From the Guidelines
Penile tumors require immediate medical attention and evaluation by a urologist, with treatment depending on the tumor type, stage, and location, and generally including surgical excision for early-stage disease, which may involve partial or total penectomy in advanced cases. The most common type is squamous cell carcinoma, which typically presents as a painless growth, ulcer, or rash on the penis. For early-stage disease, such as Tis or Ta, penile-preserving techniques, including topical therapy (5% 5-fluorouracil and 5% imiquimod cream), circumcision, and wide local excision, are recommended 1. For T1G1-2 disease, penile-preserving techniques, including wide local excision plus reconstructive surgery, laser therapy, and radiotherapy, are recommended 1.
For more advanced disease, such as T1G3-4 or T ≥ 2, treatment options include wide local excision, glansectomy, partial or total penectomy, and radiotherapy with or without chemotherapy 1. In cases with lymph node involvement, dynamic sentinel node biopsy (DSNB) is recommended for patients with non-palpable inguinal lymph nodes, and inguinal lymph node dissection (ILND) is recommended for patients with positive nodes 1.
Risk factors for penile cancer include HPV infection, phimosis, poor hygiene, smoking, and immunosuppression 1. Early detection significantly improves outcomes, so any persistent penile lesion should be promptly evaluated. Regular self-examination and practicing good genital hygiene are important preventive measures. HPV vaccination may also reduce risk, particularly when administered before sexual debut. The psychological impact of penile cancer and its treatment can be significant, so psychological support should be integrated into the care plan.
Some key points to consider in the management of penile tumors include:
- The importance of early detection and prompt evaluation
- The use of penile-preserving techniques for early-stage disease
- The role of surgery, radiotherapy, and chemotherapy in the treatment of more advanced disease
- The importance of addressing lymph node involvement
- The need for psychological support and preventive measures, such as HPV vaccination and good genital hygiene.
From the Research
Penile Tumor Overview
- Penile cancer is a rare clinical entity that contributes to significant patient morbidity and mortality 2
- Human papilloma virus (HPV) plays an important role in the carcinogenesis of penile squamous cell carcinoma (SCC) and is associated with improved clinical outcomes 2
Treatment Options
- Organ preservation strategies offer significant quality of life advantages over standard surgery and can be utilized without compromising oncological control 2
- Radiation therapy can be used for organ preservation strategies successfully in up to 70% of patients 2
- Brachytherapy yields excellent outcomes for disease control and organ and function preservation in early stage penile glans cancer 3
- External beam radiation therapy can be considered as palliative setting for irradiation of the primary tumor or for lymph node irradiation 3
Lymph Node Involvement
- Lymph node (LN) involvement in penile cancer is associated with poor survival, and early diagnosis and management significantly impact survival 4
- Surgery is the mainstay of LN disease management, with early inguinal LN dissection (ILND) associated with better outcomes 4
- Adjuvant radiotherapy may benefit pN2-3 but not pN1 disease, and adjuvant chemoradiotherapy may provide a small survival benefit in N3 disease 4
Role of Radiation Therapy
- Radiation therapy is a successful method of treatment for penile cancer in terms of local control and organ preservation after microscopically incomplete surgery 5
- Radiotherapy of the regional lymph nodes might also be effective in preventing regional recurrence and can be considered in case of high-risk features and following excision of extensive lymph node involvement 5