Materiały źródłowe

• #1 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/disease-management

  Besides its role in sexual functioning and urination, a fully functional penis is central to a patients sense of wholeness, desirability and masculinity. Hence, the aims of the treatment of the primary tumour are complete tumour removal with as much organ preservation as possible, without compromising oncological control. […] Penile preservation appears to be superior in functional and cosmetic outcomes as compared to partial or total penectomy and is considered to be the primary treatment method for localised penile cancer, based on retrospective studies. […] Local treatment modalities for small and localised penile cancer include topical therapy, laser ablation, excisional surgery, external beam radiotherapy (EBRT) and brachytherapy. […] Topical therapy with imiquimod (IQ) or 5-fluorouracil (5-FU) are effective non-invasive first-line treatment options which use is increasingly reported.

• #2 Treating Penile Cancer | Penile Cancer Treatment | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating.html

  If youve been diagnosed with penile cancer, your treatment team will discuss your options with you. Its important to weigh the benefits of each treatment option against the possible risks and side effects. […] Surgery is the main treatment for most men with penile cancers, but sometimes radiation therapy may be used, either instead of or in addition to surgery. Other local treatments might also be used for early-stage tumors. Chemotherapy may be given for some larger tumors or if the cancer has spread. […] The goal of your cancer care team is to treat the cancer while limiting the treatments effects on how your penis looks and works. […] If the cancer cant be cured, the goal may be to remove or destroy as much of the cancer as possible and prevent the tumor from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at relieving symptoms, such as pain or bleeding, even if you might not be cured.

• #3 Penile Cancer: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/6181-penile-cancer

  Treatment depends on the size of the tumor, whether its spread and how likely it is that the cancer will return (recur). Treatment may involve a care team that includes your primary care physician (PCP), a cancer specialist (oncologist), a urinary tract specialist (urologist), a radiation specialist (radiation oncologist) and a skin specialist (dermatologist). […] For early-stage cancer, your healthcare provider may recommend one or more of the following treatments: […] For cancer thats more advanced, your healthcare provider may recommend: […] Your healthcare provider may use radiation, chemotherapy or both before or after surgery. […] For cancer that has spread outside of your lower belly, chemotherapy or other medicines (systemic treatment) are the main treatment. […] Penile cancer can be curable if caught early. Cleveland Clinic provides the diagnosis, treatment and support you need to keep enjoying life.

• #4 Treatments for penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/treatment

  If you have penile cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for penile cancer, your healthcare team will consider: […] Surgery is the primary treatment for penile cancer. The type of surgery you have depends mainly on the size of the tumour, stage of the cancer, depth of the tumour and type of tumour. […] Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is sometimes used to treat penile cancer. […] Chemotherapy is sometimes used to treat penile cancer. The role of chemotherapy in treating penile cancer is still evolving. […] Penile cancer behaves differently in each man, and a standard follow-up schedule would not work for everyone. Men with penile cancer should talk to their doctor about a follow-up plan that suits their individual situation. Follow-up care is often shared among the cancer specialists (oncologists), surgeon, urologist and family doctor.

• #5 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Penile cancer is a type of cancer that forms in the tissues of the penis. […] Human papillomavirus infection may increase the risk of developing penile cancer. […] Signs of penile cancer include sores, discharge, and bleeding. […] Tests that examine the penis are used to diagnose penile cancer. […] After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body. […] Certain factors affect prognosis (chance of recovery) and treatment options. […] There are different types of treatment for people with penile cancer. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy, Immunotherapy. […] Treatment for penile cancer may cause side effects. […] Follow-up care may be needed.

• #6 5 Innovative Penile Cancer Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/penile-cancer/penile-cancer-treatment.html

  When you’re treated at MD Anderson for penile cancer, some of the nation’s top specialists focus their expertise on you. They communicate with each other and with you to ensure you receive the most advanced penile cancer treatment with the least impact on your body. […] Surgery is the most frequent form of penile cancer treatment, but laser therapy and radiation may be used for smaller tumors. The type of treatment usually depends on how far the cancer has spread. […] Your penile cancer treatment will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms. […] Surgery to remove all or part of the penis is called penectomy. Penile preservation surgery (the penis is not removed) is used to treat penile cancer whenever possible.

• #7 Treating Penile Cancer | Penile Cancer Treatment | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating.html

  If youve been diagnosed with penile cancer, your treatment team will discuss your options with you. Its important to weigh the benefits of each treatment option against the possible risks and side effects. […] Surgery is the main treatment for most men with penile cancers, but sometimes radiation therapy may be used, either instead of or in addition to surgery. Other local treatments might also be used for early-stage tumors. Chemotherapy may be given for some larger tumors or if the cancer has spread. […] The goal of your cancer care team is to treat the cancer while limiting the treatments effects on how your penis looks and works. […] If the cancer cant be cured, the goal may be to remove or destroy as much of the cancer as possible and prevent the tumor from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at relieving symptoms, such as pain or bleeding, even if you might not be cured.

• #8 Treatment of Penile Cancer, by Stage | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating/by-stage.html

  These cancers are usually treated with a partial or total penectomy, with or without surgery to remove the lymph nodes. A less common approach is to use radiation as the first treatment followed by surgery. Radiation may also be used as the main treatment in men who cant have surgery because of other health problems. […] Stage III cancers are treated with a partial or total penectomy. In some cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor so that it’s easier to remove with surgery. […] Treatment includes surgery, which is often a total penectomy. If the tumor is in the scrotum or parts of the abdominal wall, the testicles and/or the scrotum may also need to be removed. […] Chemo (sometimes with radiation) may be given before surgery to try to shrink the tumor and make it easier to remove.

• #9 Treating penile cancer : University College London Hospitals NHS Foundation Trust

  https://www.uclh.nhs.uk/our-services/find-service/cancer-services/penile-penis-cancer-1/treating-penile-cancer

  UCLH is one of only twelve specialist centres in the UK for the treatment of penile cancer, and one of only two in London. UCLH provides a comprehensive penile cancer service for patients, together with ongoing clinical trials and research. […] If the cancer is located only on the foreskin, it may be possible to treat it by the surgical removal of the foreskin (circumcision). […] If the cancer is small or only a small surface is involved with cancer and it has not spread elsewhere then it can usually be treated by removing only the affected area and a small area around it. […] For superficial (surface) pre malignant disease or superficial early cancers it may be possible to remove the top layer of the mucosa lining the glans (tip of penis) and use a skin graft from the thigh in order to cover the treated area.

• #10 Treatments for Penile Cancer | Cancer Support Community

  https://www.cancersupportcommunity.org/article/more-about-treatments-penile-cancer

  Several different kinds of surgery are used to treat penile cancers: Circumcision – This operation removes the foreskin and nearby skin. This can cure cancers that are only in the foreskin. It is also done to remove the foreskin before radiation therapy to the penis. Excision – In this operation, the tumor is removed along with normal skin. If the tumor is small, the remaining skin can be stitched back together. This is the same as an excisional biopsy. In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind. Mohs Surgery – Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells. Although the process is slow, more normal tissue near the tumor can be saved. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for precancerous conditions and for some cancers that have not invaded deeply into the penis. Laser Surgery – This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin) and for very thin or shallow basal cell cancers. Partial or Total Penectomy – This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The surgeon will try to leave as much of the shaft as possible. The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains). If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the „on-off” valve) in the urethra is left behind, but the man will have to sit down to urinate.

• #11 Treatments for Penile Cancer | Cancer Support Community

  https://www.cancersupportcommunity.org/article/more-about-treatments-penile-cancer

  Several different kinds of surgery are used to treat penile cancers: Circumcision – This operation removes the foreskin and nearby skin. This can cure cancers that are only in the foreskin. It is also done to remove the foreskin before radiation therapy to the penis. Excision – In this operation, the tumor is removed along with normal skin. If the tumor is small, the remaining skin can be stitched back together. This is the same as an excisional biopsy. In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind. Mohs Surgery – Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells. Although the process is slow, more normal tissue near the tumor can be saved. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for precancerous conditions and for some cancers that have not invaded deeply into the penis. Laser Surgery – This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin) and for very thin or shallow basal cell cancers. Partial or Total Penectomy – This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The surgeon will try to leave as much of the shaft as possible. The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains). If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the „on-off” valve) in the urethra is left behind, but the man will have to sit down to urinate.

• #12 Penile Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/penile/hp/penile-treatment-pdq

  When diagnosed early (stage 0, stage I, and stage II), penile cancer is highly curable. Curability decreases sharply for stage III and stage IV disease. Because of the rarity of this cancer in the United States, clinical trials specifically for penile cancer are infrequent. Patients with stage III and stage IV cancer are candidates for phase I and phase II clinical trials testing new drugs, biological therapy, or surgical techniques to improve local control and distant metastases. […] Treatment options: Surgical excision can result in scarring, deformity, and impaired function. To minimize these effects, Mohs micrographic surgery, which involves the excision of successive horizontal layers of tissue with microscopic examination of each layer in frozen section, has been used in patients with in situ and invasive penile cancers.

• #13 Treating penile cancer : University College London Hospitals NHS Foundation Trust

  https://www.uclh.nhs.uk/our-services/find-service/cancer-services/penile-penis-cancer-1/treating-penile-cancer

  For larger cancers involving just the head of the penis, the bulbous part (the glans) will be removed. This is called a glansectomy. […] This may be advised if the cancer is large and is involving a large area of the penis. Amputation may be partial (where only part of the penis is removed) or total (removal of the whole penis). […] UCLH is the only centre in the country that currently offers total penile reconstruction (radial artery phalloplasty). […] Radiotherapy treats cancer using high-energy rays to destroy cancer cells, while doing as little harm as possible to healthy cells. […] Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. […] After your treatment is completed, you will have regular check-ups and possibly scans or X-rays. These will probably continue for several years.

• #14 Treatment options for penile cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/penile-cancer/treatment/treatment-options

  Your doctor will talk to you about the treatment they suggest. They will explain its benefits and the possible side effects. The main treatments for cancer of the penis are: surgery, radiotherapy, chemotherapy. You might have one or more of these treatments. A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). To decide which treatment you need, your team looks at your test and scan results to see: where your cancer is, how big it is and whether it has spread into the nearby lymph nodes or somewhere else in the body (the stage), the type of penile cancer, how abnormal the cells look under a microscope (the grade). The TNM staging system is the most common way that doctors stage penile cancer. TNM stands for Tumour, Node, Metastasis. This describes whether the cancer is in the top layers of the skin or has grown deeper into the penis. It also describes whether the cancer has spread to the lymph nodes and other parts of the body. The treatment you have will depend on: what your doctor thinks is best for your type of cancer, which treatments are available at your hospital, your personal choice, your general health and level of fitness. You might have cancer only in the top layers of the skin of the penis. The areas look like small lumps (nodules) or sores (ulcers) and can vary in size. The condition can stay at this stage for several years. The cancer hasnt spread anywhere else. Doctors might call this penile intraepithelial neoplasia (PeIN) or pre cancerous cell changes. An older term for this is carcinoma in situ (CIS). There are various treatments for PeIN. The aim is to keep the penis looking and working normally. Treatments you may have include one of the following: chemotherapy creams such as fluorouracil (5FU), or a cream called imiquimod that uses the immune system to fight cancer, laser therapy, glans resurfacing surgery – where the top layers of tissue from the glans or tip of the penis are removed and then covered with a skin graft. Surgery is the main treatment for cancer that has grown deeper into the glans. This is T1 or T2 in the TNM staging system. For small, localised cancers, your team will try to prevent the loss of your penis. You might have removal of the foreskin (circumcision) if the cancer is only in the foreskin. If your cancer is elsewhere on the penis you might have one of the following treatments: removal of the cancer and a surrounding area of tissue (wide local excision) and circumcision, removal of part of the head of the penis (partial glansectomy), total removal of the head of the penis (total glansectomy) with or without glans reconstruction, removal of part of the penis (partial penectomy) with or without a glans reconstruction from a skin graft, internal or external radiotherapy to the penis. Surgery is the main treatment for cancer that has grown deeper into the penis. You might hear this called invasive penile cancer. This is T2, T3 or T4 in the T part of the TNM system. You might have one of the following: total removal of the head of the penis (total glansectomy) with circumcision, removal of the cancer and a surrounding area of tissue (wide local excision) – this is less common than other treatments for invasive penile cancer, removal of part of the penis (partial penectomy), removal of all of the penis (penectomy), chemotherapy then surgery, internal or external radiotherapy to the penis. Doctors look at the risk of your penile cancer spreading to the lymph nodes in your groin or pelvis. If you have cancer in your lymph nodes you might have one of the following: removal of lymph nodes in your groin on one, or both, sides, removal of lymph nodes in your pelvis on one, or both, sides, chemotherapy before lymph node removal (neoadjuvant chemotherapy), chemotherapy after lymph node removal (adjuvant chemotherapy), radiotherapy to the lymph nodes the aim of this is to try and control the cancer in the lymph nodes. You might have surgery if your cancer has spread into local areas, such as the prostate, bladder, scrotum or abdominal wall. Some people have chemotherapy, sometimes with radiotherapy, before surgery. The aim is to shrink the cancer and make it easier to remove. You usually have surgery if cancer has spread into the nearby lymph nodes and surrounding tissues, or to lymph nodes in the pelvis. You might have radiotherapy to the lymph node areas to try to kill any cancer cells that might be left behind. Your cancer is advanced if it has spread to distant organs and tissues. The aim of your treatment is to keep the cancer under control and prevent or relieve symptoms. You might have surgery to remove as much of the cancer in the penis as possible. Your treatment will depend on several factors if the cancer comes back after treatment. Your specialist may suggest more surgery. Or you might have radiotherapy if you are not able to have surgery. You might have chemotherapy if the cancer has spread to other parts of the body. Your doctor might ask if youd like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

• #15 Treatment options for penile cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/penile-cancer/treatment/treatment-options

  Your doctor will talk to you about the treatment they suggest. They will explain its benefits and the possible side effects. The main treatments for cancer of the penis are: surgery, radiotherapy, chemotherapy. You might have one or more of these treatments. A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). To decide which treatment you need, your team looks at your test and scan results to see: where your cancer is, how big it is and whether it has spread into the nearby lymph nodes or somewhere else in the body (the stage), the type of penile cancer, how abnormal the cells look under a microscope (the grade). The TNM staging system is the most common way that doctors stage penile cancer. TNM stands for Tumour, Node, Metastasis. This describes whether the cancer is in the top layers of the skin or has grown deeper into the penis. It also describes whether the cancer has spread to the lymph nodes and other parts of the body. The treatment you have will depend on: what your doctor thinks is best for your type of cancer, which treatments are available at your hospital, your personal choice, your general health and level of fitness. You might have cancer only in the top layers of the skin of the penis. The areas look like small lumps (nodules) or sores (ulcers) and can vary in size. The condition can stay at this stage for several years. The cancer hasnt spread anywhere else. Doctors might call this penile intraepithelial neoplasia (PeIN) or pre cancerous cell changes. An older term for this is carcinoma in situ (CIS). There are various treatments for PeIN. The aim is to keep the penis looking and working normally. Treatments you may have include one of the following: chemotherapy creams such as fluorouracil (5FU), or a cream called imiquimod that uses the immune system to fight cancer, laser therapy, glans resurfacing surgery – where the top layers of tissue from the glans or tip of the penis are removed and then covered with a skin graft. Surgery is the main treatment for cancer that has grown deeper into the glans. This is T1 or T2 in the TNM staging system. For small, localised cancers, your team will try to prevent the loss of your penis. You might have removal of the foreskin (circumcision) if the cancer is only in the foreskin. If your cancer is elsewhere on the penis you might have one of the following treatments: removal of the cancer and a surrounding area of tissue (wide local excision) and circumcision, removal of part of the head of the penis (partial glansectomy), total removal of the head of the penis (total glansectomy) with or without glans reconstruction, removal of part of the penis (partial penectomy) with or without a glans reconstruction from a skin graft, internal or external radiotherapy to the penis. Surgery is the main treatment for cancer that has grown deeper into the penis. You might hear this called invasive penile cancer. This is T2, T3 or T4 in the T part of the TNM system. You might have one of the following: total removal of the head of the penis (total glansectomy) with circumcision, removal of the cancer and a surrounding area of tissue (wide local excision) – this is less common than other treatments for invasive penile cancer, removal of part of the penis (partial penectomy), removal of all of the penis (penectomy), chemotherapy then surgery, internal or external radiotherapy to the penis. Doctors look at the risk of your penile cancer spreading to the lymph nodes in your groin or pelvis. If you have cancer in your lymph nodes you might have one of the following: removal of lymph nodes in your groin on one, or both, sides, removal of lymph nodes in your pelvis on one, or both, sides, chemotherapy before lymph node removal (neoadjuvant chemotherapy), chemotherapy after lymph node removal (adjuvant chemotherapy), radiotherapy to the lymph nodes the aim of this is to try and control the cancer in the lymph nodes. You might have surgery if your cancer has spread into local areas, such as the prostate, bladder, scrotum or abdominal wall. Some people have chemotherapy, sometimes with radiotherapy, before surgery. The aim is to shrink the cancer and make it easier to remove. You usually have surgery if cancer has spread into the nearby lymph nodes and surrounding tissues, or to lymph nodes in the pelvis. You might have radiotherapy to the lymph node areas to try to kill any cancer cells that might be left behind. Your cancer is advanced if it has spread to distant organs and tissues. The aim of your treatment is to keep the cancer under control and prevent or relieve symptoms. You might have surgery to remove as much of the cancer in the penis as possible. Your treatment will depend on several factors if the cancer comes back after treatment. Your specialist may suggest more surgery. Or you might have radiotherapy if you are not able to have surgery. You might have chemotherapy if the cancer has spread to other parts of the body. Your doctor might ask if youd like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

• #16 Treatments for Penile Cancer | Cancer Support Community

  https://www.cancersupportcommunity.org/article/more-about-treatments-penile-cancer

  Several different kinds of surgery are used to treat penile cancers: Circumcision – This operation removes the foreskin and nearby skin. This can cure cancers that are only in the foreskin. It is also done to remove the foreskin before radiation therapy to the penis. Excision – In this operation, the tumor is removed along with normal skin. If the tumor is small, the remaining skin can be stitched back together. This is the same as an excisional biopsy. In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind. Mohs Surgery – Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells. Although the process is slow, more normal tissue near the tumor can be saved. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for precancerous conditions and for some cancers that have not invaded deeply into the penis. Laser Surgery – This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin) and for very thin or shallow basal cell cancers. Partial or Total Penectomy – This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The surgeon will try to leave as much of the shaft as possible. The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains). If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the „on-off” valve) in the urethra is left behind, but the man will have to sit down to urinate.

• #17 Penile Cancer Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/446554-treatment

  European Association of Urology guidelines note that superficial lesions (Tis, Ta, and T1a disease) can be treated with the following penis-sparing techniques: local excision with or without circumcision, laser therapy, Mohs micrographic surgery (for verrucous carcinoma), and photodynamic therapy (for superficial lesions). […] The standard of therapy for the primary cancer is local excision and either partial or total penectomy. […] A partial amputation is appropriate when the cancer involves the glans and distal shaft. […] Local wedge resection is feasible in some situations, but this is associated with a recurrence rate of 50%. […] Mohs micrographic surgery (MMS) is applicable in some patients with noninvasive disease. […] Laser surgery has been used for patients with superficial benign and malignant lesions.

• #18 Treatments for Penile Cancer | Cancer Support Community

  https://www.cancersupportcommunity.org/article/more-about-treatments-penile-cancer

  Several different kinds of surgery are used to treat penile cancers: Circumcision – This operation removes the foreskin and nearby skin. This can cure cancers that are only in the foreskin. It is also done to remove the foreskin before radiation therapy to the penis. Excision – In this operation, the tumor is removed along with normal skin. If the tumor is small, the remaining skin can be stitched back together. This is the same as an excisional biopsy. In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind. Mohs Surgery – Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells. Although the process is slow, more normal tissue near the tumor can be saved. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for precancerous conditions and for some cancers that have not invaded deeply into the penis. Laser Surgery – This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin) and for very thin or shallow basal cell cancers. Partial or Total Penectomy – This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The surgeon will try to leave as much of the shaft as possible. The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains). If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the „on-off” valve) in the urethra is left behind, but the man will have to sit down to urinate.

• #19 Penile cancer | Treatment | UK Healthcare

  https://ukhealthcare.uky.edu/markey-cancer-center/cancer-types/penile-cancer/treatment

  Outstanding cancer care requires an unparalleled team. Our specialists in medical oncology, chemotherapy, radiation medicine, pathology and urology all work and consult together to deliver you the most effective treatments. […] If penile cancer is detected very early, it may be treatable with: Cryotherapy, where the tumor is frozen off; Laser therapy, where the tumor is burned off; Topical skin cream. […] Different types of surgery may be used to remove the cancer and prevent its return, including: Circumcision, where the foreskin of the penis is removed; Glansectomy, which removes the tip of the penis; Emasculation, which removes the penis, scrotum and testicles; Partial penectomy, which removes more of the penis than just the head; Total penectomy, which removes the entire penis; Wide local excision, which cuts out the tumor and the skin immediately around it.

• #20 Penile Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/penile/hp/penile-treatment-pdq

  Stage II penile cancer is most frequently managed by penile amputation for local control. […] External-beam radiation therapy and brachytherapy with surgical salvage are alternative approaches. […] Inguinal adenopathy in patients with penile cancer is common but may be the result of infection rather than neoplasm. […] If palpable enlarged lymph nodes exist 3 or more weeks after removal of the infected primary lesion and completion of a course of antibiotic therapy, bilateral inguinal lymph node dissection should be performed. […] No standard treatment exists that is curative for patients with stage IV penile cancer. Therapy is directed at palliation, which may be achieved either with surgery or radiation therapy. […] Palliative surgery may be considered for control of the local penile lesion and even for the prevention of the necrosis, infection, and hemorrhage that can result from neglected regional adenopathy. […] Radiation therapy may be palliative for the primary tumor, regional adenopathy, and bone metastases. […] Patients with locally recurrent disease can be treated with surgery or radiation therapy. If the initial treatment of radiation therapy fails, patients often undergo penile amputation.

• #21 Multimodality therapy in penile cancer: when and which treatments?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4164341/

  Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. […] To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review. […] There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. […] Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting. […] In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. […] Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy.

• #22 Treatment for penile cancer – NHS

  https://www.nhs.uk/conditions/penile-cancer/treatment/

  Penile cancer may be more treatable if it’s found early. […] Treatment for early cancer often involves non-surgical treatments, for example, a chemotherapy cream, such as 5 fluorouracil (5FU), and laser therapy. […] If the cancer is found later, treatment may include surgery, chemotherapy and radiotherapy. […] Surgery for penile cancer can include removing the cancer and a small area around it to reduce the risk of it coming back. […] Reconstructive surgery may be possible if your penis needs to be removed. This uses skin and muscle from other parts of the body to create a working penis. […] If caught early, penile cancer can sometimes be treated with creams you apply to the skin of your penis or foreskin. […] You may be treated with a cream if your penile cancer has been caught early, and the cancer affects your foreskin or the end of your penis.

• #23 5 Innovative Penile Cancer Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/penile-cancer/penile-cancer-treatment.html

  New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target penile cancer more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. In penile cancer, radiation therapy may be used to treat early stage tumors, with surgery to remove lymph nodes, and in advanced cancers to control spread and help relieve symptoms. […] MD Anderson offers the most up-to-date and advanced chemotherapy options for penile cancer. […] Penile cancer is treated in our Genitourinary Center. […] MD Anderson patients have access to clinical trials offering promising new treatments that cannot be found anywhere else.

• #24 Penile Cancer Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/446554-treatment

  Circumcision is recommended prior to initiating radiation therapy for cancers involving the prepuce. […] Various dose-fractionated schedules have been reported, but the most widely accepted schedule for cancers smaller than 4 cm is 4,000 cGy in 20 fractions over 4 weeks to the entire shaft of the penis. […] In carefully selected patients, the local control rate varies from 60-90%. […] Two techniques have been described for brachytherapy. […] A wide variety of agents and schedules have been used to treat patients with metastases beyond the pelvic and inguinal lymph nodes. […] Response rates for cisplatin monotherapy range from 15-23%, and these have been largely partial responses of short duration. […] Current National Comprehensive Cancer Network (NCCN) penile cancer guidelines recommend neoadjuvant chemotherapy with paclitaxel, ifosfamide, and cisplatin in patients with palpable bulky inguinal lymph node involvement.

• #25 Penile Cancer Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/446554-treatment

  Circumcision is recommended prior to initiating radiation therapy for cancers involving the prepuce. […] Various dose-fractionated schedules have been reported, but the most widely accepted schedule for cancers smaller than 4 cm is 4,000 cGy in 20 fractions over 4 weeks to the entire shaft of the penis. […] In carefully selected patients, the local control rate varies from 60-90%. […] Two techniques have been described for brachytherapy. […] A wide variety of agents and schedules have been used to treat patients with metastases beyond the pelvic and inguinal lymph nodes. […] Response rates for cisplatin monotherapy range from 15-23%, and these have been largely partial responses of short duration. […] Current National Comprehensive Cancer Network (NCCN) penile cancer guidelines recommend neoadjuvant chemotherapy with paclitaxel, ifosfamide, and cisplatin in patients with palpable bulky inguinal lymph node involvement.

• #26 Penile cancer | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/rare-cancers/penile-cancer

  Radiation therapy (also known as radiotherapy) uses high energy x-rays to destroy cancer cells. The radiation comes from a machine outside the body. It may be used for penile cancer: to treat smaller penile cancers instead of surgery, after surgery, to destroy any remaining cancer cells and stop the cancer coming back, if the cancer cannot be removed with surgery, at the same time as chemotherapy to help shrink the tumour before surgery to make it easier to remove with less damage to the penis, if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of pain). […] Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or a combination of drugs. This is because different drugs can destroy or shrink cancer cells in different ways.

• #27 Penile Cancer Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/446554-treatment

  Circumcision is recommended prior to initiating radiation therapy for cancers involving the prepuce. […] Various dose-fractionated schedules have been reported, but the most widely accepted schedule for cancers smaller than 4 cm is 4,000 cGy in 20 fractions over 4 weeks to the entire shaft of the penis. […] In carefully selected patients, the local control rate varies from 60-90%. […] Two techniques have been described for brachytherapy. […] A wide variety of agents and schedules have been used to treat patients with metastases beyond the pelvic and inguinal lymph nodes. […] Response rates for cisplatin monotherapy range from 15-23%, and these have been largely partial responses of short duration. […] Current National Comprehensive Cancer Network (NCCN) penile cancer guidelines recommend neoadjuvant chemotherapy with paclitaxel, ifosfamide, and cisplatin in patients with palpable bulky inguinal lymph node involvement.

• #28 An update on treatment of penile cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9511530/

  For PeIN, topical chemotherapy is an effective frontline approach including 5-fluorouracil (5-FU) and Imiquimod. […] For PeIN and pT1a, laser ablation therapy is an option for superficial lesions with good functional outcomes. […] An alternative organ preserving technique for patients with localized tumors includes radiotherapy such as external beam radiation therapy and brachytherapy (BT). […] The recommendation for TIP is based on a single-arm, non-randomized, phase II trial. […] The mainstay of treatment in the metastatic setting remains TIP per Pagliaro et al. based on prospective neoadjuvant data for locally advanced disease. […] Given the high prevalence of HPV DNA in PSCC (approximately 50%), research should also be focused on HPV-directed therapies. […] Immunotherapies including immune checkpoint blockade (ICB) and ACTs are novel treatment options, primarily being investigated in ongoing clinical trials. […] Overall, the treatment of penile cancer represents a complex landscape, particularly in developing nations as there is an unfulfilled need for high-level, multidisciplinary therapeutic options.

• #29 Penile Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/penile/hp/penile-treatment-pdq

  Topical application of fluorouracil cream has been effective in cases of erythroplasia of Queyrat and Bowen disease. […] Imiquimod 5% cream is a topical immune response modifier that has been effective with good cosmetic and functional results. […] Laser therapy with Nd:YAG or CO2 lasers has also resulted in excellent cosmetic results. […] Stage I penile cancer is curable. […] For infiltrating tumors of the glans with or without involvement of the adjacent skin, the choice of therapy is dictated by tumor size, extent of infiltration, and degree of tumor destruction of normal tissue. Equivalent therapeutic options include: Penile amputation. […] Radiation therapy (i.e., external-beam radiation therapy and brachytherapy). […] Microscopically controlled surgery. […] Nd:YAG laser therapy has offered excellent control/cure with preservation of cosmetic appearance and sexual function (under clinical evaluation).

• #30 Penile cancer

  https://www.cancervic.org.au/cancer-information/types-of-cancer/penis_cancer/penile-cancer-treatment.html

  Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It is usually given through a drip into a vein (intravenously) or as a tablet to swallow. […] For low grade carcinoma in situ, lower doses of chemotherapy can be used on the skin in the form of a cream. The cream is applied often twice a day for several weeks to the affected area on the penis and does not cause the side effects people often have with intravenous or tablet chemotherapy. […] Doctors will always try to give you the treatment that preserves as much of your penis as possible. If you have had early-stage cancer, treatment is unlikely to have any direct impact on your sex life. […] After a partial penectomy, the remaining part of the penis can still become erect with arousal and penetration may be possible. While intercourse is not possible after a total penectomy, sexual pleasure still is. You may also be able to have a surgical reconstruction of the penis.

• #31 Multimodality therapy in penile cancer: when and which treatments?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4164341/

  Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. […] To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review. […] There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. […] Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting. […] In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. […] Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy.

• #32

  https://link.springer.com/article/10.1007/s40487-020-00135-z

  Patients with fixed or bulky inguinal lymph nodes should be offered multimodal therapy with neoadjuvant chemotherapy. […] The primary goal of NAC is to eliminate micro-metastases and shrink the tumor to facilitate surgery. […] In patients not receiving NAC, adjuvant chemotherapy is recommended if there is bilateral inguinal lymph node involvement. […] To date, adjuvant radiotherapy has not been rigorously evaluated. […] Systemic chemotherapy is the standard of care for patients with unresectable locally advanced or metastatic disease; however, treatment outcomes remain suboptimal. […] Unfortunately, response to chemotherapy is often limited and short-lived for most patients, underscoring the need for novel therapeutic strategies. […] Immunotherapy using checkpoint inhibitors, such as anti-programmed death 1 (PD1), anti-PD-L1 and anti-cytotoxic T-lymphocyte antigen 4 (CTLA4), have emerged as promising treatment options for a variety of cancers. […] Advanced penile cancer represents a significant challenge in clinical practice, as options are limited and prospective data are sparse.

• #33 Treatments for Penile Cancer | Cancer Support Community

  https://www.cancersupportcommunity.org/article/more-about-treatments-penile-cancer

  Different types of treatment are available for patients with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Your treatment options depend on the stage of cancer, your overall health and your preferences about treatment. In metastatic disease, the location and extent of the penile cancer is also an important consideration. […] Surgery is the most common treatment for all stages of penile cancer. If the cancer is detected early, the tumor can often be treated without having to remove part of the penis. If the cancer is detected at a more advanced stage, part or all of the penis might have to be removed with the tumor. Patients with cancers that have invaded deep within the penis (stage T2 or higher) usually need to have some nearby lymph nodes removed as well to check for cancer spread.

• #34 An update on treatment of penile cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9511530/

  For PeIN, topical chemotherapy is an effective frontline approach including 5-fluorouracil (5-FU) and Imiquimod. […] For PeIN and pT1a, laser ablation therapy is an option for superficial lesions with good functional outcomes. […] An alternative organ preserving technique for patients with localized tumors includes radiotherapy such as external beam radiation therapy and brachytherapy (BT). […] The recommendation for TIP is based on a single-arm, non-randomized, phase II trial. […] The mainstay of treatment in the metastatic setting remains TIP per Pagliaro et al. based on prospective neoadjuvant data for locally advanced disease. […] Given the high prevalence of HPV DNA in PSCC (approximately 50%), research should also be focused on HPV-directed therapies. […] Immunotherapies including immune checkpoint blockade (ICB) and ACTs are novel treatment options, primarily being investigated in ongoing clinical trials. […] Overall, the treatment of penile cancer represents a complex landscape, particularly in developing nations as there is an unfulfilled need for high-level, multidisciplinary therapeutic options.

• #35 5 Common Penile Cancer Medications

  https://www.healthline.com/health/penile-cancer-medication

  Medications for penile cancer typically include chemotherapy drugs, which work by combating cancer cells in the body. […] Its typically treated with a combination of surgical interventions, radiation therapy, and chemotherapy medications such as cisplatin, bleomycin, and 5-fluorouracil. Targeted therapies and immunotherapies have also shown promise in improving treatment outcomes and may provide additional options for people with penile cancer. […] Medications used for penile cancer typically include chemotherapy drugs such as cisplatin, bleomycin sulfate, and 5-fluorouracil. […] These medications work by targeting and killing cancer cells, either by interfering with their DNA replication or by blocking their ability to divide and grow. Chemotherapy is often used in combination with other treatments like surgery or radiation therapy to improve outcomes.

• #36 An update on treatment of penile cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9511530/

  For PeIN, topical chemotherapy is an effective frontline approach including 5-fluorouracil (5-FU) and Imiquimod. […] For PeIN and pT1a, laser ablation therapy is an option for superficial lesions with good functional outcomes. […] An alternative organ preserving technique for patients with localized tumors includes radiotherapy such as external beam radiation therapy and brachytherapy (BT). […] The recommendation for TIP is based on a single-arm, non-randomized, phase II trial. […] The mainstay of treatment in the metastatic setting remains TIP per Pagliaro et al. based on prospective neoadjuvant data for locally advanced disease. […] Given the high prevalence of HPV DNA in PSCC (approximately 50%), research should also be focused on HPV-directed therapies. […] Immunotherapies including immune checkpoint blockade (ICB) and ACTs are novel treatment options, primarily being investigated in ongoing clinical trials. […] Overall, the treatment of penile cancer represents a complex landscape, particularly in developing nations as there is an unfulfilled need for high-level, multidisciplinary therapeutic options.

• #37 Immune-based therapies in penile cancer | Nature Reviews Urology

  https://www.nature.com/articles/s41585-022-00617-x

  Penile cancer is a rare genitourinary malignancy that is associated with poor outcomes and severely limited therapeutic options that are generally non-curative when used to treat localized disease with high-risk features or advanced disease. […] To address the unmet need for treatment modalities with increased effectiveness, immune-based therapies such as immune-checkpoint blockade, human papilloma virus (HPV)-directed vaccines and adoptive T cell therapies have emerged as potential treatment options for advanced penile cancer. […] Immune-based therapies including immune-checkpoint blockade, adoptive T cell therapies, and HPV-targeting therapeutic vaccines are each promising candidate therapies, although these treatments are largely unexplored in penile cancer; however, they are currently being evaluated prospectively.

• #38 Penile Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/penile/hp/penile-treatment-pdq

  Topical application of fluorouracil cream has been effective in cases of erythroplasia of Queyrat and Bowen disease. […] Imiquimod 5% cream is a topical immune response modifier that has been effective with good cosmetic and functional results. […] Laser therapy with Nd:YAG or CO2 lasers has also resulted in excellent cosmetic results. […] Stage I penile cancer is curable. […] For infiltrating tumors of the glans with or without involvement of the adjacent skin, the choice of therapy is dictated by tumor size, extent of infiltration, and degree of tumor destruction of normal tissue. Equivalent therapeutic options include: Penile amputation. […] Radiation therapy (i.e., external-beam radiation therapy and brachytherapy). […] Microscopically controlled surgery. […] Nd:YAG laser therapy has offered excellent control/cure with preservation of cosmetic appearance and sexual function (under clinical evaluation).

• #39 Penile Cancer Treatment – San Diego – Scripps Health

  https://www.scripps.org/services/cancer-care/penile-cancer-treatment

  Topical chemotherapy is when a chemotherapy drug may be applied directly onto the skin to help fight cancer growth. […] Systemic chemotherapy may include bleomycin, an injected chemotherapy drug that may help slow or stop the growth of cancer cells, which may be part of a penile cancer treatment plan. […] Imiquimod cream, a biologic therapy that works with the body’s immune system to destroy cancer, may be used to treat very early stage cancers.

• #40 Pembrolizumab Plus Chemo May Be New Option for Advanced Penile Cancer – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/reports/pembrolizumab-chemo-new-treatment-option-penile-cancer/

  Results from the HERCULES trial support pembrolizumab plus platinum-based chemotherapy as a new treatment option for advanced penile cancer, according to Fernando C. Maluf, MD. […] Pembrolizumab plus platinum-based chemotherapy demonstrated efficacy and a manageable safety profile as first-line treatment for advanced penile cancer in the phase 2 HERCULES trial, according to a presentation at the ASCO Annual Meeting 2024. […] The results suggest that pembrolizumab plus platinum-based therapy is a new treatment option for advanced penile cancer patients, said study presenter Fernando C. Maluf, MD, from A Beneficncia Portuguesa de So Paulo and Hospital Israelita Albert Einstein in So Paulo, Brazil. […] The confirmed overall response rate (ORR) by investigator assessment (the studys primary endpoint) was 39.4%. […] The median progression-free survival was 5.4 months, and the median overall survival was 9.6 months.

• #41 Study Shows Promise of Immunotherapy Treatment for Penile Cancer < Yale School of Medicine

  https://medicine.yale.edu/news-article/new-international-study-shows-promise-of-immunotherapy-treatment-for-patients-with-penile-cancer/

  Penile squamous cell carcinoma is a rare form of penile cancer with limited treatment options. An international study led by Yale Cancer Center researchers at Yale School of Medicine finds that the use of immune checkpoint inhibitors (ICIs) offers promising clinical benefits for some patients with advanced penile squamous cell carcinoma. […] „We believe that further translational studies and biomarker-based research are essential to identify patients most likely to benefit from this therapy and improve the outcomes for individuals with penile cancer.” […] The study highlights the importance of high-quality, real-world research to advance therapeutic options for this rare cancer, said co-first author Talal El Zarif, an oncology research fellow at Dana Farber Cancer Institute and a member of Yale Cancer Center. We are hopeful that response and survival rates will continue to improve for patients fighting penile cancer.

• #42 Immune-based therapies in penile cancer | Nature Reviews Urology

  https://www.nature.com/articles/s41585-022-00617-x

  Penile cancer is a rare genitourinary malignancy that is associated with poor outcomes and severely limited therapeutic options that are generally non-curative when used to treat localized disease with high-risk features or advanced disease. […] To address the unmet need for treatment modalities with increased effectiveness, immune-based therapies such as immune-checkpoint blockade, human papilloma virus (HPV)-directed vaccines and adoptive T cell therapies have emerged as potential treatment options for advanced penile cancer. […] Immune-based therapies including immune-checkpoint blockade, adoptive T cell therapies, and HPV-targeting therapeutic vaccines are each promising candidate therapies, although these treatments are largely unexplored in penile cancer; however, they are currently being evaluated prospectively.

• #43 Immune-based therapies in penile cancer | Nature Reviews Urology

  https://www.nature.com/articles/s41585-022-00617-x

  Penile cancer is a rare genitourinary malignancy that is associated with poor outcomes and severely limited therapeutic options that are generally non-curative when used to treat localized disease with high-risk features or advanced disease. […] To address the unmet need for treatment modalities with increased effectiveness, immune-based therapies such as immune-checkpoint blockade, human papilloma virus (HPV)-directed vaccines and adoptive T cell therapies have emerged as potential treatment options for advanced penile cancer. […] Immune-based therapies including immune-checkpoint blockade, adoptive T cell therapies, and HPV-targeting therapeutic vaccines are each promising candidate therapies, although these treatments are largely unexplored in penile cancer; however, they are currently being evaluated prospectively.

• #44 Penile Cancer Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/446554-treatment

  European Association of Urology guidelines note that superficial lesions (Tis, Ta, and T1a disease) can be treated with the following penis-sparing techniques: local excision with or without circumcision, laser therapy, Mohs micrographic surgery (for verrucous carcinoma), and photodynamic therapy (for superficial lesions). […] The standard of therapy for the primary cancer is local excision and either partial or total penectomy. […] A partial amputation is appropriate when the cancer involves the glans and distal shaft. […] Local wedge resection is feasible in some situations, but this is associated with a recurrence rate of 50%. […] Mohs micrographic surgery (MMS) is applicable in some patients with noninvasive disease. […] Laser surgery has been used for patients with superficial benign and malignant lesions.

• #45 Penile Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/penile/hp/penile-treatment-pdq

  Topical application of fluorouracil cream has been effective in cases of erythroplasia of Queyrat and Bowen disease. […] Imiquimod 5% cream is a topical immune response modifier that has been effective with good cosmetic and functional results. […] Laser therapy with Nd:YAG or CO2 lasers has also resulted in excellent cosmetic results. […] Stage I penile cancer is curable. […] For infiltrating tumors of the glans with or without involvement of the adjacent skin, the choice of therapy is dictated by tumor size, extent of infiltration, and degree of tumor destruction of normal tissue. Equivalent therapeutic options include: Penile amputation. […] Radiation therapy (i.e., external-beam radiation therapy and brachytherapy). […] Microscopically controlled surgery. […] Nd:YAG laser therapy has offered excellent control/cure with preservation of cosmetic appearance and sexual function (under clinical evaluation).

• #46 Penile cancer

  https://www.cancervic.org.au/cancer-information/types-of-cancer/penis_cancer/penile-cancer-treatment.html

  Some early-stage, low-grade penile cancers, especially carcinoma in situ (where the cancer is only in the top layers of skin), can be treated with techniques other than surgery. These treatments are called penile sparing techniques and cause the least damage to the penis. […] If the cancer is very small and only on the surface of the penis, laser therapy may be used to kill cancer cells. Laser therapy uses powerful beams of light to destroy the cancer cells and can be used for tumours with lower staging instead of surgery. […] Photodynamic therapy uses special drugs, called photosensitising agents, along with light to kill cancer cells. The drugs only work after they have been activated or turned on by the light. The procedure is usually painless and less invasive than surgery. […] Radiation therapy (also known as radiotherapy) uses high energy x-rays to destroy cancer cells. It may be used for penile cancer: to treat smaller penile cancers instead of surgery; after surgery, to destroy any remaining cancer cells and stop the cancer coming back; if the cancer cannot be removed with surgery; at the same time as chemotherapy to help shrink the tumour before surgery to make it easier to remove with less damage to the penis; if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of pain).

• #47 Treatment for penile cancer – NHS

  https://www.nhs.uk/conditions/penile-cancer/treatment/

  You may have laser treatment for penile cancer if the affected area is small or the cancer is at an early stage. […] You may have cryotherapy if you have very early stage penile cancer, or the cancer is unlikely to have spread to other parts of your body. […] You may have chemotherapy for penile cancer with radiotherapy (chemoradiotherapy). […] You may have radiotherapy for penile cancer with chemotherapy (chemoradiotherapy). […] The aim of treatment will be to slow down the growth and spread of the cancer, to help with the symptoms, and help you live longer.

• #48 Penile cancer

  https://www.cancervic.org.au/cancer-information/types-of-cancer/penis_cancer/penile-cancer-treatment.html

  Some early-stage, low-grade penile cancers, especially carcinoma in situ (where the cancer is only in the top layers of skin), can be treated with techniques other than surgery. These treatments are called penile sparing techniques and cause the least damage to the penis. […] If the cancer is very small and only on the surface of the penis, laser therapy may be used to kill cancer cells. Laser therapy uses powerful beams of light to destroy the cancer cells and can be used for tumours with lower staging instead of surgery. […] Photodynamic therapy uses special drugs, called photosensitising agents, along with light to kill cancer cells. The drugs only work after they have been activated or turned on by the light. The procedure is usually painless and less invasive than surgery. […] Radiation therapy (also known as radiotherapy) uses high energy x-rays to destroy cancer cells. It may be used for penile cancer: to treat smaller penile cancers instead of surgery; after surgery, to destroy any remaining cancer cells and stop the cancer coming back; if the cancer cannot be removed with surgery; at the same time as chemotherapy to help shrink the tumour before surgery to make it easier to remove with less damage to the penis; if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of pain).

• #49 Penile cancer | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/rare-cancers/penile-cancer

  The main treatments for penile cancer include surgery, radiation therapy and chemotherapy. These can be given alone or in combination. […] Surgery is the main treatment for penile cancer. A surgeon will remove the tumour as well as some surrounding healthy tissue (margin). The extent and type of surgery depends on the location and the grade and stage of the tumour. Your surgeon will discuss the type of operation you may need. In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery. […] Some early-stage, low-grade penile cancers can be treated with techniques other than surgery. […] Photodynamic therapy uses special drugs, called photosensitising agents, along with light to kill cancer cells. The drugs only work after they have been activated or turned on by the light.

• #50 Treatment of Penile Cancer, by Stage | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating/by-stage.html

  The treatment options for penile cancer are based mainly on the stage (extent) and grade of the cancer, but other factors can also be important. Here are the most common treatment options based on the stage of the cancer. […] Patients with CIS that’s only on the foreskin can often be treated with circumcision. If the tumor is in the glans and doesn’t affect other tissues, it might be treated with a type of local therapy (laser ablation, topical 5-FU or imiquimod, or cryotherapy). Other options might include some type of surgery, such as glansectomy, Mohs surgery, or wide local excision. […] Options for treatment may include circumcision (for tumors confined to the foreskin) or a more extensive surgery (Mohs surgery, wide excision, glansectomy, or removal of part of the penis). Radiation therapy or laser ablation in a clinical trial may also be an option.

• #51 Treatment of Penile Cancer, by Stage | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating/by-stage.html

  These cancers are usually treated with a partial or total penectomy, with or without surgery to remove the lymph nodes. A less common approach is to use radiation as the first treatment followed by surgery. Radiation may also be used as the main treatment in men who cant have surgery because of other health problems. […] Stage III cancers are treated with a partial or total penectomy. In some cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor so that it’s easier to remove with surgery. […] Treatment includes surgery, which is often a total penectomy. If the tumor is in the scrotum or parts of the abdominal wall, the testicles and/or the scrotum may also need to be removed. […] Chemo (sometimes with radiation) may be given before surgery to try to shrink the tumor and make it easier to remove.

• #52 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Treatment of stage 0 may include: Mohs microsurgery, topical chemotherapy, topical immunotherapy with imiquimod, laser surgery, cryosurgery. […] Treatment of stage I penile cancer may also include: surgery (partial or total penectomy with or without removal of lymph nodes in the groin), external or internal radiation therapy, Mohs microsurgery. […] Treatment of stage II penile cancer may include: surgery (partial or total penectomy, with or without removal of lymph nodes in the groin), external or internal radiation therapy followed by surgery. […] Treatment of stage III penile cancer may include: surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy, radiation therapy. […] Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include: surgery (wide local excision and removal of lymph nodes in the groin), radiation therapy. […] Treatment of recurrent penile cancer may include: surgery (penectomy), radiation therapy.

• #53 Treatment of Penile Cancer, by Stage | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating/by-stage.html

  The treatment options for penile cancer are based mainly on the stage (extent) and grade of the cancer, but other factors can also be important. Here are the most common treatment options based on the stage of the cancer. […] Patients with CIS that’s only on the foreskin can often be treated with circumcision. If the tumor is in the glans and doesn’t affect other tissues, it might be treated with a type of local therapy (laser ablation, topical 5-FU or imiquimod, or cryotherapy). Other options might include some type of surgery, such as glansectomy, Mohs surgery, or wide local excision. […] Options for treatment may include circumcision (for tumors confined to the foreskin) or a more extensive surgery (Mohs surgery, wide excision, glansectomy, or removal of part of the penis). Radiation therapy or laser ablation in a clinical trial may also be an option.

• #54 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Treatment of stage 0 may include: Mohs microsurgery, topical chemotherapy, topical immunotherapy with imiquimod, laser surgery, cryosurgery. […] Treatment of stage I penile cancer may also include: surgery (partial or total penectomy with or without removal of lymph nodes in the groin), external or internal radiation therapy, Mohs microsurgery. […] Treatment of stage II penile cancer may include: surgery (partial or total penectomy, with or without removal of lymph nodes in the groin), external or internal radiation therapy followed by surgery. […] Treatment of stage III penile cancer may include: surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy, radiation therapy. […] Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include: surgery (wide local excision and removal of lymph nodes in the groin), radiation therapy. […] Treatment of recurrent penile cancer may include: surgery (penectomy), radiation therapy.

• #55 Stages of penile cancer: What they mean, treatment, and outlook

  https://www.medicalnewstoday.com/articles/penile-cancer-staging

  Penile cancer is the growth of harmful cells in the skin and tissues of the penis. Treatment options and outlook for a person with penile cancer depend on the stage of cancer at the time of diagnosis. […] A doctor can determine the stage of penile cancer to help inform which treatment is the most appropriate. […] Treatments depend on the stage of cancer at the time of diagnosis: […] Stage 0: For a person with cancer on the foreskin only, circumcision is sufficient. If cancer is elsewhere, treatment may include local therapies, such as cryotherapy, wide local excision, or Mohs surgery. […] Stage 1: Treatment is the same as stage 0, with the addition of radiation therapy or laser ablation for tumors below the skin. […] Stage 2: Treatment includes a partial or total penectomy. This surgery removes a part of, or all of, the penis. Surgeons may also perform surgery to remove lymph nodes if cancer is present. Radiation therapy may also be suitable for people who cannot undergo surgery.

• #56 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Treatment of stage 0 may include: Mohs microsurgery, topical chemotherapy, topical immunotherapy with imiquimod, laser surgery, cryosurgery. […] Treatment of stage I penile cancer may also include: surgery (partial or total penectomy with or without removal of lymph nodes in the groin), external or internal radiation therapy, Mohs microsurgery. […] Treatment of stage II penile cancer may include: surgery (partial or total penectomy, with or without removal of lymph nodes in the groin), external or internal radiation therapy followed by surgery. […] Treatment of stage III penile cancer may include: surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy, radiation therapy. […] Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include: surgery (wide local excision and removal of lymph nodes in the groin), radiation therapy. […] Treatment of recurrent penile cancer may include: surgery (penectomy), radiation therapy.

• #57 Treatment of Penile Cancer, by Stage | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating/by-stage.html

  These cancers are usually treated with a partial or total penectomy, with or without surgery to remove the lymph nodes. A less common approach is to use radiation as the first treatment followed by surgery. Radiation may also be used as the main treatment in men who cant have surgery because of other health problems. […] Stage III cancers are treated with a partial or total penectomy. In some cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor so that it’s easier to remove with surgery. […] Treatment includes surgery, which is often a total penectomy. If the tumor is in the scrotum or parts of the abdominal wall, the testicles and/or the scrotum may also need to be removed. […] Chemo (sometimes with radiation) may be given before surgery to try to shrink the tumor and make it easier to remove.

• #58 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Treatment of stage 0 may include: Mohs microsurgery, topical chemotherapy, topical immunotherapy with imiquimod, laser surgery, cryosurgery. […] Treatment of stage I penile cancer may also include: surgery (partial or total penectomy with or without removal of lymph nodes in the groin), external or internal radiation therapy, Mohs microsurgery. […] Treatment of stage II penile cancer may include: surgery (partial or total penectomy, with or without removal of lymph nodes in the groin), external or internal radiation therapy followed by surgery. […] Treatment of stage III penile cancer may include: surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy, radiation therapy. […] Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include: surgery (wide local excision and removal of lymph nodes in the groin), radiation therapy. […] Treatment of recurrent penile cancer may include: surgery (penectomy), radiation therapy.

• #59 Treatment of Penile Cancer, by Stage | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating/by-stage.html

  These cancers are usually treated with a partial or total penectomy, with or without surgery to remove the lymph nodes. A less common approach is to use radiation as the first treatment followed by surgery. Radiation may also be used as the main treatment in men who cant have surgery because of other health problems. […] Stage III cancers are treated with a partial or total penectomy. In some cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor so that it’s easier to remove with surgery. […] Treatment includes surgery, which is often a total penectomy. If the tumor is in the scrotum or parts of the abdominal wall, the testicles and/or the scrotum may also need to be removed. […] Chemo (sometimes with radiation) may be given before surgery to try to shrink the tumor and make it easier to remove.

• #60 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Treatment of stage 0 may include: Mohs microsurgery, topical chemotherapy, topical immunotherapy with imiquimod, laser surgery, cryosurgery. […] Treatment of stage I penile cancer may also include: surgery (partial or total penectomy with or without removal of lymph nodes in the groin), external or internal radiation therapy, Mohs microsurgery. […] Treatment of stage II penile cancer may include: surgery (partial or total penectomy, with or without removal of lymph nodes in the groin), external or internal radiation therapy followed by surgery. […] Treatment of stage III penile cancer may include: surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy, radiation therapy. […] Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include: surgery (wide local excision and removal of lymph nodes in the groin), radiation therapy. […] Treatment of recurrent penile cancer may include: surgery (penectomy), radiation therapy.

• #61 Penile Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/penile/hp/penile-treatment-pdq

  Stage II penile cancer is most frequently managed by penile amputation for local control. […] External-beam radiation therapy and brachytherapy with surgical salvage are alternative approaches. […] Inguinal adenopathy in patients with penile cancer is common but may be the result of infection rather than neoplasm. […] If palpable enlarged lymph nodes exist 3 or more weeks after removal of the infected primary lesion and completion of a course of antibiotic therapy, bilateral inguinal lymph node dissection should be performed. […] No standard treatment exists that is curative for patients with stage IV penile cancer. Therapy is directed at palliation, which may be achieved either with surgery or radiation therapy. […] Palliative surgery may be considered for control of the local penile lesion and even for the prevention of the necrosis, infection, and hemorrhage that can result from neglected regional adenopathy. […] Radiation therapy may be palliative for the primary tumor, regional adenopathy, and bone metastases. […] Patients with locally recurrent disease can be treated with surgery or radiation therapy. If the initial treatment of radiation therapy fails, patients often undergo penile amputation.

• #62 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Treatment of stage 0 may include: Mohs microsurgery, topical chemotherapy, topical immunotherapy with imiquimod, laser surgery, cryosurgery. […] Treatment of stage I penile cancer may also include: surgery (partial or total penectomy with or without removal of lymph nodes in the groin), external or internal radiation therapy, Mohs microsurgery. […] Treatment of stage II penile cancer may include: surgery (partial or total penectomy, with or without removal of lymph nodes in the groin), external or internal radiation therapy followed by surgery. […] Treatment of stage III penile cancer may include: surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy, radiation therapy. […] Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include: surgery (wide local excision and removal of lymph nodes in the groin), radiation therapy. […] Treatment of recurrent penile cancer may include: surgery (penectomy), radiation therapy.

• #63 Treatment of Penile Cancer, by Stage | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating/by-stage.html

  Treatment of cancer that comes back after treatment (recurrent cancer) depends on where the cancer comes back (recurs) and which treatments were used before. If penectomy was not done before, a recurrent penile cancer may be treated with surgical removal of part or all of the penis. Radiation therapy may also be an option.

• #64 An update on treatment of penile cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9511530/

  Penile cancer is a rare malignancy, particularly in industrialized nations. […] The most noteworthy risk factor for penile cancer is the association with human papillomavirus infection, which may be present in up to 50% of all penile carcinomas. […] In addition to local primary tumor approaches, multimodality treatment strategies are vital to patients with clinical regional nodal disease, locally advanced disease. […] These treatment approaches include neoadjuvant chemotherapy, adjuvant therapy, including chemotherapy and radiation. […] Systemic therapy for distant recurrent or metastatic disease is primarily a platinum-based chemotherapy, however with poor overall response. […] In this review, we will highlight treatment updates for penile cancer. In addition to standard of care, we will review novel lines of therapies including immunotherapies and targeted therapies as well as sequencing approaches.

• #65 Multimodality therapy in penile cancer: when and which treatments?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4164341/

  Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. […] To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review. […] There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. […] Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting. […] In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. […] Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy.

• #66 Multimodality therapy in penile cancer: when and which treatments?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4164341/

  Chemo-radiotherapy has been successful in squamous cell cancers from other sites (vulva and anal canal) and may be considered for unresectable penile cancer. […] In patients who have concurrent adenopathy and a locally advanced primary tumor, penectomy with groin dissection is the treatment of choice because treatment with external radiotherapy is prolonged and the chances of local control with radiotherapy diminish markedly with bulky disease. […] In the case of unresectable nodes, although there is no definitive answer, a multimodality approach is desirable. […] Possible strategies in this setting include neoadjuvant chemotherapy followed by surgery, or chemo-radiotherapy as the primary treatment. […] In summary, chemo-radiotherapy or initial chemotherapy alone may render disease resectable in locally advanced penile cancer.

• #67 Multimodality therapy in penile cancer: when and which treatments?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4164341/

  Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. […] To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review. […] There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. […] Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting. […] In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. […] Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy.

• #68

  https://link.springer.com/article/10.1007/s40487-020-00135-z

  Patients with fixed or bulky inguinal lymph nodes should be offered multimodal therapy with neoadjuvant chemotherapy. […] The primary goal of NAC is to eliminate micro-metastases and shrink the tumor to facilitate surgery. […] In patients not receiving NAC, adjuvant chemotherapy is recommended if there is bilateral inguinal lymph node involvement. […] To date, adjuvant radiotherapy has not been rigorously evaluated. […] Systemic chemotherapy is the standard of care for patients with unresectable locally advanced or metastatic disease; however, treatment outcomes remain suboptimal. […] Unfortunately, response to chemotherapy is often limited and short-lived for most patients, underscoring the need for novel therapeutic strategies. […] Immunotherapy using checkpoint inhibitors, such as anti-programmed death 1 (PD1), anti-PD-L1 and anti-cytotoxic T-lymphocyte antigen 4 (CTLA4), have emerged as promising treatment options for a variety of cancers. […] Advanced penile cancer represents a significant challenge in clinical practice, as options are limited and prospective data are sparse.

• #69 An update on treatment of penile cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9511530/

  For PeIN, topical chemotherapy is an effective frontline approach including 5-fluorouracil (5-FU) and Imiquimod. […] For PeIN and pT1a, laser ablation therapy is an option for superficial lesions with good functional outcomes. […] An alternative organ preserving technique for patients with localized tumors includes radiotherapy such as external beam radiation therapy and brachytherapy (BT). […] The recommendation for TIP is based on a single-arm, non-randomized, phase II trial. […] The mainstay of treatment in the metastatic setting remains TIP per Pagliaro et al. based on prospective neoadjuvant data for locally advanced disease. […] Given the high prevalence of HPV DNA in PSCC (approximately 50%), research should also be focused on HPV-directed therapies. […] Immunotherapies including immune checkpoint blockade (ICB) and ACTs are novel treatment options, primarily being investigated in ongoing clinical trials. […] Overall, the treatment of penile cancer represents a complex landscape, particularly in developing nations as there is an unfulfilled need for high-level, multidisciplinary therapeutic options.

• #70 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/disease-management

  In non-resectable disease, induction chemotherapy offers the ability to downstage disease and thereby enable surgical resection among responders, even among men with advanced penile cancer. […] Neoadjuvant chemotherapy before inguinal LN surgery allows for early treatment of systemic disease and down-sizing of the inguinal LN metastases. […] Adjuvant radiation therapy for node-positive penile cancer remains controversial. […] Offer adjuvant radiotherapy (with or without chemo sensitisation) to patients with pN2/N3 disease, including those who received prior neoadjuvant chemotherapy.

• #71 An update on treatment of penile cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9511530/

  Penile cancer is a rare malignancy, particularly in industrialized nations. […] The most noteworthy risk factor for penile cancer is the association with human papillomavirus infection, which may be present in up to 50% of all penile carcinomas. […] In addition to local primary tumor approaches, multimodality treatment strategies are vital to patients with clinical regional nodal disease, locally advanced disease. […] These treatment approaches include neoadjuvant chemotherapy, adjuvant therapy, including chemotherapy and radiation. […] Systemic therapy for distant recurrent or metastatic disease is primarily a platinum-based chemotherapy, however with poor overall response. […] In this review, we will highlight treatment updates for penile cancer. In addition to standard of care, we will review novel lines of therapies including immunotherapies and targeted therapies as well as sequencing approaches.

• #72

  https://link.springer.com/article/10.1007/s40487-020-00135-z

  Penile cancer is a rare condition, which mostly affects men in their sixth decade of life. […] Timely multidisciplinary care at experienced centers is therefore critical for improving outcomes. For patients with advanced disease, treatment options are limited and prognosis remains poor. […] Targeted therapies and immune checkpoint inhibitors could potentially play a role in advanced disease and are under evaluation in clinical trials. […] A multimodal approach, involving surgery, radiotherapy and chemotherapy, is imperative for optimizing patient outcomes. […] Several trials are currently underway evaluating novel therapeutic strategies and approaches which may hopefully translate into improved patient outcomes in the near future. […] Treatment options for loco-regional disease includes surgical resection and organ-sparing strategies, while for patients with recurrent or metastatic disease, systemic therapy is the cornerstone.

• #73

  https://link.springer.com/article/10.1007/s40487-020-00135-z

  Patients with fixed or bulky inguinal lymph nodes should be offered multimodal therapy with neoadjuvant chemotherapy. […] The primary goal of NAC is to eliminate micro-metastases and shrink the tumor to facilitate surgery. […] In patients not receiving NAC, adjuvant chemotherapy is recommended if there is bilateral inguinal lymph node involvement. […] To date, adjuvant radiotherapy has not been rigorously evaluated. […] Systemic chemotherapy is the standard of care for patients with unresectable locally advanced or metastatic disease; however, treatment outcomes remain suboptimal. […] Unfortunately, response to chemotherapy is often limited and short-lived for most patients, underscoring the need for novel therapeutic strategies. […] Immunotherapy using checkpoint inhibitors, such as anti-programmed death 1 (PD1), anti-PD-L1 and anti-cytotoxic T-lymphocyte antigen 4 (CTLA4), have emerged as promising treatment options for a variety of cancers. […] Advanced penile cancer represents a significant challenge in clinical practice, as options are limited and prospective data are sparse.

• #74 Study Shows Promise of Immunotherapy Treatment for Penile Cancer < Yale School of Medicine

  https://medicine.yale.edu/news-article/new-international-study-shows-promise-of-immunotherapy-treatment-for-patients-with-penile-cancer/

  Penile squamous cell carcinoma is a rare form of penile cancer with limited treatment options. An international study led by Yale Cancer Center researchers at Yale School of Medicine finds that the use of immune checkpoint inhibitors (ICIs) offers promising clinical benefits for some patients with advanced penile squamous cell carcinoma. […] „We believe that further translational studies and biomarker-based research are essential to identify patients most likely to benefit from this therapy and improve the outcomes for individuals with penile cancer.” […] The study highlights the importance of high-quality, real-world research to advance therapeutic options for this rare cancer, said co-first author Talal El Zarif, an oncology research fellow at Dana Farber Cancer Institute and a member of Yale Cancer Center. We are hopeful that response and survival rates will continue to improve for patients fighting penile cancer.

• #75 Pembrolizumab Plus Chemo May Be New Option for Advanced Penile Cancer – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/reports/pembrolizumab-chemo-new-treatment-option-penile-cancer/

  Results from the HERCULES trial support pembrolizumab plus platinum-based chemotherapy as a new treatment option for advanced penile cancer, according to Fernando C. Maluf, MD. […] Pembrolizumab plus platinum-based chemotherapy demonstrated efficacy and a manageable safety profile as first-line treatment for advanced penile cancer in the phase 2 HERCULES trial, according to a presentation at the ASCO Annual Meeting 2024. […] The results suggest that pembrolizumab plus platinum-based therapy is a new treatment option for advanced penile cancer patients, said study presenter Fernando C. Maluf, MD, from A Beneficncia Portuguesa de So Paulo and Hospital Israelita Albert Einstein in So Paulo, Brazil. […] The confirmed overall response rate (ORR) by investigator assessment (the studys primary endpoint) was 39.4%. […] The median progression-free survival was 5.4 months, and the median overall survival was 9.6 months.

• #76

  https://link.springer.com/article/10.1007/s40487-020-00135-z

  Penile cancer is a rare condition, which mostly affects men in their sixth decade of life. […] Timely multidisciplinary care at experienced centers is therefore critical for improving outcomes. For patients with advanced disease, treatment options are limited and prognosis remains poor. […] Targeted therapies and immune checkpoint inhibitors could potentially play a role in advanced disease and are under evaluation in clinical trials. […] A multimodal approach, involving surgery, radiotherapy and chemotherapy, is imperative for optimizing patient outcomes. […] Several trials are currently underway evaluating novel therapeutic strategies and approaches which may hopefully translate into improved patient outcomes in the near future. […] Treatment options for loco-regional disease includes surgical resection and organ-sparing strategies, while for patients with recurrent or metastatic disease, systemic therapy is the cornerstone.

• #77 An update on treatment of penile cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9511530/

  For PeIN, topical chemotherapy is an effective frontline approach including 5-fluorouracil (5-FU) and Imiquimod. […] For PeIN and pT1a, laser ablation therapy is an option for superficial lesions with good functional outcomes. […] An alternative organ preserving technique for patients with localized tumors includes radiotherapy such as external beam radiation therapy and brachytherapy (BT). […] The recommendation for TIP is based on a single-arm, non-randomized, phase II trial. […] The mainstay of treatment in the metastatic setting remains TIP per Pagliaro et al. based on prospective neoadjuvant data for locally advanced disease. […] Given the high prevalence of HPV DNA in PSCC (approximately 50%), research should also be focused on HPV-directed therapies. […] Immunotherapies including immune checkpoint blockade (ICB) and ACTs are novel treatment options, primarily being investigated in ongoing clinical trials. […] Overall, the treatment of penile cancer represents a complex landscape, particularly in developing nations as there is an unfulfilled need for high-level, multidisciplinary therapeutic options.

• #78 Treating Penile Cancer | Penile Cancer Treatment | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating.html

  Its important to discuss all treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. […] Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment. […] You may hear about alternative or complementary methods to relieve symptoms or treat your cancer that your doctors havent mentioned. […] Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms.

• #79 Penile cancer

  https://www.cancervic.org.au/cancer-information/types-of-cancer/penis_cancer/penile-cancer-treatment.html

  Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It is usually given through a drip into a vein (intravenously) or as a tablet to swallow. […] For low grade carcinoma in situ, lower doses of chemotherapy can be used on the skin in the form of a cream. The cream is applied often twice a day for several weeks to the affected area on the penis and does not cause the side effects people often have with intravenous or tablet chemotherapy. […] Doctors will always try to give you the treatment that preserves as much of your penis as possible. If you have had early-stage cancer, treatment is unlikely to have any direct impact on your sex life. […] After a partial penectomy, the remaining part of the penis can still become erect with arousal and penetration may be possible. While intercourse is not possible after a total penectomy, sexual pleasure still is. You may also be able to have a surgical reconstruction of the penis.

• #80 Penile cancer

  https://www.cancervic.org.au/cancer-information/types-of-cancer/penis_cancer/penile-cancer-treatment.html

  Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It is usually given through a drip into a vein (intravenously) or as a tablet to swallow. […] For low grade carcinoma in situ, lower doses of chemotherapy can be used on the skin in the form of a cream. The cream is applied often twice a day for several weeks to the affected area on the penis and does not cause the side effects people often have with intravenous or tablet chemotherapy. […] Doctors will always try to give you the treatment that preserves as much of your penis as possible. If you have had early-stage cancer, treatment is unlikely to have any direct impact on your sex life. […] After a partial penectomy, the remaining part of the penis can still become erect with arousal and penetration may be possible. While intercourse is not possible after a total penectomy, sexual pleasure still is. You may also be able to have a surgical reconstruction of the penis.

• #81 Treatments for Penile Cancer | Cancer Support Community

  https://www.cancersupportcommunity.org/article/more-about-treatments-penile-cancer

  Several different kinds of surgery are used to treat penile cancers: Circumcision – This operation removes the foreskin and nearby skin. This can cure cancers that are only in the foreskin. It is also done to remove the foreskin before radiation therapy to the penis. Excision – In this operation, the tumor is removed along with normal skin. If the tumor is small, the remaining skin can be stitched back together. This is the same as an excisional biopsy. In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind. Mohs Surgery – Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells. Although the process is slow, more normal tissue near the tumor can be saved. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for precancerous conditions and for some cancers that have not invaded deeply into the penis. Laser Surgery – This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin) and for very thin or shallow basal cell cancers. Partial or Total Penectomy – This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The surgeon will try to leave as much of the shaft as possible. The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains). If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the „on-off” valve) in the urethra is left behind, but the man will have to sit down to urinate.

• #82 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/disease-management

  Besides its role in sexual functioning and urination, a fully functional penis is central to a patients sense of wholeness, desirability and masculinity. Hence, the aims of the treatment of the primary tumour are complete tumour removal with as much organ preservation as possible, without compromising oncological control. […] Penile preservation appears to be superior in functional and cosmetic outcomes as compared to partial or total penectomy and is considered to be the primary treatment method for localised penile cancer, based on retrospective studies. […] Local treatment modalities for small and localised penile cancer include topical therapy, laser ablation, excisional surgery, external beam radiotherapy (EBRT) and brachytherapy. […] Topical therapy with imiquimod (IQ) or 5-fluorouracil (5-FU) are effective non-invasive first-line treatment options which use is increasingly reported.

• #83 Treating Penile Cancer | Penile Cancer Treatment | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/treating.html

  Its important to discuss all treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. […] Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment. […] You may hear about alternative or complementary methods to relieve symptoms or treat your cancer that your doctors havent mentioned. […] Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms.

• #84 Penile Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/penile/hp/penile-treatment-pdq

  When diagnosed early (stage 0, stage I, and stage II), penile cancer is highly curable. Curability decreases sharply for stage III and stage IV disease. Because of the rarity of this cancer in the United States, clinical trials specifically for penile cancer are infrequent. Patients with stage III and stage IV cancer are candidates for phase I and phase II clinical trials testing new drugs, biological therapy, or surgical techniques to improve local control and distant metastases. […] Treatment options: Surgical excision can result in scarring, deformity, and impaired function. To minimize these effects, Mohs micrographic surgery, which involves the excision of successive horizontal layers of tissue with microscopic examination of each layer in frozen section, has been used in patients with in situ and invasive penile cancers.

• #85

  https://link.springer.com/article/10.1007/s40487-020-00135-z

  Patients with fixed or bulky inguinal lymph nodes should be offered multimodal therapy with neoadjuvant chemotherapy. […] The primary goal of NAC is to eliminate micro-metastases and shrink the tumor to facilitate surgery. […] In patients not receiving NAC, adjuvant chemotherapy is recommended if there is bilateral inguinal lymph node involvement. […] To date, adjuvant radiotherapy has not been rigorously evaluated. […] Systemic chemotherapy is the standard of care for patients with unresectable locally advanced or metastatic disease; however, treatment outcomes remain suboptimal. […] Unfortunately, response to chemotherapy is often limited and short-lived for most patients, underscoring the need for novel therapeutic strategies. […] Immunotherapy using checkpoint inhibitors, such as anti-programmed death 1 (PD1), anti-PD-L1 and anti-cytotoxic T-lymphocyte antigen 4 (CTLA4), have emerged as promising treatment options for a variety of cancers. […] Advanced penile cancer represents a significant challenge in clinical practice, as options are limited and prospective data are sparse.

• #86 Penile Cancer Treatment – NCI

  https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

  Penile cancer is a type of cancer that forms in the tissues of the penis. […] Human papillomavirus infection may increase the risk of developing penile cancer. […] Signs of penile cancer include sores, discharge, and bleeding. […] Tests that examine the penis are used to diagnose penile cancer. […] After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body. […] Certain factors affect prognosis (chance of recovery) and treatment options. […] There are different types of treatment for people with penile cancer. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy, Immunotherapy. […] Treatment for penile cancer may cause side effects. […] Follow-up care may be needed.

• #87 Treatments for penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/treatment

  If you have penile cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for penile cancer, your healthcare team will consider: […] Surgery is the primary treatment for penile cancer. The type of surgery you have depends mainly on the size of the tumour, stage of the cancer, depth of the tumour and type of tumour. […] Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is sometimes used to treat penile cancer. […] Chemotherapy is sometimes used to treat penile cancer. The role of chemotherapy in treating penile cancer is still evolving. […] Penile cancer behaves differently in each man, and a standard follow-up schedule would not work for everyone. Men with penile cancer should talk to their doctor about a follow-up plan that suits their individual situation. Follow-up care is often shared among the cancer specialists (oncologists), surgeon, urologist and family doctor.

• #88 Treating penile cancer : University College London Hospitals NHS Foundation Trust

  https://www.uclh.nhs.uk/our-services/find-service/cancer-services/penile-penis-cancer-1/treating-penile-cancer

  For larger cancers involving just the head of the penis, the bulbous part (the glans) will be removed. This is called a glansectomy. […] This may be advised if the cancer is large and is involving a large area of the penis. Amputation may be partial (where only part of the penis is removed) or total (removal of the whole penis). […] UCLH is the only centre in the country that currently offers total penile reconstruction (radial artery phalloplasty). […] Radiotherapy treats cancer using high-energy rays to destroy cancer cells, while doing as little harm as possible to healthy cells. […] Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. […] After your treatment is completed, you will have regular check-ups and possibly scans or X-rays. These will probably continue for several years.

• #89 Penile Cancer: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/penile-cancer-your-chances-recovery-prognosis

  For cancers that have not spread outside the penis, the 5-year survival rate is about 85%. […] For cancers that have spread into nearby areas or lymph nodes, the 5-year survival rate is about 59%. […] For cancers that have spread to other parts of the body, the 5-year survival rate is about 11%. […] When penile cancer is found early, its treatment is simple and works as best it can. The treatment is less likely to cause side effects or complications.

• #90 Penile Cancer: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/penile-cancer-your-chances-recovery-prognosis

  For cancers that have not spread outside the penis, the 5-year survival rate is about 85%. […] For cancers that have spread into nearby areas or lymph nodes, the 5-year survival rate is about 59%. […] For cancers that have spread to other parts of the body, the 5-year survival rate is about 11%. […] When penile cancer is found early, its treatment is simple and works as best it can. The treatment is less likely to cause side effects or complications.

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