Surgical management of penile carcinoma in situ: results from an international collaborative study and review of the literature

Objectives To evaluate recurrence after penile sparing surgery (PSS) in the management of carcinoma-in-situ (CIS) of the penis in a large multicenter cohort of patients. Patients and Methods We identified consecutive patients from 5 major, academic centers treated from June 1986 to November 2014 who underwent PSS for pathologically proven penile CIS. Primary outcome was local recurrence free survival (RFS) and estimated using the Kaplan-Meier method. Results A total of 205 patients were identified. Treatment modalities included circumcision, glansectomy, wide local excision, laser therapy and total glans resurfacing. Over a median follow-up of 40 months (interquartile range [IQR]: 26-65.6), there were 48 local recurrences with 45.8% occurring in the first year and 81.3% occurring by year 5. Majority of recurrences were observed in the laser group (58.3%). Median time to local recurrence was 15.9 months (5.66-26.14). The 1, 2, and 5-yr RFS were 88.4, 85.6, and 75%, respectively; and the median RFS was 106.5 months (80.2-132.2). Conclusions Among patients with penile CIS selected for surgical management, durable responses at intermediate to long-term follow-up were noted. For those with glandular CIS, glans resurfacing offered the best outcomes. This article is protected by copyright. All rights reserved.