REDUCING DIAGNOSTIC AND TREATMENT DELAYS IN PENILE CANCER: A CALL FOR IMPROVED REFERRAL SYSTEMS

Penile cancer (PeCa) is often stigmatized by patients and their families, leading to delays in diagnosis. Timely referral is essential for improving outcomes. We aimed to examine the critical link between the time frame from the appearance to patient referral and its impact on clinical outcomes.

Data from a prospectively database of the last PeCa who underwent surgical resection at a single center were analysed. Three time intervals from the moment PeCa was first identified were considered: i) time until first medical consultation with a general practitioner (GP) (T0); ii) time until evaluation by a general urologist (GU) (T1); iii) time until treatment at specialised urology center (SC) (T2). We assessed the correlation between the segregated time intervals and the surgical stage and oncological treatments.

Data from 37 patients were analysed. Median (IQR) age at surgery was 68 (52.5-76) years. 14 (37.8%) patients were referred through GP, GU, and SC, whilst 7 (18.9%) referred directly by the GP to the SC. 14 (37.8%) went straight to SC. Among those referred through the GP, GU, and SC, the median waiting time for GP was 6 mo (3.25-21.25), 8.5 mo (5-23.75) for GU, and 13 mo (7.75-30.25) for SC treatment. The median time from GP to GU was 1 mo (1-2), from GU to SC 3.5 mo (1.75-5.25), and from GP to SC 1 mo (1-2). The median waiting time from GP or GU referral to SC was 3 mo (1-6) and 3.5 mo (1.75-5.25), respectively. Overall, the median time from PeCa appearance to SC treatment was 12 mo (4-28), with 26 (70%) men experiencing delays over 6 mo. The longer the delay in referral to SC the higher the T stages (>T2 6 (35%) vs. 0 (0%), p = 0.03) and the more frequent the need for radical treatments (8 (31%) vs. 0 (0%), p = 0.046).

Delays often lead to reduced conservative treatment, potentially impacting oncological outcomes and quality of life. Raising social awareness and establishing dedicated referral channels to direct patients to the appropriate centers should be prioritized to reduce time wasting.

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