1. Second Urologic Clinic, Milan University, Ospedale S. Giuseppe, Milano 20100, Italy;2. Pathology Section, Fundació Puigvert, Universitat Autónoma de Barcelona, Barcelona, Spain;3. Nederlands Kanker Instituut–Antoni van Leeuwenhoek Ziekenhuis, Department of Urology, Amsterdam, The Netherlands;4. Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain;5. Radiotherapy Department, Fondazione Istituto Nazionale Tumori, Milano, Italy;6. Department of Urology, St George''s Hospital, London, UK
Abstract:
Context
Squamous cell carcinoma (SCC) of the penis is a relatively rare but ominous disease.
Objective
To present a condensed version of the updated 2009 European Association of Urology (EAU) guidelines on penile SCC.
Evidence acquisition
We performed a literature search of new data available up to December 2009. No randomized study was found; consequently, level of evidence (LE) and grade of recommendations (GR) are low.
Evidence synthesis
More insight was gained into the etiology of SCC of the penis, together with improved staging and treatment: Human papillomavirus 16 plays an etiologic role in approximately 40–50% of cases. Similarities in etiology with SCC of the head and neck, the female genitalia, and the anal canal have been found. Improved diagnostics allowed earlier diagnosis, leading to more conservative treatments. Adjuvant and neoadjuvant chemotherapy showed promising results in patients with advanced or recurrent disease. Centralization of the disease contributed to standardization and rapid diffusion of new treatments with improved results and increased organ preservation.
Conclusions
Improvements in the management of SCC of the penis are reflected in changes in the guidelines, but the rarity of the disease precluded randomized studies, leading to low level of evidence and grade of recommendation.
