Lasorsa Francesco, Bignante Gabriele, Orsini Angelo, Rossetti Sofia S, Marchioni Michele, Porpiglia Francesco, Ditonno Pasquale, Lucarelli Giuseppe, Autorino Riccardo, Manfredi Celeste
Department of Urology, Rush University, Chicago, IL, USA.
Department of Precision and Regenerative Medicine and Ionian Area- Urology, Andrology and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy.
Res Rep Urol. 2024 Oct 2;16:225-233. doi: 10.2147/RRU.S465546. eCollection 2024.
Penile cancer (PeCa) is a rare urologic tumor worldwide. In 2024, 2100 new cases and 500 deaths are estimated in the United States. Radical surgery via total penectomy has historically been the cornerstone of treatment, since it provides excellent long-term oncological control. The rationale of surgery for penile cancer was to achieve a 2 cm macroscopic surgical margin that is historically advocated to reduce recurrences. Over time, numerous studies have demonstrated that resection margin status does not affect patients' survival. Different penile-sparing techniques are currently recommended in the European Association of Urology-American Society of Clinical Oncology (EAU-ASCO) guidelines for the treatment of localized primary PeCa. Centralization of care could yield multiple benefits, including improved disease awareness, higher rates of penile-sparing surgery, enhanced detection rates, increased utilization of less invasive lymph node staging techniques, enhanced quality of specialized histopathological examinations, and the establishment of specialized multidisciplinary teams. Compared to more aggressive treatments, the higher recurrence rates after penile-sparing surgery do not hamper neither the metastasis-free survival nor the overall survival. Repeated penile-sparing surgery could be considered for selected cases. The psychological impact of penile cancer is not negligible since the perceived loss of masculinity might adversely affect mental health and overall well-being. Quality of life may be compromised by sexual and urinary dysfunction which may be the result either of the loss of penile tissue or the psychological status of the patient. It is of utmost importance to offer rehabilitative treatment as sexual therapy, physical therapy, occupational therapy, family and peer counseling.
阴茎癌（PeCa）在全球范围内是一种罕见的泌尿系统肿瘤。2024年，美国预计有2100例新发病例和500例死亡病例。传统上，通过阴茎全切术进行的根治性手术一直是治疗的基石，因为它能提供出色的长期肿瘤学控制。阴茎癌手术的基本原理是实现2厘米的宏观手术切缘，长期以来一直主张这样做以减少复发。随着时间的推移，大量研究表明手术切缘状态并不影响患者的生存。目前，欧洲泌尿外科学会 - 美国临床肿瘤学会（EAU - ASCO）指南推荐采用不同的保留阴茎技术来治疗局限性原发性阴茎癌。集中治疗可能带来多重益处，包括提高疾病认知度、提高保留阴茎手术的比例、提高检测率、增加使用侵入性较小的淋巴结分期技术、提高专业组织病理学检查的质量以及建立专业的多学科团队。与更积极的治疗方法相比，保留阴茎手术后较高的复发率既不影响无转移生存期也不影响总生存期。对于选定的病例，可以考虑重复进行保留阴茎手术。阴茎癌的心理影响不可忽视，因为男性气概的丧失感可能会对心理健康和整体幸福感产生不利影响。性功能和排尿功能障碍可能会影响生活质量，这可能是阴茎组织丧失或患者心理状态导致的结果。提供康复治疗，如性治疗、物理治疗、职业治疗、家庭和同伴咨询，至关重要。
