Importance of Addressing the Psychosocial Impact of Penile Cancer on Patients and Their Families.

OBJECTIVE: In this article we review the quality of life and the psychosocial and functional outcomes experienced by patients and their partners following penile cancer diagnosis and treatment. DATA SOURCES: A literature search for primary articles related to patient reported outcomes following penile cancer treatment was conducted using the electronic database PubMed. CONCLUSION: Penile cancer is a rare malignancy in the United States, and it carries an excellent prognosis if diagnosed early. However, increased survivorship carries devastating long-term consequences on the mental health of patients and their families. Factors impacting the quality of life of patients include sexual dysfunction, cosmetic changes, voiding dysfunction, depression, and anxiety. Treatment modalities vary depending on the extent of the cancer but include medical, interventional, and surgical options. IMPLICATIONS FOR NURSING PRACTICE: The multidisciplinary team can support patients and their partners to develop, test and deliver posttreatment survivorship interventions to optimize psychosocial well-being and quality of life outcomes for this rare disease.

Penile Cancer: Managing Sexual Dysfunction and Improving Quality of Life After Therapy.

PURPOSE OF REVIEW: To review the most current literature on how the treatment for penile cancer can affect quality of life and to discuss current treatment options to overcome sexual dysfunction and ultimately improve patient wellbeing. RECENT FINDINGS: Multiple medical and surgical therapies exist to address the high incidence of sexual dysfunction following penile cancer treatment. Advancements and refinements in the neophalloplasty, penile prosthesis, and penile lengthening procedures have opened the door to improved long-term outcomes. Additionally, studies continue to highlight the severe psychological toll that penile cancer treatment can have on patients. We explore the potential options for addressing the inherent psychologic effects of these treatments and highlight the need for further research in this domain. Although rare, it is important for all urologists to be familiar with the treatments and post-treatment sequelae of penile cancer. Penile cancer is associated with dramatic decline in quality of life and sexual function. Multiple medical and surgical therapies exist that addresses these concerns. Additionally, urologists must also be mindful of the psychologic component regarding surgical disfigurement and the decline in sexual function.

Penile cancer trends and economic burden in the Brazilian public health system.

OBJECTIVE: To gather information on penile cancer epidemiologic trends and its economic impact on the Brazilian Public Health System across the last 25 years. METHODS: The Brazilian Public Health System database was used as the primary source of data from January 1992 to December 2017. Mortality and incidence data from the Instituto Nacional de Câncer José Alencar Gomes da Silva was collected using the International Classification of Diseases ICD10 C60. Demographic data from the Brazilian population was obtained from the last census by the Brazilian Institute of Geography and Statistics, performed in 2010 and its 2017 review. RESULTS: There were 9,743 hospital admissions related to penile cancer from 1992 to 2017. There was a reduction (36%) in the absolute number of admissions per year related to penile cancer in 2017, as compared to 1992 (2.7versus 1.7 per 100,000; p<0.001). The expenses with admissions related to this condition in this period were US$ 3,002,705.73 (US$ 115,488.68/year). Approximately 38% of the total amount was spent in Northeast Region. In 1992, penile cancer costed US$ 193,502.05 to the public health system, while in 2017, it reduced to US$ 47,078.66 (p<0.02). Penile cancer incidence in 2017 was 0.43/100,000 male Brazilian, with the highest incidence rate found in the Northeast Region. From 1992 to 2017, the mortality rates of penile cancer in Brazil were 0.38/100,000 man, and 0.50/100,000 man in the North Region. CONCLUSION: Despite the decrease in admissions, penile cancer still imposes a significant economic and social burden to the Brazilian population and the Public Health System.

What are the unmet supportive care needs of men affected by penile cancer? A systematic review of the empirical evidence.

PURPOSE: To systematically evaluate evidence regarding the unmet supportive care needs of men affected by penile cancer and their partners to create a holistic model of care and inform clinical practice guidelines. METHODS: We searched CINAHL, MEDLINE, PsychINFO, Embase, and the Cochrane Library (CCRT and CDSR) controlled trials databases and clinicaltrial.gov from 1990 to April 2020. This review was reported according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. RESULTS: 18 articles were included, reporting the results from 17 studies. Included reports used qualitative (seven studies) and survey (ten studies). Across these studies, men reported that the diagnosis and subsequent treatment of penile cancer affected physical, psychological and sexual well-being with each facet impacting and being intertwined with the other at varying degrees. There was varying complexity of unmet needs in men and partners pre-surgery, post-surgery and into survivorship. CONCLUSIONS: Moderate evidence exists that men affected by penile cancer experience a range of unmet supportive care needs across the international literature. Further work to evaluate the impact of penile cancer on partners is required.

A surgical approach to squamous cell carcinoma of penis that also resolved the psychological dysfunction of the patient.

In this case study, we present an unusual case with squamous cell carcinoma surrounding the penis involving foreskin and glans of penis. In addition, multiple satellite nodules were noted in the pubis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 10 years. At the same time, he was referred to an outpatient memory clinic because of persistent subjective memory complaints associated with depression and anxiety. The patient was operated under general anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. Histopathological analysis of the lesion revealed an invasive and poorly differentiated squamous cell carcinoma, and the surgical margins were free from tumour. The patient was followed for 18 months. He did not have voiding difficulty. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. Treatment of carcinoma resulted in a simultaneous full recovery of his memory decline and he remained free of depression and anxiety symptoms over time.

Penile cancer trends and economic burden in the Brazilian public health system / Tendências e carga econômica do câncer de pênis no sistema público de saúde brasileiro

ABSTRACT Objective: To gather information on penile cancer epidemiologic trends and its economic impact on the Brazilian Public Health System across the last 25 years. Methods: The Brazilian Public Health System database was used as the primary source of data from January 1992 to December 2017. Mortality and incidence data from the Instituto Nacional de Câncer José Alencar Gomes da Silva was collected using the International Classification of Diseases ICD10 C60. Demographic data from the Brazilian population was obtained from the last census by the Brazilian Institute of Geography and Statistics, performed in 2010 and its 2017 review. Results: There were 9,743 hospital admissions related to penile cancer from 1992 to 2017. There was a reduction (36%) in the absolute number of admissions per year related to penile cancer in 2017, as compared to 1992 (2.7versus 1.7 per 100,000; p<0.001). The expenses with admissions related to this condition in this period were US$ 3,002,705.73 (US$ 115,488.68/year). Approximately 38% of the total amount was spent in Northeast Region. In 1992, penile cancer costed US$ 193,502.05 to the public health system, while in 2017, it reduced to US$ 47,078.66 (p<0.02). Penile cancer incidence in 2017 was 0.43/100,000 male Brazilian, with the highest incidence rate found in the Northeast Region. From 1992 to 2017, the mortality rates of penile cancer in Brazil were 0.38/100,000 man, and 0.50/100,000 man in the North Region. Conclusion: Despite the decrease in admissions, penile cancer still imposes a significant economic and social burden to the Brazilian population and the Public Health System.

RESUMO Objetivo: Reunir informações sobre as tendências epidemiológicas do câncer de pênis e seu impacto econômico no Sistema Único de Saúde nos últimos 25 anos. Métodos: O banco de dados de informações do Sistema Único de Saúde foi utilizado como fonte primária de dados de janeiro 1992 a dezembro 2017. Os dados demortalidade e incidência do Instituto Nacional de Câncer José Alencar Gomes da Silva foram coletados usando a Classificação Internacional de Doença CID10 C60. Os dados demográficos da população brasileira foram obtidos do último censo do Instituto Brasileiro de Geografia e Estatística, realizado em 2010, e em sua revisão, de 2017. Resultados: Ocorreram 9.743 internações relacionadas ao câncer de pênis de 1992 a 2017. Houve redução (36%) nas internações anuais absolutas em 2017 em comparação com 1992 (2,7 versus 1,7 por 100.000; p<0,001). Os gastos com internações neste período foram de US$ 3,002,705.73 (US$ 115,488.68/ano). Cerca de 38% do valor total foi gasto na Região Nordeste. Em 1992, o câncer de pênis custou US$ 193,502.05 ao sistema público, enquanto em 2017 reduziu para US$ 47,078.66 (p<0,02). A incidência em 2017 foi de 0,43/100.000 brasileiro do sexo masculino, com a maior taxa de incidência encontrada na Região Nordeste. De 1992 a 2017, as taxas de mortalidade por câncer de pênis foram de 0,38/100.000 homem, sendo 0,50/100.000 homem na Região Norte. Conclusão: Apesar da diminuição nas hospitalizações, o câncer de pênis ainda impõe uma carga econômica e social significativa à população brasileira e ao Sistema Único de Saúde.

Treating advanced penile cancer: where do we stand in 2019?

PURPOSE OF REVIEW: Penile squamous cell carcinoma (PSCC) remains a challenging malignancy to treat and there is an urgent need of significant improvements at all levels of medical care. In the current review, we summarized the significant obstacles encountered during management of PSCC and discussed the clinical relevance of novel findings and their potential to address these obstacles. RECENT FINDINGS: The recent genetic and immunological advances suggest that patients with PSCC can benefit from available targeted therapy and immunotherapy options. Moreover, evidence has accumulated over time suggesting that majority of the patients diagnosed with PSCC suffer from psychosocial problems and impaired rehabilitation. SUMMARY: Effective prevention strategies against PSCC are urgently needed especially in developing countries given the limited therapeutic options. About a quarter of patients with metastatic PSCC appear to benefit from available targeted therapies and about half of the patients can be a suitable candidate for immune checkpoint blockade as half of the PSCC cases exhibit PD-L1 expression. Moreover, increased public awareness, healthcare provider education and social support programs may help patients suffering from PSCC coping with the psychosocial burdens of the disease.

Assessment of selected quality of life domains in patients who have undergone conservative or radical surgical treatment for penile cancer: an observational study.

Background Surgery is the standard treatment for organ-restricted penile cancer, but it is also a disfiguring procedure that can profoundly affect quality of life. Using a survey, in this study we assessed the effect of different surgical invasiveness on satisfaction in selected life domains of patients who underwent penile-sparing surgery and partial penectomy. METHODS: Forty patients who underwent penile-sparing surgery (n=13) or partial penectomy (n=27) were enrolled in the study. The response rate was 71%. Information was obtained after surgery on sexuality, self-esteem, masculinity and partner relationships using the International Index of Erectile Function, the Self-Esteem Scale and the Conformity to Masculinity Norms Inventory questionnaires. We evaluated the effect of primary surgery type on selected domains of quality of life and correlations between study variables after surgery. RESULTS: High self-esteem, satisfactory erectile function and masculinity results in both groups were comparable to those in the published literature. Men who underwent less disfiguring treatment had a significantly higher sense of masculinity than those who underwent partial penectomy (P=0.05). No significant differences were observed in erectile dysfunction and self-esteem. The level of aggressiveness of a surgical procedure was a predictor of sense of masculinity (P=0.01), but was not associated with self-esteem and sexual dysfunction (P=0.28 and P=0.55 respectively); 83% of patients were able to satisfactorily maintain partner relationships. CONCLUSIONS: Disfiguring treatments for penile cancer significantly interfere with the sense of masculinity, but sexual functioning and self-esteem do not differ according to the type of surgical procedure. Most men maintained stable partner relationships after surgery, regardless of surgery type.

Cross-Sectional Patient-Reported Outcome Measuring of Health-Related Quality of Life With Establishment of Cancer- and Treatment-Specific Functional and Symptom Scales in Patients With Penile Cancer.

BACKGROUND: In the field of uro-oncology, the assessment of quality of life (QoL) is considered an integral part of clinical research. Because of the rarity of penile cancer, there is currently no cancer-specific questionnaire module available to assess the tumor-specific loss of function and symptoms in terms of influencing QoL. The aim of the study was to apply a validated questionnaire (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30) in a population of patients diagnosed with penile cancer and to compare these results to reference data of the general population. We also developed a new unvalidated questionnaire (Quality of Life Questionnaire-Penile Cancer-Rostock, HRO-PE29) in this population to promote QoL research in the field of uro-oncology. PATIENTS AND METHODS: Cross-sectional evaluation of patients with penile cancer after local surgical treatment (n = 76) was performed using EORTC QLQ-C30 and HRO-PE29. The QLQ-C30 provides information on QoL, functional scales, symptom scales, and 6 individual items (inappetence, insomnia, dyspnea, constipation, diarrhea, financial difficulties). Cancer-specific functional and symptom scales (HRO-PE29) were then established for use in different disease states and forms of treatment. These provide information on QoL as well as on cancer-specific function and symptom scores. RESULTS: The global QoL score was 54, which corresponds to an average QoL (score 0-100) and was well below the age-standardized average for German patients. For the general function scores, the following mean values were determined: physical (x¯ = 73), social (x¯ = 61), emotional (x¯ = 60), cognitive functioning (x¯ = 69), and role function (x¯ = 63). With regard to the general symptom scores and the individual items, the following values were found: fatigue (x¯ = 35), nausea (x¯ = 6), pain (x¯ = 27), dyspnea (x¯ = 23), insomnia (x¯ = 41), loss of appetite (x¯ = 25), constipation (x¯ = 19), diarrhea (x¯ = 10), and financial difficulties (x¯ = 25). The following mean values were found for the cancer-specific functional scores: voiding (x¯ = 77), sexuality (x¯ = 69, function and pleasure), body image (x¯ = 64), lymphedema (x¯ = 75), future prospects (x¯ = 72), and adverse effects of systemic treatment (x¯ = 73). CONCLUSION: Defects of the external genitalia have implications for identity, personality, and interpersonal relationships. The mental stress of these patients results from the diagnosis of cancer as well as the partly mutilating treatment. Reconstructive surgery in penile cancer patients promises to maintain sexual and micturition function and thus improve QoL. Cancer-specific functional losses can be sufficiently named and their influence on QoL determined.

Health-Related Quality of Life and Sexual Function in Patients Treated for Penile Cancer.

PURPOSE: To assess the impact of primary surgery, partial and total penectomy, and of inguinal lymphadenectomy on health-related quality of life (HRQoL) and the sexual function of penile cancer patients. MATERIALS AND METHODS: We invited 15 patients surgically treated for penile cancer in the Regional Hospital of Specialized Medicine of the Yucatan Peninsula between 2012 and 2016 to complete the SF-36 quality of life and International Index of Erectile Function (IIEF-5) sexual function questionnaires. We evaluated the impact of primary surgery type and inguinal lymphadenectomy on the outcome of HRQoL and sexual function. RESULTS: A total of 10 patients (66%) completed the SF-36 questionnaire. Surgery type and extent of resection were overall not associated significantly with worse outcomes on the assessed domains of quality of life. However, men treated with partial penectomy reported significantly more pain (p = 0.0547) than men treated with total penectomy. Similarly, men who underwent lymphadenectomy reported significantly more pain (p = 0.0547) than those who were spared from the procedure due to the -primary tumor´s stage and grade. Sexual function was severely affected (IIEF mean = 6.5) in patients treated with partial penectomy. CONCLUSIONS: Although partial penectomy and lymphadenectomy were significantly associated with more postoperative pain, no differences were observed in other HRQoL domains. Sexual function was severely affected in patients treated with partial penectomy.

[Psychosocial effects in patients with penile cancer : A systematic review]. / Psychosoziale Auswirkungen bei Patienten mit Peniskarzinom : Ein systematischer Überblick.

BACKGROUND: Psychological stress of patients with penile cancer arises from the cancer diagnosis itself and the treatment consequences. In addition, there is cancer-specific distress. There is the chance of cure in localized stages and in those with limited regional lymph node metastases but this requires surgery and often adjuvant chemotherapy. This systematic review gives a summary of the existing literature to date. MATERIALS AND METHODS: A critical database search using Medline was made in Ovid from 1946 to 2017, in the Cochrane Central Register of Controlled Trials (CENTRAL) and in the Web of Science from 1900 to 2017. This was complemented by a search of the World Health Organization's International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. The reference lists of the included studies were manually searched for additional references. RESULTS: Selected studies (n = 10) addressed the psychosocial effects of penile cancer treatment on quality of life and sexual function. Due to the heterogeneity of the study designs only a narrative description of the results was possible. Defects or mutilation due to penile cancer cause psychological distress in a significant number of patients. Organ-sparing interventions have a positive impact on quality of life and sexual function. CONCLUSION: The external genitals are a focus of sexual identity. Mutilating treatment causes significant distress but organ-sparing treatment and reconstruction positively influence quality of life.

Analysis of Suicide Risk in Patients with Penile Cancer and Review of the Literature.

The treatment for penile cancer has been shown to cause harmful psychiatric symptoms as well as have detrimental effects on well-being. In the past several years, alternatives to total or partial penectomy have emerged, such as chemotherapy, radiation, penile sparing, and laser ablation therapies. A more specific breakdown for penile cancer is in order as the therapy has the potential for life changing surgery. We examined the Surveillance, Epidemiology, and End Results (SEER) database (1973-2013), comprising 28% of the United States population. International Classification of Diseases, Tenth revision codes C60.8-C60.9 and the International Classification of Diseases-Oncology codes 8010/2, 8010/3, 8051/2, 8051/3, 8052/2, 8052/3, 8070/2, 8070/3-8072/3, 8074/3, 8076/3, and 8083/3-8084/3 were used. Age, race, marital status, and clinicopathologic variables were studied. We used contingency tables of suicide rates; mid-P exact test was used for analysis. There were 13 suicides noted in 6155 patients with squamous cell carcinoma of the penis. All patients that committed suicide had undergone a surgical intervention. Certainly, penile cancer after treatment has a powerful effect on quality of life as increased depression and sexual anxiety have been documented in postoperative patients. This is in contrast to the observed suicide rate. Despite the reported negative psychological effects in patients with penile cancer, suicide rates are among the lowest of all urologic malignancies.

Assessment of quality of life in patients surgically treated for penile cancer: Impact of aggressiveness in surgery.

PURPOSE: Health-related quality of life (HRQoL) evaluations are being increasingly used for clinical assessment of cancer treatment outcomes. For a patient, not only is life expectancy important, but also a general sense of sustained global health. Intuitively, the more disfiguring the treatment, the more pronounced could be the deterioration in the QoL. We aimed to compare various aspects of QoL in three groups of patients surgically treated for penile cancer by local excision, partial penectomy, or total penectomy. METHODS: HRQoL was assessed in 51 patients surgically treated for penile cancer. Total penectomy, partial penectomy, or wide local excision was performed in 11, 27, and 13 patients, respectively. The EORTC QLQ-C30 questionnaire was used for HRQoL assessment. Relations between the patients and their partners were also assessed. RESULTS: Statistically significant negative correlation was found between aggressiveness of the surgical procedure and both, assessment of global health status (p = 0.04) and physical functioning (p = 0.047). The more aggressive the surgery, the lower was the patients' assessment of their QoL. Among the patients who maintained their partner relations postsurgery, 58.9% declared that their relations postoperatively were not inferior compared to those preoperatively. There was no statistically significant effect of the surgery type on relations with female partners (p = 0.619). CONCLUSION: The magnitude of disfigurement caused by surgical treatment of penile cancer had a significant impact on the selected QoL domains assessed by the EORTC QLQ C-30 questionnaire. There was no correlation between the scope of surgical intervention and partner relations.

Identifying Psychosocial Distress and Stressors Using Distress-screening Instruments in Patients With Localized and Advanced Penile Cancer.

BACKGROUND: We examined the effects of treatment on the psychological well-being of patients with localized or advanced penile cancer using screening questionnaires to determine the consecutive need for psychosocial care. Penile cancer is a rare, but highly aggressive, malignancy. The psychological stress of patients with penile cancer arises from the cancer diagnosis per se and the corresponding consequences of treatment. In addition, cancer-specific distress results (eg, fear of metastasis, progression, relapse, death). Studies of the psychosocial stress of penile cancer patients are rare. MATERIAL AND METHODS: We undertook a prospective analysis of the data from patients with penile cancer who had undergone surgery or chemotherapy from August 2014 to October 2016 at our department. Patients were evaluated using standardized questionnaires for stress screening and the identification for the need for psychosocial care (National Comprehensive Cancer Network Distress Thermometer and Hornheider screening instrument) and by assessing the actual use of psychosocial support. RESULTS: The average stress level was 4.5. Of all the patients, 42.5% showed increased care needs at the time of the survey. Younger patients, patients undergoing chemotherapy, and patients with recurrence were significantly more integrated with the psychosocial care systems. Finally, 67% of all patients received inpatient psychosocial care. CONCLUSION: Owing to the potentially mutilating surgery, patients with penile cancer experience increased psychological stress and, consequently, have an increased need for psychosocial care. Therefore, the emotional stress of these patients should be recognized and support based on interdisciplinary collaboration offered.

Penis Cancer: The Lived Experience.

BACKGROUND: This qualitative study examined the experiences of men with penis cancer. Cancer of the penis is a rare and debilitating disease, affecting 1 in 100 000 men in Western countries. Although much has been written about the medical treatment of the disease, little has been published about the experiences of men who have penis cancer. OBJECTIVE: The aim of this study is to gain an understanding of the lived experiences of men with cancer of the penis. METHODS: Using face-to-face audio-taped interviews with a semi-structured guide, the researcher recruited a purposive sample of 13 men who had been treated for penile cancer. Heidegger's hermeneutic phenomenology served as the philosophical underpinning and Colazzi's method was used to analyze the data. RESULTS: Six main themes emerged from the data: Misdiagnosis, Secrecy, "Cancer is cancer," Sexual Issues, Support, and Awareness and Prevention. CONCLUSIONS: Men diagnosed and treated for penis cancer reported numerous issues related to misdiagnosis, delayed treatment, and reluctance to share experience with family, friends, and coworkers. IMPLICATIONS FOR PRACTICE: Gaining more knowledge of the experiences of men with penile cancer will provide additional insights for healthcare providers to create holistic practice guidelines for the care of men and their loved ones who are affected. It is recommended to change the terminology to penis cancer, instead of penile cancer, to promote public awareness, education, prevention, and early treatment.

Sexual outcomes after partial penectomy for penile cancer: results from a multi-institutional study.

Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients' sexual life we want to evaluate sexual function and satisfaction after partial penectomy. The patients in this study (n = 25) represented all those who attended our institutions and were diagnosed and treated for penile cancer from October 2011 to November 2013. All patients underwent partial penectomy and followed-up (mean: 14 months; range: 12-25). Sexual presurgical baseline was estimated using the International Index of Erectile Dysfunction 15 (IIEF-15). Sexual outcomes of each patient were estimated considering four standardized and validated questionnaires. We analyzed the means and ranges of IIEF-15 including erectile function (IIEF-1-5 and -15), orgasmic function (IIEF-9 and -10), sexual desire (IIEF-11 and -12), intercourse satisfaction (IIEF-6-8), and overall satisfaction (IIEF-13 and -14). Then, we also used Quality of Erection Questionnaire (QEQ), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Self-Esteem and Relationship (SEAR) to evaluate the sexual function and satisfaction of our patients. The final results showed that penile cancer leads to several sexual and psychosexual dysfunctions. Nevertheless, patients who undergo partial penectomy for penile cancer can maintain the sexual outcomes at levels slightly lower to those that existed in the period before surgery.

Risk factors and negative consequences of patient's delay for penile carcinoma.

BACKGROUND: Delayed first medical consultation (patient's delay) is quite common in cases of penile carcinoma (PC), but its reasons and impacts remain unclear. We conducted this study to ascertain risk factors resulting in delayed treatment seeking and evaluate its influence on prognosis. METHODS: From 2004 to 2010 at 4 centers, 254 patients were enrolled into this study from 262 consecutive PC cases. Patients' sexual performance was investigated using the International Index of Erectile Function (IIEF)-15 at the sixth-month end after treatment. Data for prognostic analyses was obtained via a 5-year follow-up. RESULTS: A multivariate model ascertained 4 risk factors (single, living in rural areas, heavy drinking alcohol, and aspecific initial symptoms) and 1 protective factor (history of condyloma) significantly associated with patient's delay. Delay >3 months led to significant risks for adverse clinical characteristics, low penis-sparing rate, and poor sexual function restoration. Although patient's delay was not found to impact on postoperative relapses and 5-year overall survival (OS), patients with delay >6 months had significantly inferior 2-year OS. CONCLUSIONS: Single, living in rural areas, heavy drinking alcohol, and aspecific initial symptoms are significant risk factors of PC associated with patient's delay. Delay >3 months will lead to significantly inferior clinical consequences. Minimizing patient's delay is the key to avoid amputation and retain superior sexual potency. Improving patient education on initial symptoms of PC is necessary in men of >40 years old.

Sexual Function after Partial Penectomy: A Prospectively Study From China.

The Purpose of this study was to evaluate the sexual function after partial penectomy for penile carcinoma patients. Between January 2010 and May 2013, patients treated with partial penectomy at our institution were prospectively enrolled in this study. Sexual function (IIEF-15), age, body mass index, penile length in the flaccid state after partial penectomy (PL), treatment, having a partner and psychological factors (SAS scores and SDS scores) were assessed. Univariate and multivariate linear regression analyses were performed. 43 patients were included in our study. The median age was 56 years, and the median PL was 4 cm. The preoperative IIEF-15, SAS, SDS scores were significantly different from the postoperative scores. There was no statistically significant difference between the patients treated with partial penectomy and partial penectomy+ lymphadenectomy on IIEF-15 scores. Age was negatively associated with erectile function, sexual desire, and overall satisfaction; PL was positively associated with intercourse satisfaction; SAS score was negatively associated with erectile function, orgasmic function, sexual desire, and intercourse satisfaction. Our preliminary findings suggest that the sexual function after partial penectomy was significantly reduced. The sexual function was negatively affected by age and anxiety but positively affected by PL.