said Hussain Alnajjar, MD, a research fellow in Urology at St. George’s Healthcare NHS Trust in London, at the European Association of Urology (EAU) 27th Annual Congress in Paris in February.

Alnajjar pointed out that the EAU guidelines are very broad and do not take into account the different disease stages and risks.

He and colleagues prospectively reviewed all newly diagnosed cases of primary squamous cell carcinoma of the penis treated surgically at their institution over a recent 11-year period. They found few recurrences overall in this group of patients, and most recurrences occurred within 12 months of the definitive primary treatment.

The analysis included all patients regardless of tumor grade who had had penile surgery leaving no residual glanular epithelium, with clear local margins, fully-staged regional nodes, and pathological N stage pN0/pN1.

In addition, follow-up protocols are generally predicated on small retrospective studies. And under current guidelines, patients have to present for follow-up consultation and clinical examination about four times a year. This can be especially difficult for patients who are elderly and/or live far away from specialized centers.

The study was undertaken to provide more stratified follow-up arrangements based on risk of recurrence derived from a large contemporary series of patients treated at a single supra-network center. St. George’s Healthcare NHS Trust provides highly specialized penile cancer healthcare services to a population of 10 million.

“In essence, we wanted to see if there is an identifable group of lowrisk patients who have had their glans epithelium removed totally by total glans resurfacing, glansectomy, partial penectomy, or even total penectomy and who have N0/N1 inguinal node status,” Alnajjar said.

Overall, 228 of 420 patients with newly diagnosed squamous cell carcinoma of the penis satisfied the inclusion criteria. In the first 12 months of surveillance, there were five local, two regional, and two distant recurrences (3.9%). Two patients developed late local recurrence (17 months and 29 months), and both had G1T1 lesions locally excised. No patient had nodal or metastatic disease after 12 months. The remaining 217 (95%) patients remained disease-free at a mean of 44 months follow-up.

“Based on our observations, we recommend that these low-risk patients be followed for a maximum of one year provided they are recurrence-free,” Alnajjar said. “They can then be discharged in the community and followed by their general practitioner. In addition, we recommend that patients perform routine self-examination.”

Alnajjar HM, Perry MJA, Rees RW, et al. Optimal follow up arrangements for invasive squamous carcinoma of the penis. Presented at the European Association of Urology 27th Annual Congress; February 24-28, 2012; Paris, France. Abstract 523.