Psychological Impacts and in Quality of Life of Patients with Penile Cancer: Systematic Literature Review

Martins, Lucas Quaresma; Bezerra, Jade de Moraes; Silva, Carlos Eduardo Oliveira da; Silva, Stefanne de Cássia Pereira da; Figueiredo, Luma Fleury de; Lima, Julio César Coelho de; Lima, Luiz Felipe Leão; Nunes, Giovanna Gilioli da Costa; Carvalho, Luis Eduardo Werneck de

doi:10.32635/2176-9745.RBC.2025v71n3.4823EN

person Lucas Quaresma Martins

Substantially contributed to the study design and planning · acquisition · analysis and interpretation of data · wording and critical review

schoolUniversidade do Estado do Pará, Curso de Medicina. Belém (PA), Brasil.

0009-0006-2427-0576

person Jade de Moraes Bezerra

Substantially contributed to the study design and planning · acquisition · analysis and interpretation of data · wording and critical review

schoolUniversidade do Estado do Pará, Curso de Medicina. Belém (PA), Brasil.

0000-0002-3380-502X

person Carlos Eduardo Oliveira da Silva

contributed to the study design · analysis and interpretation of data · as well as the wording and critical review

schoolUniversidade do Estado do Pará, Curso de Medicina. Belém (PA), Brasil.

0009-0004-4783-2733

person Stefanne de Cássia Pereira da Silva

contributed to the study design · analysis and interpretation of data · as well as the wording and critical review

schoolUniversidade do Estado do Pará, Curso de Medicina. Belém (PA), Brasil.

0000-0002-9093-5330

person Luma Fleury de Figueiredo

contributed to the study design · data acquisition and wording

schoolUniversidade do Estado do Pará, Curso de Medicina. Belém (PA), Brasil.

0009-0001-3399-6575

person Julio César Coelho de Lima

contributed to the study design · data analysis and critical review · All the authors approved the final version for publication

schoolUniversidade do Estado do Pará, Curso de Medicina. Belém (PA), Brasil.

0000-0001-7542-4113

person Luiz Felipe Leão Lima

contributed to the study design · data analysis and critical review · All the authors approved the final version for publication

schoolUniversidade do Estado do Pará, Curso de Medicina. Belém (PA), Brasil.

0000-0003-4629-8589

person Giovanna Gilioli da Costa Nunes

contributed to the study design · data analysis and critical review · All the authors approved the final version for publication

schoolUniversidade Federal do Pará (UFPA). Belém (PA), Brasil.

0009-0002-9005-0281

person Luis Eduardo Werneck de Carvalho

contributed to the study design · data analysis and critical review · All the authors approved the final version for publication

schoolInstituto Oncológica do Brasil Ensino e Pesquisa. Belém (PA), Brasil.

0000-0002-4185-6871

personCorresponding author: Lucas Quaresma Martins. Rua Arcipreste Manoel Teodoro, 359, Edifício Dom Pedro I, Apartamento 213 – Batista Campos. Belém (PA), Brasil. CEP
66023-700. E-mail:
lucasquaresmamartins@gmail.com

DECLARATION OF CONFLICT OF INTERESTS

There is no conflict of interest to declare.

Associate-editor:

Fernando Lopes Tavares de Lima. Orcid iD: https://orcid.org/0000-0002-8618-7608

Scientific-editor:

Anke Bergmann. Orcid iD: https://orcid.org/0000-0002-1972-8777

Type of study	SN	Joanna Briggs Institute scale											Risk of bias
		Q.1	Q.2	Q.3	Q.4	Q.5	Q.6	Q.7	Q.8	Q.9	Q.10	Q.11
Cohort	1	Y	Y	Y	Y	Y	Y	Y	Y	N	N	Y	Low
	2	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Low
	3	Y	N	Y	N	N	Y	Y	Y	Y	N	Y	Moderate
Cross--sectional	4	Y	N	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	5	Y	N	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	6	Y	N	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	7	Y	Y	Y	Y	N	N	Y	Y	NA	NA	NA	Low
	8	Y	Y	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	9	Y	Y	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	10	Y	Y	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	11	Y	N	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	12	Y	N	Y	Y	Y	Y	Y	Y	NA	NA	NA	Low
	13	Y	Y	Y	Y	Y	N	Y	Y	NA	NA	NA	Low
	14	Y	Y	Y	Y	Y	N	Y	Y	NA	NA	NA	Low
	15	Y	Y	Y	Y	Y	N	Y	Y	NA	NA	NA	Low

SN	Author/Year	Type of study	Country	Sample	Main findings
1	Dräger; Protzel; Hakenberg, 2017¹⁶	Prospective cohort	Germany	40	Self-reported global QoL average was 54, significantly lower than the age-standardized average for German patients. Concerning general function, there was a significant decrease in roles (daily, leisurely), cognitive, emotional, and social functioning. Regarding specific cancer scores, patients reported limitations related to sexual function and their body image, as well as adverse effects related to the treatment
2	Jakobsen et al., 2022¹⁷	Prospective cohort	Denmark	157	Life satisfaction compared between patients with penile cancer 0, 1, and 2 years or more after the diagnosis was no different among the groups. Compared to a control cohort, there was a difference only in the score attributed to the “daily life activities” item in the three groups. Concerning satisfaction with life in groups 2 and 3, by type of treatment, most invasive treatments showed a tendency toward decreasing satisfaction
3	Wan et al., 2018¹⁸	Retrospective cohort	China	15	The orgasmic function score of patients who had a PP was significantly lower than the preoperative score, just like the score of patients who underwent wide local excision. Postoperative SEAR scores were significantly better than before the surgery and higher than in the wide excision group. There was no difference in the EDITS scores, on urinary function, or QVRH among groups
4	Chavarriaga et al., 2022¹⁹	Cross--sectional	Colombia	74	After assessing QoL, lower urinary tract symptoms, and erectile dysfunction in patients with penis cancer, compared scores between groups who underwent PP and inverted urethral flap, associated with a dynamic biopsy of the sentinel lymph node or dissection of the ilioinguinal lymph node were not significantly different
5	Cilio et al., 2023²⁰	Cross--sectional	Italy	60	Two penis-sparing procedures were compared: wide local excision and glandectomy. Patients who underwent glandectomies had significantly worse IIEF-5 and CSFQ scores
6	Croghan et al., 2021²¹	Cross--sectional	Ireland	35	Functional and QoL results of patients who underwent partial or radical glandectomy and PP were analyzed. Overall QoL was similar between groups. The tendency to urinate while standing was significantly associated with a better perception of overall urinary function. Patients who underwent glandectomy were more satisfied with the appearance of their genitalia and mostly reported absent or moderate erectile dysfunction, as well as some sensibility in the reconstructed glans. Better sexual performance was significantly related to better self-reported QoL
7	Firmansyah et al., 2023²²	Cross--sectional	Indonesia	9	All the patients who answered the questionnaire reported low QoL after penile cancer treatment
8	Gambachidze et al., 2018²³	Cross--sectional	France	23	Brachytherapy is related to greater satisfaction with the male genital self-image. There was a meaningful relationship between reported QoL and patient pain, not with sexual or urinary function. Average reported QoL was 80
9	Harju et al., 2021²⁴	Cross-sectional	Finland	68	The self-reported average QoL was 0.841, significantly lower than the average Finnish population. Statistical differences were in the following dimensions: breathing, sleep, usual activities, suffering, depression, vitality, and sexual activity. Overall sexual function and hardness of the erection were associated with the reported QoL. Patients with no changes to sexual function had better QoL scores
10	Kieffer et al., 2014²⁵	Cross-sectional	Netherlands	90	The overall QoL of patients was similar to that of men of the same age in the population. Men who underwent PP reported significantly more problems with orgasm, appearance, interference in life, and urinary function. Those who underwent lymphadenectomy reported significantly more interference in life than those who did not undergo it. Urinary problems were significantly greater after PP compared to conservative procedures
11	Perez et al., 2020²⁶	Cross-sectional	Colombia	32	The average QoL score reported was 82.5%, and 94% reported not being depressed or anxious after the treatment. There was no significant functional difference among the adopted penis-sparing procedures
12	Santos-Lopes et al., 2017²⁷	Cross-sectional	Portugal	16	After the cancer treatment, the average IIFE-5 score was 16.25 – highlighting mild/moderate erectile dysfunction, compared to the absence of dysfunction before treatment. The score was lower in the group of patients that underwent PP (15.0), compared to other treatments (18.6)
13	Sosnowski et al., 2017²⁸	Cross-sectional	Poland	51	More aggressive interventions were significantly related to a worse QoL and overall health state perceived by some of the patients, as well as worse physical function
14	Sosnowski et al., 2018²⁹	Cross-sectional	Poland	40	High self-esteem levels were reported in both penectomy groups with low or intermediate disfigurement. Men who underwent conservative treatment reported feeling significantly more masculine. Patients prefer treatment methods associated with worse survival but with a greater chance of having satisfactory sexual performance. No significant difference was perceived between erectile function or self-esteem
15	Suarez-Ibarrola; Cortes-Telles; Miernik, 2018³⁰	Cross-sectional	Mexico	10	Patients kept high QoL scores, despite alterations in the pain sub-scale. Men who underwent PP reported more pain than those who underwent total penectomy. Similarly, patients submitted to inguinal lymphadenectomy also reported significantly more pain than other groups. The average IIEF-5 score in patients who underwent PP was 6.5, indicating severe erectile dysfunction

Study	Applied Questionnaires	Assessed Domain
S1, S3, S6, S7, S13	European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EOETC-QLQ-C30)	Quality of life
S4, S8, S11	EQ-5D-5L	Quality of life
S9	15D	Quality of life
S10, S15	Short Form-36 (SF-36)	Quality of life
S10	Impact Of Cancer (IOCV2)	Quality of life
S1	Health-Related Outcomes in Penile Cancer (HRO-PE29)	Quality of life
S2	Life-Satisfaction Questionnaire-11 (LISAT-11)	Satisfaction with life
S3, S4, S5, S6, S10, S11, S12, S14, S15	International Index of Erectile Function (IIEF-15)	Erectile function
S3	Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)	Erectile function
S9	Erection Hardness Score	Erectile function
S3	Sexual Experience and Relationship Quality Questionnaire (SEAR)	Self-esteem and sexual function
S9	Rosenberg Self-Esteem Scale	Self-esteem
S5	Changes in Sexual Functioning Questionnaire (CSFQ)	Sexual function
S9	Overall Sexual Functioning Questionnaire (OSFQ)	Sexual function
S4, S8, S11	International Consultation on Incontinence Questionnaire – Male Lower Urinary Tract Symptoms (ICIQ-MLUTS)	Lower Urinary Tract Symptoms
S8	International Continence Society Male Short Form (ICSmaleSF)	Lower Urinary Tract Symptoms
S6, S8	Index of Male Genital Image (IMGI)	Genital image
S14	Conformity to Masculine Norms Inventory-22 (CMNI-22)	Feeling masculine

[1] Captions: “SN” means study number. Q.1 to Q.11 indicate questions 1-11 of the Joanna Briggs Institute risk of bias questionnaire. “Y” = yes; “N” = no; “U” = uncertain; “NA” = not applicable.

Psychological Impacts and in Quality of Life of Patients with Penile Cancer: Systematic Literature Review

ABSTRACT