Transformation in penile cancer management with centralisation and multidisciplinary care


Penile squamous cell carcinoma is a rare male cancer with an annual incidence of 1 per 100,000. In many cases (75%) the condition is curable but in a minority (25%) the condition can rapidly progress and become incurable. Before 2002, patients were typically managed in local centres where a consultant urological surgeon might see and manage one case per year. The team defined new surgical techniques for penile preservation, evaluated new ways of staging disease, introduced standardised histopathological reporting, worked with charities to improve patient information, monitored and improved patient experience, established a basic science research programme and designed and participated in national clinical trials.


Penile squamous cell carcinoma has an annual incidence of one case per 100,000. Three quarters of cases are curable, but in 25 per cent the condition can become incurable. Before 2002, patients were managed in local centres where a consultant urological surgeon might see one case per year and aggressive resection of the penis or complete amputation was usually recommended. 

In terms of disease management patients were offered either radical groin lymph node dissection or surveillance until a recurrence was detected. They tended to suffer significant pyschosexual issues, functional voiding problems and further lower limb morbidities such as lymphoedema. With so few patients, there was little opportunity to evaluate new treatments. 

The Improving Outcomes Guidance (IOG) recommended the establishment of specialist centres to manage the disease.


The service was new to St George’s in 2002, so the team could set standards and goals from the outset. They designed the seven key objectives around which the service remains based. Among these, they agreed to offer new surgical techniques in penile preserving surgery without compromising local recurrence rates, and to develop new staging techniques for detecting inguinal node metastasis. 

The team also agreed to develop optimum guidelines for management at regional, national and international levels, and to improve the patient experience. They committed to streamlining oncology services and to encourage participation in national trials, to develop a basic research programme and to ensure optimum communication between the referring clinicians, specialist centre and the patient.

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