Local Tumor Destruction Versus Partial Penectomy for T1a Squamous Cell Carcinoma of the Penis

Local tumor destruction (LTD) represents a relatively novel approach for the management of early-stage squamous cell carcinoma of the penis (SCCP). Its cancer control efficacy has never been tested in large-scale epidemiologic studies. We addressed this knowledge gap and tested for differences in cancer-specific mortality (CSM) between LTD versus partial penectomy (PP) in T1aN0M0 SCCP.

Within the Surveillance, Epidemiology, and End Results database (2000-2020), we identified T1aN0M0 SCCP patients treated with LTD or PP. Cumulative incidence plots as well as multivariable competing risks regression models addressed CSM. Additional accounting was made for the confounding effect of other-cause mortality.

Of 1,239 patients with T1aN0M0 SCCP, 615 (49.6%) underwent LTD versus 624 (50.4%) PP. The majority of patients were Caucasian in LTD 393 (63.9%) and in PP 406 (65.1%) groups. Local tumor destruction patients were young (median age 65 versus 70 years). In cumulative incidence plots, 10-year CSM was 12.4% in LTD versus 13.5% in PP SCCP patients (p = 0.8). In multivariable competing risks regression models, LTD did not independently predict higher CSM relative to PP (hazard ratio 0.99; p = 0.97).

In this large population-based cohort of T1a SCCP patients, the rate of LTD virtually perfectly approximated that of PP. Local tumor destruction patients exhibited virtually the same cancer-control outcomes as their PP counterparts. In consequence, LTD may be considered a safe alternative to PP in T1aN0M0 SCCP based on cancer-control outcomes.