Penile tissue preserving methods in the treatment of lower T categories of penile cancer
Authors:
Milan Hora 1; Ivan Trávníček 1; Kristýna Kalusová 1; Ondřej Hes 2; Karel Pizinger 3; Tomáš Fikrle 3; Jan Říčař 3; Dmitry Kazakov 2; Denisa Kacerovská 2; Michal Michal 2
Authors‘ workplace:
Urologická klinika LF UK a FN, Plzeň
1; Šiklův patologicko-anatomický ústav LF UK a FN, Plzeň
2; Dermatovenerologická klinika LF UK a FN, Plzeň
3
Published in:
Ces Urol 2014; 18(3): 199-207
Category:
Review article
Overview
Aim:
Standard treatment of lower T categories of penile cancer usually includes partial amputation. However, in a significant number of cases, this approach could prove to be an overtreatment. Today, we have a possibility to use other less, radical methods, which proved to be sufficient. This article provides a review of these treatment alternatives.
Overview:
An ideal method to treat a localized lesion would be its excision. Unfortunately, in penile cancer, this option is only rarely acceptable. A flat lesion type of PeIN (penile intraepitelial neoplasia) or carcinoma in situ can be treated by local therapy (5-fluorouracil, imiquimod, photodynamic therapy – senzibilisator aminolevulinate). The alternative options are destruction with CO2, Nd:YAG or Er:YAG laser. These methods can be replaced by technically challenging surgery, namely resurfacing with skin graft. Mohs method frequently mentioned in the literature for treatment of cancerous lesions of skin (consecutive excisions with repeated peroperative pathological investigation of margins) is not widely used in penile cancer. In more locally advanced tumours, with failure of the above mentioned less radical methods, in cases where the patients prefers faster and/or more radical treatment, or in cases when appropriate follow-up could not be guaranteed, a glansectomy is indicated. Brachytherapy represents an alternative with worse results, and should be reserved only for men who refuse surgery.
Conclusion:
Contemporary penis preserving methods allow us, even in case of precancerous PeIN, complete preservation of the organ. There are no clear recommendations guiding the selection of the specific treatment modalities and/or sequence of individual treatments. The choice of treatment depends on the preferences of the physician and the patient. As in other areas of oncourology, the involvement of a multidisciplinary team is crucial (most importantly it has to include pathologist, dermatovenereologist and urologist). Referral of patients to highly specialised centres is highly recommended.
Key words:
penile cancer, penile intraepithelial neoplasia, 5-fluorouracil, imiquimod, photodynamic therapy, resurfacing, laser, glansectomy.
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Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2014 Issue 3
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