New developments in the treatment of localized penile cancer.

OBJECTIVES: To analyze the current trends in local therapy approaches in patients with penile carcinoma.

METHODS: The relevant published data since 2000 were reviewed; important series published before 2000 were also included. The reports were classified according to the level of evidence. Review studies and others indirectly related to the topic were also included but not classified.

RESULTS: New information has suggested that surgical margins of only a few millimeters might be adequate for most localized tumors. A trend toward the use of more conservative therapies instead of amputative surgery has been observed, especially in developed countries. Although the local recurrence rate has been greater after conservative therapies than after amputative surgery, this increased rate does not seemed to have had a negative effect on cancer-specific survival. The quality of life has been superior after conservative procedures with preservation of the penis that seems to give the best results with regard to sexual function. Reconstructive surgery can be performed in selected patients after amputative surgery.

CONCLUSIONS: Although the level of evidence is low, conservative therapies can be recommended for selected patients with penile carcinoma. Despite the trend for conservative approaches, these patients need psychological support.