What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes.

CONTEXT: The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh's micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. OBJECTIVE: To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. EVIDENCE ACQUISITION: The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. EVIDENCE SYNTHESIS: The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh's micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. CONCLUSIONS: Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. PATIENT SUMMARY: We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh's micrographic surgery could be used for smaller lesions

Maximum-Entropy Inference with a Programmable Annealer

Optimisation problems in science and engineering typically involve finding the ground state (i.e. the minimum energy configuration) of a cost function with respect to many variables. If the variables are corrupted by noise then this approach maximises the likelihood that the solution found is correct. An alternative approach is to make use of prior statistical information about the noise in conjunction with Bayes's theorem. The maximum entropy solution to the problem then takes the form of a Boltzmann distribution over the ground and excited states of the cost function. Here we use a programmable Josephson junction array for the information decoding problem which we simulate as a random Ising model in a field. We show experimentally that maximum entropy decoding at finite temperature can in certain cases give competitive and even slightly better bit-error-rates than the maximum likelihood approach at zero temperature, confirming that useful information can be extracted from the excited states of the annealing device. Furthermore we introduce a microscopic bit-by-bit analytical method which is agnostic to the specific application and use it to show that the annealing device samples from a highly Boltzmann-like distribution. Machines of this kind are therefore candidates for use in a wide variety of machine learning applications which exploit maximum entropy inference, including natural language processing and image recognition. We further show that the limiting factor for performance in our experiments is likely to be control errors rather than failure to reach equilibrium. Our work also provides a method for determining if a system is in equilibrium which can be easily generalized. We discuss possible applications of this method to spin glasses and probing the performance of the quantum annealing algorithm.Comment: 9 figures in main text 9 figures in supplemental material. Significant amount of new Monte Carlo data added in v2 at referees request. Accepted for Scientific Report