National penile cancer surgery centralisation in Ireland: five-year service performance, survival, and recurrence outcomes.

Abstract

Purpose: The provision of penile cancer care in specialist centres decreases overtreatment and improves patient outcomes. Penile cancer care was centralised in the Republic of Ireland in 2021. We assess five-year service performance versus international standards, oncologic outcomes, and evaluate risk factors for disease recurrence.

Methods: A retrospective analysis of prospectively collected data was performed. All patients undergoing penile cancer surgery at the National Penile Cancer Centre from January 2021 to July 2025 were included. Service metrics were compared against NHS and European Association of Urology standards. Overall survival (OS) was estimated by Kaplan-Meier. Multivariable logistic regression was carried out to assess factors associated with disease recurrence and mortality.

Results: 151 patients were included. Phallus preservation was performed in 77% (n = 116). Centralisation met or approached most international targets, but timely multidisciplinary discussion lagged. Definitive treatment was received by 80% of patients (n = 121) within 62 days. Median OS was 58.7 months; 1 and 3-year disease-specific survival was 90% and 82%, respectively. Lymph node positivity (OR 8.29, 95% CI 2.01-34.3, p = 0.003), lymphovascular invasion (OR 4.58, 95% CI 1.48-14.22, p = 0.008) and perineural invasion (OR 5.83, 95% CI 1.84-18.51, p = 0.003) were associated with increased risk of mortality on univariate analysis. Local recurrence was 6% (n = 7) following organ-sparing surgery. Positive margins were significantly associated with higher recurrence risk on multivariate analysis (OR 3.20, 95% CI 1.02-10.04, p = 0.046).

Conclusion: Centralisation of penile cancer services has delivered high rates of organ preservation and guideline-concordant care. Gaps in multidisciplinary discussion and pathological reporting identify priorities for ongoing service improvement.