Skip to main content

Advertisement

SpringerLink
Log in

Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study

  • Original Article – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The European Association of Urology (EAU) guidelines for penile cancer (PC) are exclusively based on retrospective studies and have low grades of recommendation. The aim of this study was to assess the adherence to guidelines by investigating the management strategies for primary tumours and inguinal lymph nodes.

Methods

We retrospectively reviewed the clinical charts of 176 PC patients who underwent surgery in eight European centres from 2010 to 2016. The stage and grade were assessed according to the 2009 AJCC–UICC TNM classification system. To assess adherence rates, we compared theoretical and practical adherence to the EAU guidelines.

Results

Overall, 176 patients were enrolled. Partial amputation was the most frequent surgical approach (39%). 53.7% of tumours were stage Tis-T1b and the remaining 46.3% were stage T2-T4. Palpable lymph nodes were detected in 30.1% of patients and 45.1% underwent lymphadenectomy (LY). A sizeable group of tumours (43.2%) were N0. For primary treatment, adherence to the EAU guidelines was good (66%). In non-adherent cases, reasons for discrepancy were patient’s choice (17%), surgeon’s preference (36%), and other causes (47%). For LY, the guideline adherence was 70%, with either patient’s or surgeon’s choice or other causes accounting for discrepancy in 28, 20, and 52% of non-adherent cases, respectively.

Conclusion

Adherence to the EAU guidelines for PC was quite high across the eight European centres involved in the study. This notwithstanding, strategies for further improvement should be developed and evenly adopted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Alnajjar HM, Lam W, Bolgeri M, Rees RW, Perry MJ, Watkin NA (2012) Treatment of carcinoma in situ of the glans penis with topical chemotherapy agents. Eur Urol 62(5):923–928

    Article  CAS  PubMed  Google Scholar 

  • Breen KJ, O’Connor KM, Power DG, Mayer NJ, Rogers E, Sweeney P (2015) Penile cancer-Guideline adherence produces optimum results. Surgeon 13(4):200–206

    Article  CAS  PubMed  Google Scholar 

  • Cabana MD, Rand CS, Powe NR et al (1999) Why do not physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–1465

    Article  CAS  PubMed  Google Scholar 

  • Catalona WJ (1988) Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 140:306–310

    Article  CAS  PubMed  Google Scholar 

  • Christodoulidou M, Sahdev V, Houssein S, Muneer A (2015) Epidemiology of penile cancer. Curr Probl Cancer 39(3):126–136

    Article  PubMed  Google Scholar 

  • Clark PE, Spiess PE, Agarwal N et al (2013) National comprehensive cancer network. Penile cancer: clinical practice guidelines in oncology. J Natl Compr Cancer Netw 11:594–615

    Article  CAS  Google Scholar 

  • Colecchia M, Nicolai N, Secchi P et al (2009) pT1 penile squamous cell carcinoma: a clinicopathologic study of 56 cases treated by CO2 laser therapy. Anal Quant Cytol Histol 31(3):153–160

    PubMed  Google Scholar 

  • D’Ancona CAL, de Lucena RG, Querne FA, de O, Martins, Denardi MHT, Netto F NR (2004) Long-term follow up of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol 172(2):498–501

    Article  PubMed  Google Scholar 

  • Daling JR, Madeleine MM, Johnson LG et al (2005) Penile cancer:importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer 116(4):606–616

    Article  CAS  PubMed  Google Scholar 

  • Djajadiningrat RS, van Werkhoven E, Horenblas S (2015) Prophylactic pelvic lymph node dissection in patients with penile cancer. J Urol. 193:1976

    Article  PubMed  Google Scholar 

  • Ficarra V, Zattoni F, Cunico CSC et al (2005) Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. Cancer 103:2507–2516

    Article  PubMed  Google Scholar 

  • Garaffa G, Raheem AA, Christopher NA, Ralph DJ (2009) Total phallic reconstruction after penile amputation for carcinoma. BJU Int 104:852–856

    Article  PubMed  Google Scholar 

  • Harish K, Ravi R (1995) The role of tobacco in penile carcinoma. Br J Urol 75(3):375–377

    Article  CAS  PubMed  Google Scholar 

  • Heins MJ, de Jong JD, Spronk I, Ho VK, Brink M, Korevaar JC (2016) Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics. Eur J Public Health 27:616–620

    Google Scholar 

  • Hernandez BY, Barnholtz-Sloan J, German RR et al (2008) Burden of invasive squamous cell carcinoma of the penis in the United States. Cancer 113(10 Suppl):2883–2891

    Article  PubMed  Google Scholar 

  • Hughes BE, Leijte JA, Kroon BK et al (2010) Lymph node metastasis in intermediate-risk penile squamous cell cancer: a two-centre experience. Eur Urol 57:688–692

    Article  PubMed  Google Scholar 

  • Kumar P, Singh S, Goddard JC, Terry TR, Summerton DJ (2012) The development of a supraregional network for the management of penile cancer. Ann R Coll Surg Engl 94(3):204–209

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Leijte JAP, Kirrander P, Antonini N, Windahl T, Horenblas S (2008) Recurrence patterns of squamous cell carcinoma of the penis: recommendations for follow-up based on a two-centre analysis of 700 patients. Eur Urol 54:161–168

    Article  PubMed  Google Scholar 

  • Leone A, Diorio GJ, Pettaway C, Master V, Spiess PE (2017) Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 14(6):335–347

    Article  PubMed  Google Scholar 

  • Maden C, Sherman KJ, Beckmann AM et al (1993) History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst 85:19–24

    Article  CAS  PubMed  Google Scholar 

  • McDougal WS (2005) Preemptive lymphadenectomy markedly improves survival in patients with cancer of the penis who harbor occult metastases. J Urol 173:681

    Article  PubMed  Google Scholar 

  • Opjordsmoen S, Fossa SD (1994) Quality of life in patients treated for penile cancer. A follow-up study. Br J Urol 74:652–657

    Article  CAS  PubMed  Google Scholar 

  • Ornellas AA, Kinchin EW, Nobrega BL, Wisnescky A, Koifman N, Quirino R (2008) Surgical treatment of invasive squamous carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol 97:487–495

    Article  PubMed  Google Scholar 

  • Pandey D, Mahajan V, Kannan RR (2006) Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol 93(2):133–138

    Article  PubMed  Google Scholar 

  • Pizzocaro G, L Piva (1988) Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27:823–824

    Article  CAS  PubMed  Google Scholar 

  • Pizzocaro G, Algaba F, Horenblas S et al (2010) European Association of Urology (EAU) Guidelines Group on Penile Cancer. EAU penile cancer guidelines 2009. Eur Urol 57(6):1002–1012

    Article  PubMed  Google Scholar 

  • Rubin MA, Kleter B, Zhou M et al (2001) Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol 159(4):1211–1218

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Thuret R, Sun M, Lughezzani G et al (2011) A contemporary population- based assessment of the rate of lymphnode dissection for penile carcinoma. Ann Surg Oncol 18:439–446

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, S. Pio da Pietrelcina Hospital, ASL 2 Abruzzo, Vasto, Italy

    Maida Bada, Francesco Berardinelli & Luca Cindolo

  2. Department of Urology, Hospital of Budapest, Budapest, Hungary

    Peter Nyiràdy & Judith Varga

  3. Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy

    Pasquale Ditonno & Michele Battaglia

  4. Department of Medical Statistics Unit, Second University, Naples, Italy

    Paolo Chiodini

  5. Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

    Cosimo De Nunzio & Giorgia Tema

  6. Department of Urology, Spedali Civili Hospital, Brescia, Italy

    Alessandro Veccia, Alessandro Antonelli & Claudio Simeone

  7. Department of Urology, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy

    Stefano Puliatti & Salvatore Micali

  8. Department of Urology, G. D’Annunzio University, Chieti, Italy

    Luigi Schips

Authors
  1. Maida Bada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Berardinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Nyiràdy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Judith Varga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pasquale Ditonno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michele Battaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Chiodini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cosimo De Nunzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giorgia Tema
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alessandro Veccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alessandro Antonelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Luca Cindolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Claudio Simeone
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Stefano Puliatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Salvatore Micali
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Luigi Schips
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maida Bada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bada, M., Berardinelli, F., Nyiràdy, P. et al. Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study. J Cancer Res Clin Oncol 145, 921–926 (2019). https://doi.org/10.1007/s00432-019-02864-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-019-02864-9

Keywords

Search

Navigation