Quality of Life After Penile Cancer Surgery: A Systematic Review
Penile cancer, though rare, affects over 36,000 individuals globally each year, with increasing incidence in some countries including the United States, the United Kingdom, and Norway. Surgical approaches have evolved from radical amputation to organ-sparing surgery, aiming to preserve the penis.
A new study published in Sexual Medicine Reviews focused on not only oncological (cancer-related) outcomes, but also non-oncological aspects such as penile cosmetic and functional results, quality of life, and psychological well-being following surgical treatment for penile cancer.
This authors of this study conducted a systematic review of penile cancer management, focusing on functional, aesthetic, psychological, and global health outcomes of studies from 2000 to 2022.
Functional outcomes included urinary, sexual, and genital sensory function; aesthetic outcomes were genital appearance and cosmetic satisfaction; psychological and interpersonal outcomes were self-esteem and psychosocial and relational wellness; and global outcomes were overall quality of life.
Case series, cohort studies, and randomized controlled trials were considered for inclusion, with specific criteria for eligible studies. Data were extracted using predefined templates and analyzed using subjective or objective measures, such as patient-reported outcomes and clinical assessments of the various domains mentioned above. Ultimately, the authors decided against performing a meta-analysis due to the heterogeneity of the studies.
The study included 26 publications that examined diverse surgical techniques for penile cancer management, including radical penectomy, partial penectomy, radical glansectomy, partial glansectomy, wide local excision (WLE) and primary closure, total glans resurfacing, and radical circumcision.
Sexual function was assessed in 20 studies with 805 patients, primarily using the International Index of Erectile Function (IIEF). Results varied, with some studies reporting improvements in sexual function post-surgery, while others showed declines.
Urinary function was reported in 9 studies with 283 patients, using various questionnaires. While results varied, more patients than not were able to urinate while standing or as they did previously after their surgeries.
Sensory function was assessed in 4 studies with 99 patients, and results indicated a mixed impact on sensitivity following surgery. Although many reported a reduction in sensitivity after surgery, others reported preserved sensitivity.
There was limited data on aesthetic satisfaction, but 4 studies suggested positive aesthetic outcomes, especially with certain reconstructive surgical techniques.
Health-related quality of life was assessed in 13 studies using different instruments, and results varied across studies.
Lastly, self-image, social, relational, and psychological well-being were explored in a limited number of studies, with some reporting anxiety, depression, and varying levels of self-esteem.
Due to the great heterogeneity of outcomes, it was challenging for the researchers to draw consistent conclusions regarding the impact of different surgical techniques on functional and psychosocial aspects in penile cancer patients.
Discussion & Conclusion
The results of this study emphasize the importance of survivorship in penile cancer care and research, with a focus on organ-sparing surgery to preserve penile function and reduce the psychological burden of radical penectomy.
Nevertheless, the review reveals several challenges, including limited data due to the rarity of the condition, heterogeneous patient populations, and non-standardized reporting. The impact of surgical technique is difficult to assess independently, and current measurement tools may not adequately capture the multifaceted outcomes of penile cancer surgery.
With this in mind, the authors suggest the need for larger qualitative data to better understand patient perspectives and the development of standardized patient-reported outcome measures (PROMs) to assess outcomes before and after surgery, aiming to enhance the understanding and care of penile cancer survivors.
Ultimately, this study underscores the need for a more comprehensive understanding of the diverse outcomes of penile cancer surgery and the importance of tailored surgical approaches and postoperative support for patients.
- Croghan, S. M., Cullen, I. M., & Raheem, O. (2023). Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review. Sexual Medicine Reviews, 11(4), 441-459. https://doi.org/10.1093/sxmrev/qead021