Types of treatment of penile cancer

Summary

Doctors usually treat large penile tumours through surgery; while they prescribe alternative options; such as radiotherapy depending on the size and stage of the tumour and condition of the patients.

Introduction

Larger tumours of the penis that penetrate the corpus cavernosum or nearby organs require surgery, such as partial or complete resection of the penis. As an alternative to surgery, doctors also offer radiation therapy for the primary tumour, depending on the patient’s condition and the size and stage of the tumour.

Surgery

Surgery is the basis for the treatment of locally invasive PSCC. Resection of the primary lesion eliminates all disease locally invasive tumours and provides a final disease stage without the loss of intratumoral heterogeneity and the risk of underestimation as a result of incision or punch biopsy.

Modern European Association of Urology (EAU) guidelines now recommend using organ-sparing surgery (OSS) whenever possible. In OSS, the primary tumour is completely removed, preserving as much as possible the functional length and anatomy of the penis while preserving the three important functions of the penis: sexual pleasure and sensation; aesthetics and masculinity^​1​.

There are many OSS technologies available. In fact, doctors recommend Restoration of Glans coverage in patients with extensive PeIN (Tis) or limited epileptic seizures (T1)^​2​. However, several options are available for invasive tumours (T1-2), including Moh’s microscopic surgery, extensive local resection, migratory resection, or complete glanectomy with or without glan reconstruction. One can restrict tumours arising in the meatus or distal urethra by reconstructing the nasal passages using buccal autografts or other implants. Radical circumcision is therefore an option for tumours confined to the foreskin or tubular groove and is often used as an adjunct to all other types of resection^​3​.

Radiotherapy

One can associate primary penile surgery with significant psychological morbidity, especially if OSS is not available. An increased incidence of depression and suicide has been reported following penile resection making radiotherapy a potent long-term conservative treatment option. In localized cases (e.g. cT1-3, AJCC stage 1-2), treatment options include external beam radiotherapy (EBRT) and epilepsy brachytherapy (BT). The choice of radiotherapy depends on the size and location of the lesion as BT is not widely available and depends on the availability of expertise. Minor distal lesions may be considered for BT, whereas lesions >4 cm or involving the shaft are more appropriate in EBRT.

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