Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Prognostic factors in squamous cell carcinoma of the penis

Nature Clinical Practice Urology volume 4, pages 140–146 (2007)Cite this article

Abstract

Squamous cell carcinoma (SCC) of the penis is an uncommon disease in the US and Europe. Without treatment, patients with penile SCC usually die within 2 years after diagnosis of the primary lesion, because of uncontrollable locoregional disease or from distant metastases. The spread of the tumor to the locoregional lymph nodes (lymph-node positivity) is the most relevant prognostic factor. With the available treatments, 5-year cancer-specific survival probabilities are between 75% and 93% for those patients with clinically node-negative disease, and progressively lower for those with increasingly extensive node-positive disease. Similarly, patients with pathologically proven negative nodes have 5-year cancer-specific survival probabilities ranging from 85% to 100%. While patients with a single positive superficial lymph node on pathology have very good cancer-related outcomes, patients with multiple involved lymph nodes have significantly less favorable outcomes. This article focuses on the most important issues that surround the prognosis of squamous cell carcinoma of the penis, with special attention to the prognostic nomograms for penile cancer patients published in 2006.

Key Points

  • Squamous cell carcinoma (SCC) of the penis is an uncommon malignant disease, which substantially limits the value of epidemiologic studies and comprehension of risk factors

  • Without treatment, patients with penile SCC usually die within 2 years after diagnosis of the primary lesion, because of complications due to uncontrollable locoregional growth or from distant metastases

  • The main clinical and pathologic prognostic variables are lymph node stage, venous embolization, and lymphatic embolization

  • Prognostic nomograms that incorporate pathologic variables have been developed, which might be useful for patient counseling and planning of treatment with regard to early inguinal lymphadenectomy and (when available) adjuvant therapies; however, the external validation of these nomograms is ongoing

  • A few studies indicate a possible prognostic role for molecular markers, such as expression of tumor-suppressor genes, adhesion molecules and metalloproteinases, but further research is needed in this field

  • The research performed on SCC in other areas of the body (such as the head and neck) as well as multi-institutional collaborations that pool the number of cases of penile SCC will be useful to increase the available knowledge on penile SCC

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Nomogram that predicts the probability of pathological lymph node involvement
Figure 2: Nomogram that predicts the 5-year cancer specific survival according to the pathological findings of the primary tumor and pathological stage of lymph nodes
Figure 3: Nomogram predicting the 5-year cancer specific survival according to the pathological findings of the primary tumor and clinical stage of lymph nodes

Similar content being viewed by others

References

  1. Mobilio G et al. (2001) Genital treatment of penile carcinoma. Curr Opin Urol 11: 299–304

    Article  CAS  PubMed  Google Scholar 

  2. Jemal A et al. (2006) Cancer statistics, 2006. CA Cancer J Clin 56: 106–130

    Article  PubMed  Google Scholar 

  3. Misra S et al. (2004) Penile carcinoma: a challenge for the developing world. Lancet Oncol 5: 240–247

    Article  PubMed  Google Scholar 

  4. Busby JE et al. (2005) What's new in the management of penile cancer? Curr Opin Urol 15: 350–357

    Article  PubMed  Google Scholar 

  5. Lont AP et al. (2006) Presence of high-risk human papillomavirus DNA in penile carcinoma predicts favorable outcome in survival. Int J Cancer 119: 1078–1081

    Article  CAS  PubMed  Google Scholar 

  6. Kroon BK et al. (2005) Contemporary management of penile squamous cell carcinoma. J Surg Oncol 89: 43–50

    Article  PubMed  Google Scholar 

  7. Fraley EE et al. (1989) The role of ilioinguinal lymphadenectomy and significance of histological differentiation in treatment of carcinoma of the penis. J Urol 142: 1478–1482

    Article  CAS  PubMed  Google Scholar 

  8. McDougal WS (1995) Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol 154: 1364–1366

    Article  CAS  PubMed  Google Scholar 

  9. Lopes A et al. (1996) Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol 156: 1637–1642

    Article  CAS  PubMed  Google Scholar 

  10. Slaton JW et al. (2001) Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol 165: 1138–1142

    Article  CAS  PubMed  Google Scholar 

  11. Solsona E et al. (1992) Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma. Eur Urol 22: 115–118

    Article  CAS  PubMed  Google Scholar 

  12. Solsona E et al. (2001) Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes. J Urol 165: 1506–1509

    Article  CAS  PubMed  Google Scholar 

  13. Solsona E et al. (2004) EAU guidelines on penile cancer. Eur Urol 46: 1–8

    Article  CAS  PubMed  Google Scholar 

  14. Ficarra V 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 

  15. Ficarra V et al. (2006) Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol 175: 1700–1705

    Article  PubMed  Google Scholar 

  16. Horenblas S et al. (1993) Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol 149: 492–497

    Article  CAS  PubMed  Google Scholar 

  17. Horenblas S et al. (1994) Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol 151: 1239–1243

    Article  CAS  PubMed  Google Scholar 

  18. Bezerra ALR et al. (2001) Human papillomavirus as a prognostic factor in carcinoma of the penis analysis of 82 patients treated with amputation and bilateral lymphadenectomy. Cancer 91: 2315–2321

    Article  CAS  PubMed  Google Scholar 

  19. Kattan MW et al. (2006) Nomogram predictive of cancer specific survival in patients undergoing partial or total amputation for squamous cell carcinoma of the penis. J Urol 175: 2103–2108

    Article  PubMed  Google Scholar 

  20. Villavicencio H et al. (1997) Grade, local stage and growth pattern as prognostic factors in carcinoma of the penis. Eur Urol 32: 442–447

    CAS  PubMed  Google Scholar 

  21. Lopes A et al. (2002) p53 as a new prognostic factor for lymph node metastasis in penile carcinoma: analysis of 82 patients treated with amputation and bilateral lymphadenectomy. J Urol 168: 81–86

    Article  PubMed  Google Scholar 

  22. Campos RS et al. (2006) E-cadherin, MMP-2, and MMP-9 as prognostic markers in penile cancer: analysis of 125 patients. Urology 67: 797–802

    Article  PubMed  Google Scholar 

  23. Kamat MR et al. (1993). Carcinoma of the penis: the Indian experience. J Surg Oncol 52: 50–55

    Article  CAS  PubMed  Google Scholar 

  24. Kulkarni JN et al. (1994) Prophylactic bilateral groin node dissection versus prophylactic radiotherapy and surveillance in patients with N0 and N1 ± 2 carcinoma of the penis. Eur Urol 26: 123–128

    Article  CAS  PubMed  Google Scholar 

  25. Srinivas V et al. (1987) Penile cancer: relation of extent of nodal metastasis to survival. J Urol 137: 880–882

    Article  CAS  PubMed  Google Scholar 

  26. Ornellas AA et al. (1991) Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol 146: 330–332

    Article  CAS  PubMed  Google Scholar 

  27. Ravi R (1993) Morbidity following groin dissection for penile carcinoma. Br J Urol 72: 941–945

    Article  CAS  PubMed  Google Scholar 

  28. Brkovic D et al. (1997) Surgical treatment of invasive penile cancer—the Heidelberg experience from 1968 to 1994. Eur Urol 31: 339–342

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. and V Ficarra is an Associate Professor of Urology in the Department of Oncological and Surgical Sciences, G Novara and V De Marco are Consultant Urologists, A Galfano is a Resident in Urology, W Artibani is a Professor of Urology, Urology Clinic, University of Padua, Padua, Italy.,

    Giacomo Novara, Antonio Galfano, Vincenzo De Marco, Walter Artibani & Vincenzo Ficarra

Authors
  1. Giacomo Novara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Galfano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo De Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Walter Artibani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincenzo Ficarra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vincenzo Ficarra.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Novara, G., Galfano, A., De Marco, V. et al. Prognostic factors in squamous cell carcinoma of the penis. Nat Rev Urol 4, 140–146 (2007). https://doi.org/10.1038/ncpuro0751

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0751

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing