Penile%20cancer Management

• Goal is to detect early recurrence as majority of recurrences occur within the first 2-5 years of primary treatment
  
  • Local recurrence rate is higher in the first 2 years of follow-up after penile-preserving surgery than with penectomy
  • Regional recurrences happen within 2 years after dynamic sentinel node biopsy (DSNB) or inguinal lymph node dissection (ILND)
  • As life-threatening metastases are rare after 5 years, follow-up can be stopped after 5 years provided patient can reliably regularly perform self-examination & immediately report any changes
• Follow-up is also significant in the detection & management of complications arising from treatment
• Clinical evaluation includes examination of the penis & inguinal region
  
  • If clinical evaluation has abnormal results or patient is obese or had a prior inguinal surgery, consider imaging with an ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) scans
• Additional imaging with a chest x-ray or CT or an abdominopelvic CT or MRI scan may be requested for surveillance in N2 or N3 lymph nodes
• Follow-up schedule for the primary tumor includes the following:
  
  • Clinical evaluation every 3 months in the first 2 years & every 6 months in the subsequent 3 years after penile-preserving treatment
  • Clinical evaluation every 6 months in the first 2 years & annually in the subsequent 3 years after penectomy
• Follow-up schedule for lymph node involvement includes a clinical evaluation every 3-6 months in the first 2 years & every 6-12 months in the subsequent 3 years

 Recurrent Disease

• Up to 30% of all patients with penile cancer will later recur
  
  • A higher risk of recurrence can be seen in T2 to T4 tumors or grade 3 tumors of any T stage
• Local recurrent disease can be managed depending on the type of recurrence, ie penile or inguinal
  • Salvage penectomy (eg partial or total) is performed in most cases & may also be done if initial radiation therapy failed or if invasion of corpora cavernosa is present
  • Consider salvage penile-sparing options if without invasion of the corpora cavernosa
  • For a localized inguinal recurrence, multimodality treatment may be given using systemic chemotherapy, radiation therapy, &/or surgical resection
    • Phase I & II clinical trials using new chemotherapeutic drugs or biologicals may be offered to patients with nodal recurrence uncontrolled by above local treatment measures
• A nodal re-evaluation should be performed in patients undergoing recurrent penile tumor resection as a prophylactic inguinal staging procedure (ie DSNB or ILND) can be a treatment option if a prior node dissection has not been performed
• For patients with fixed inguinal nodes or high tumor burden not amenable to resection, radiation therapy to relieve pressure from tumor compression or further treatment with palliative chemotherapy may be advised