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Treatment of penile cancer

Treatment can be chosen when the tumor type and stage have been diagnosed. The European Association of Urology (2009) has guidelines for treatment of penile cancer (5).

Therapeutic schedule for penile cancer

Tumor- stage

Treatment 

Recommendations

Strong Optional  Investigational
Primary tumor Conservative therapy Primary/recurrent
PeIN, Ta-1 G1-2
T1 G3, T ≥ 2 (patients fit for surveillance) with metastasis to < 50% of nodes After chemotherapy, according to tumor response
Total/partial amputation Primary/recurrent
T1 G3, T ≥
Primary/recurrent Ta-1 G1-2 (conservative therapy not feasible)  
Radiation therapy Tumor invasion < 4 cm Primary T1-2 < 4 cm
(Patient refuses amputation)
In combination with chemotherapy
Regional (non-palpable nodes) Surveillance (Follow-up) PeIN, Ta G1-2, T1 G1, T1 G2 superficial growth T2 G2-3 (Patients prefering and fit for close follow-up) Negative dynamic sentinel node
Modified LND1 T1 G2 nodular or vascular growth, T1G3 or any T2. T1 G2 no vascular growth, no papillary growth (patients unfit for "follow-up". Positive dynamic sentinel node
Regional (palpable nodes) LND2 Postive nodes at presentation or positive nodes after "follow-up". Adjuvant chemotherapy or radiation therapy (> 1 positive node). Unilateral LND on nodal site (disease-free interval > 3-6 months)   
Chemotherapy + LND3 Fixed inguinal masses, pelvic nodes > 2 cm (patients fit for chemotherapy)       
Radiation therapy4 + LND     Fixed masses (patients unfit for chemotherapy)   
Distant metastases       Chemotherapy or palliative therapy (according to performance status, age, etc.)   

LND = lymphadenectomy

1. Modified LND can be extended to radical in cases where there are positive nodes.
2. If unilateral with non-papable nodes on the opposite side, modified LND can be carried out. Pelvic LND should be carried out only if there are >1 positive inguinal node. 
3. Chemotherapy should be discussed with oncologist and preferably be given in the context of clinical trials.
4. Radiation therapy has inconsistent results and high morbidity associated with surgery.

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