title: Is there a role for the development of a supra-regional network for the management of penile cancer in the Republic of Ireland?
abstract: BACKGROUND
  There is an average of 25 cases of penile cancer in the Republic of Ireland each year. Due to the low volume of cases, the National Institute for Clinical Excellence recommends that treatment is centralised to allow the best standardised treatment for primary tumours and nodal disease.
  
  
  OBJECTIVE
  To determine whether outcomes for patients with penile cancer differed significantly between secondary and tertiary referral centres in the Republic of Ireland.
  
  
  METHODS
  Between 2001 and 2014, 36 patients were treated in the Mercy University Hospital (MUH) with penile cancer. Twenty patients were treated primarily in MUH and 16 patients underwent initial management in a secondary referral centre (SRC) with subsequent referral to the MUH. A retrospective matched case-control study was performed on this patient cohort.
  
  
  RESULTS
  There were no significant differences in length of follow-up or risk factors for the development of penile cancer between both groups (p = 0.6 and p = 0.5 respectively) Ultimately, the incidence of high risk disease, nodal metasases, high grade disease and pelvic lymph node dissection were significantly greater in patients that were initially managed in a SRC (p = 0.02, p = 0.03, p = 0.004 and p = 0.028 respectively). Patients undergoing initial treatment in a SRC had a non-significantly reduced rate of cancer specific survival (88 Vs 66%, MUH Vs SRCs, p = 0.495) and recurrence free survival (85 Vs 46%, MUH Vs SRCs, p = 0.24).
  
  
  CONCLUSIONS
  Our findings suggest that managing penile cancer in special interest centres may improve oncological outcome.
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland. Electronic address: nialldavis@rcsi.ie.
authors.forename: N F
authors.initials: NF
authors.lastname: Davis
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Fitzgerald
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland.
authors.forename: J P
authors.initials: JP
authors.lastname: Burke
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland.
authors.forename: K J
authors.initials: KJ
authors.lastname: Breen
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Elamin
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland.
authors.forename: C M
authors.initials: CM
authors.lastname: Brady
authors.affiliation: Department of Medical Oncology, Mercy University Hospital, Co. Cork, Ireland.
authors.forename: D G
authors.initials: DG
authors.lastname: Power
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland; Mater Misericordiae Univeristy Hospital and Mater Private Hospital, Ireland.
authors.forename: P K
authors.initials: PK
authors.lastname: Hegarty
authors.affiliation: Department of Urology, Mercy University Hospital, Co. Cork, Ireland. Electronic address: psweeney@muh.ie.
authors.forename: P
authors.initials: P
authors.lastname: Sweeney
mesh_terms: D000368:Aged; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies
keywords: Cancer specific survival; Centralisationm; Penile cancer; Recurrence free survival; Supra-regional network; Urology