gms | German Medical Science

Background: Carcinoma of the penis is a rare disease in Europe and the USA. For the patient, the diagnosis of penile carcinoma is an extreme strain. The fear of the malignant disease goes along with anxiety about mutilating surgery. Thus, men with obvious symptoms of early stages of penis carcinoma often hesitate to consult a physician unless painful penile lesions arise. Considerable differences in 5-year survival rates between patients with pathological lymph nodes and patients without pathological inguinal lymph nodes are reflecting this problem, as demonstrated in this study. According to data from Epidemiological Cancer Register Berlin, an approximate incidence of malignant diseases 0.8 and 1.8 per 100.000 inhabitants and year was reported for the years 1996-2003: Based on the data from the Epidemiological Cancer Registry Berlin, the calculated completeness of Thuringia Clinical Cancer Registry in this tumor entity was over 90%.

Methods: All males diagnosed with carcinoma of the penis and registered in the five Thuringian Clinical Cancer Registries between 1996 and 2004 were included (n=112).

All patients were followed up for survival and tumor stage until 12/31/2004 or until death.

Results: Differential diagnoses, histological differential diagnoses, age pattern and distribution of stages of penile carcinoma are overviewed.

The 5-year survival rate of 70% in all patients decreased to 35% in patients with pathological lymph nodes.

Separating time of diagnosis in two periods, 1996-1998 and 1999-2001, results in a lower number of patients with positive lymph nodes in the latter period.

Conclusions: Actuarial survival curves demonstrate that for tumors beyond stage pT2 without positive lymph nodes (N0) (n=22, p=0.04) early lymphadenectomy should be preferred.

The optimal time point is 4-6 weeks posterior to the penectomy, after antibiotic therapy of frequently occurring infections of the primary tumor and secondary inflamed lymph nodes.

Alternative to surgery, an interstitial radiotherapy is an option for primary treatment in carcinomas of stage pTa/pT1. Advantages and disadvantages of both therapies are discussed.