title: Locally advanced penile carcinoma: classic emasculation or testis-sparing surgery?
abstract: OBJECTIVE
  The study evaluates the clinical and pathological findings of 16 patients with locally advanced penile carcinoma (PC) submitted to emasculation, and discusses questions related to the usefulness of bilateral orchiectomy.
  
  
  METHODS
  Between 1999 and 2010, 172 patients with PC were treated. Sixteen (9 %) underwent emasculation. Data were retrieved from the institution's database including age, ethnicity, date of surgery, residential setting, level of schooling, time to diagnosis, type of reconstruction, complications, tumor stage and grade, vascular and perineural invasion along with invasion of corpus cavernosum, corpus spongiosum, testicles, scrotum and urethra.
  
  
  RESULTS
  A total of 16 patients (average: 63.1 years) with locally advanced PC were included. All were illiterate or semiliterate rural dwellers and 87% were white. The time to diagnosis was 8-12 months. The mean follow-up time was 31.9 months (1-119). By the time of the last follow-up, only seven patients (43.75%) were alive. Tumors were pT4 (n = 6), pT3 (n = 8), pT2 (n = 2), Grade I (n = 5) and Grade II (n = 11). The histopathological examination revealed invasion of the urethra (n = 13), scrotum (n = 5) and testicles (n = 1). The surgical margin was positive in one patient. Six patients (37.5%) had vascular invasion and 11 (68.7%) had perineural invasion. Currently, only one of the former is alive.
  
  
  CONCLUSIONS
  The finding of focal microscopic testicular infiltration in only one of 32 testicles, even in the presence of clinically apparent scrotal invasion, suggests that emasculation without bilateral orchiectomy is a safe treatment option for patients with locally advanced PC.
authors.affiliation: Ceará Cancer Hospital and Federal University of Ceará, Ceará, Brazil. gonzaga-silva@ufc.br
authors.forename: Lúcio Flávio
authors.initials: LF
authors.lastname: Gonzaga-Silva
authors.forename: George R M
authors.initials: GR
authors.lastname: Lima
authors.forename: José M
authors.initials: JM
authors.lastname: Tavares
authors.forename: Vladmir O
authors.initials: VO
authors.lastname: Pinheiro
authors.forename: George A
authors.initials: GA
authors.lastname: Magalhães
authors.forename: Manoel E
authors.initials: ME
authors.lastname: Tomas
authors.forename: Cleto D
authors.initials: CD
authors.lastname: Nogueira
authors.forename: Marcos V A
authors.initials: MV
authors.lastname: Lima
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods; D010412:Penile Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D013737:Testis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome