Patients with Penile Intraepithelial Neoplasia (PeIN), a premalignant lesion on the penis, have several treatment options, each with varying levels of risk and efficacy. Researchers conducted a retrospective study, in The Surgeon, demonstrating that CO2 laser treatment is safe and effective for patients with PeIN.
Penile Intraepithelial Neoplasia (PeIN) is a premalignant lesion that can affect the glans (head), prepuce (foreskin), or shaft of the penis. It can also be referred to as Erythroplasia of Queyrat (EQ), Bowen’s disease, or penile carcinoma in situ (CIS). Patients can present with asymptomatic red, moist patches on the mucosal surfaces of the glans, or present with pruritus (itching of the skin), pain, contact bleeding, and phimosis (the inability of the foreskin to retract behind the glans, in uncircumcised males).
Several treatment options, approved by the European Association of Urology (EAU), are available for patients. These include topical chemotherapy (5-fluorourcil) in adjunct to photodynamic control, surgery, or CO2 laser treatment. Only 57-67% of patients have a full response to topical chemotherapy, while 70-88% respond to chemotherapy in combination with photodynamic therapy. Surgical excision is effective, but comes with risk of intraoperative bleeding and undesired cosmetic outcomes. Therefore, most patients see CO2 laser coagulation as a more attractive alternative. Laser ablation therapy works by shooting a high-energy laser, in short, pulsed durations, onto the lesion site. This vaporizes the water in the tissue region and kills the cells, without disrupting the underlying tissue.
A retrospective study, in The Surgeon, aimed to evaluate outcomes of CO2 laser treatment for PeIN, and whether it is as safe and effective as other options. The study reviewed forty-seven participants, ranging from 21 to 88 years old (average 59 years), who underwent CO2 laser ablation for PeIN, between May 2008 and June 2015. They collected information regarding patient’s response to laser treatment, recurrence rate, and subsequent treatments. Each patient was followed-up every three months for the first year, then every six months for the second year, and every year thereafter. Eight out of the total participants had recurrence within, on average, 19.4 months after laser treatment. These patients had a second round of treatment, after which, no recurrence occurred. Thirty-eight of the patients had no pain or complications, while the other nine had to stay overnight due to social circumstances or concern regarding anesthetic effect on underlying co-morbidities including cardiovascular and respiratory diseases.
In conclusion, the retrospective study demonstrated that laser ablation therapy is effective against PeIN. All of the patients were free of the condition after one or two rounds of treatment, which is quite promising. In addition, the therapy appears to be safe since none of the forty-seven patients suffered from acute or long-term complications. The use of CO2 laser ablation therapy, for PeIN, appears to be low-risk, effective, and yields cosmetically acceptable outcomes for patients.
Written By: Haisam Shah, BSc