Controversies over regional lymphadenectomy in carcinoma of the penis

: Epidermoid carcinoma of the penis, although rare, is a very aggressive tumor type. The presence or absence of inguinal metastasis is an essential prognostic factor. Treatment of these metastases is one of the current controversies in urological practice; i.e., when and to what extent lymphadenectomy should be performed. Of 24 patients with penile carcinoma, 10 had undergone regional lymphadenectomy over the past 8 years at our institution. Following treatment of the primary penile tumor, 6 patients had palpable inguinal nodes that persisted after treatment with antibiotic and antiinflammatory agents for 6 weeks. Of these, 3 had a positive node biopsy. They were submitted to regional lymphadenectomy which revealed node metastasis in 5 cases (2 pN3, 2 pN2 and 1 pN1). The patients with no palpable nodes were closely followed and were submitted to lymphadenectomy when these appeared (3 cases). The fatal outcome of 2 cases (both pN3) prompted us to perform lymphadenectomy prophylactically in the last case, a 40-year-old male with pT2G2 N0 penile cancer. This approach is advocated in patients under 65 with invasive penile carcinoma (pT greater than 1) or a high histological grade of malignancy (G2 and G3).