Expert Highlights From the Inaugural NCCN Guideline for Penile Cancer

New guidelines for penile cancer treatment

Although relatively rare in Western countries, penile cancer is associated with high morbidity and mortality. Few data are available from prospective, randomized trials, and heterogeneous approaches to care have emerged. In order to achieve the most favorable outcomes in men with penile cancer, early treatment is required. In the article published in The Journal of the National Comprehensive Cancer Network, Dr Philippe Spiess who is an associate member in the Department of Genitourinary Oncology at Moffitt Cancer Center, presents highlights from the inaugural NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for penile cancer.

In his article, Dr Spiess focusses on four areas, but primarily on treatment strategies for primary penile tumours and management of regional lymph nodes, while the recommendations regarding general surveillance strategies and guidelines for recurrent and metastatic disease are briefly explored.

Without evidenced-based treatment approaches, outcomes in patients with this cancer type have varied widely. The new protocol, created with input from experts from around the world, is intended to establish a foundation to standardize and optimize the care of patients with this potentially lethal cancer.

The debate involves radical versus non-radical surgery. Radical surgery, which involves partial or total removal of the penis, is often performed regardless of the stage of cancer. However, by employing new biopsy techniques and combination therapies, radical surgery is not always necessary. Having standardized guidelines for treatment will likely impact patient treatment by encouraging less radical surgeries, extending survival time and providing better quality of life, according to Dr Spiess.

The new guidelines offer a number of treatment options for various grades of penile cancer. Suggested treatments range from local excision to laser or radiation therapy and radiochemotherapy. Radical surgery remains the standard in managing invasive penile cancer. However, less invasive options that may improve quality of life are being considered based on the stage and grade of the tumour.

There is not much literature available about surveillance for men with penile cancer. But Dr Spiess suggests patients treated with primary lesions be examined every three months for the first two years. Those who have had penile-preserving surgery should be followed up more stringently.

Dr Spiess concluded that physicians should be cautious and not jump to surgery right away as penile cancer patients are at high risk for subsequent cancer progression.


Spiess PE. New Treatment Guidelines for Penile Cancer. J Natl Compr Canc Netw 2013; 11(Suppl 5): 659–662.