genitourinary disorders
Penile Cancer
Treatment of Penile Cancer
Usually surgical Sometimes topical treatment, laser ablation, or radiation therapy Untreated infiltrative penile cancer progresses, typically causing death within 2 years. Treated early, penile cancer can usually be cured. Topical treatment with 5-fluorourcil orimiquimodand laser ablation are effective for small, superficial lesions. Radiation therapy (brachytherapy or external beam radiation therapy) can be considered, either as monotherapy or in conjunction with surgery and chemotherapy. Circumcision is done for lesions of the foreskin. Wide excision is preferred for recurrent lesions or in patients who cannot reliably follow up. Mohs surgery, when available, can be done instead of wide excision. Invasive and high-grade lesions require more radical resection. Partial penectomy is appropriate if the tumor can be completely excised with adequate margins, leaving a penile stump that permits urination and sexual function. Total (radical) penectomy is required for large infiltrative lesions. If tumors are high-grade or invade the corpora, bilateral ilioinguinal lymphadenectomy is required. Lymph node status predicts survival, as patients with nodal metastases have significantly worse prognosis. If there is suspicion for bilateral node-positive disease, bulky unilateral lymphadenopathy, or pelvic lymphadenopathy, then chemotherapy prior to lymphadenectomy is advised. The role of radiation therapy has not been established. For advanced, invasive cancer, palliation may include surgery and radiation therapy, but cure is unlikely. Chemotherapy for advanced cancer has had limited success. Targeted and immunotherapy used for head and neck squamous cell cancers may prove useful for penile cancer patients, but no definitive studies support their use in routine clinical practice. 