Outcomes of PeIN at the surgical margin: insights from an organ-sparing penile cancer database

PURPOSE: To evaluate if the presence of penile intraepithelial neoplasia (PeIN) at the final surgical margin increases the risk of local recurrence in men with penile squamous cell carcinoma (PSCC) undergoing penile sparing surgery (PSS), we performed an analysis of our contemporary PSS database. METHODS: After IRB approval, data was retrieved from our organizational PSS database. Surgical margin status was verified by a genitourinary pathologist and patients were divided into groups with negative margins and patients with PeIN at the final surgical margins. The primary endpoint of the study was local recurrence free survival. RESULTS: A total of 62 patients, including 34 with PeIN positive margins (55%) and 28 with negative surgical margins (45%) were identified. The cohort had a median follow-up of 27 (IQR 11–57) months. In our cohort, 29 patients (46.7%) had pTis disease. The active management of surgical margin versus observation was not associated with a decreased risk of local, regional, or metastatic recurrence (HR 1.13, 95% CI 0.23–5.4, p = 0.87). Local recurrences were seen in 21 (33.9%) patients but the presence of PeIN at the surgical margin was not associated with an increase in local recurrence rates (HR 0.33, 95% CI 0.13–0.82, p = 0.01). CONCLUSIONS: In this series of contemporary management of PSCC we found that presence of PeIN at the surgical margin was not associated with higher rates of local recurrence. Patients with PeIN at the surgical margins can be safely observed without need for immediate intervention unless a clinical recurrence of penile cancer occurs.