Centralisation of penile cancer services could reduce high rates of surgery in Ireland, study finds

A new medical study has called for the centralisation of services for the treatment of patients with penile cancer in Ireland.

esearchers from the Department of Urology at the Mercy University Hospital in Cork said there was growing proof internationally that the centralisation of services to treat the rare condition resulted in improved outcomes for patients including better survival rates.

It followed the findings of the first ever national review of penile cancer in Ireland which revealed that over 80% of patients require surgery with almost a quarter requiring a total penectomy – an operation for the full removal of the penis.

Some other patients received treatment with radiotherapy and chemotherapy.

The research said it was possible that “surgeon inexperience” explained the relatively high rate of total penectomies performed in Ireland combined with the low rate of patients treated with chemotherapy

The study, which is published in medical journal The Surgeon, examined the background to 360 cases of penile cancer recorded between 1995 and 2010 by the National Cancer Registry Ireland.

The average age of patients being diagnosed with penile cancer was 65.5 years, with 88pc of cases occurring in males over 50.

Penile cancer is a very rare form of the disease and is estimated to affect just 1.5 in every 100,000 males in the Republic with an average of 24 new cases diagnosed each year.

Known risk factors include smoking, chronic inflammation, poor hygiene, HPV infection and phimosis (tight foreskin).

The study found 60pc of patients were either current or ex-smokers.

Although centralisation of the treatment of the disease in Ireland has still to be implemented, the issue has been highlighted by the Irish Society of Urology and the Royal College of Surgeons in Ireland.

The study said existing data indicated that survival rates of patients in Ireland were comparable to those in Europe and the US.

The mortality rate for men with penile cancer was 28%, while the survival rate for the disease after five years was 70%.

However, it pointed out that higher survival rates have been recorded among patients at the Mercy University Hospital where a rapid access referral pathway and management by a trained uro-oncologist is offered to patients.

It acknowledged that guidelines would indicate that only one centre is needed in the Republic based on population and incidence figures.

The study said organ preserving surgery had grown in popularity as a treatment as it offered patients equivalent oncological outcomes to a total penectomy, while also maintaining organ function.

In addition, researchers pointed out that other studies had shown that a total penectomy had a significant psychological impact on patients with some reporting that, if given the choice, they would choose reduced long-term survival if they were able to keep on having sex.

The study found the rate of non-invasive penile cancer was low in Ireland compared to elsewhere in Europe which it stated might be due to the fact that Irish patients tended to present later after the onset of symptoms.

It claimed there was a case for having greater public awareness to prevent late presentations of the disease.

The study said there was a lack of research in the area of penile cancer given the rare nature of the disease which meant defining optimal treatment of the condition remained “challenging.”

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