BackTable / Urology / Podcast / Episode #29

Management of Penile Cancer

with Dr. Philippe Spiess

Dr. Philippe Spiess from Moffitt Cancer Center discusses surgical and medical management of penile cancer. Listen now to hear more about punch biopsy techniques, surgical resection and lymph node dissection techniques, growing role of topical chemotherapy, importance of multidisciplinary tumor boards.

Management of Penile Cancer with Dr. Philippe Spiess on the BackTable Urology Podcast)
Ep 29 Management of Penile Cancer with Dr. Philippe Spiess
00:00 / 01:04

BackTable, LLC (Producer). (2022, January 26). Ep. 29 – Management of Penile Cancer [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Philippe Spiess discusses Management of Penile Cancer on the BackTable 29 Podcast

Dr. Philippe Spiess

Dr. Philippe Spiess is a professor of genitourinary oncology and sssistant chief of surgical services at Moffit Cancer Center in Florida.

Dr. Aditya Bagrodia discusses Management of Penile Cancer on the BackTable 29 Podcast

Dr. Aditya Bagrodia

Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.

Show Notes

In this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Phillipe Spiess from Moffitt Cancer Center discuss surgical and medical management of penile cancer.

When examining a patient for potential penile cancer, it is important to obtain a thorough history to classify the disease and perform a complete physical exam to describe the characteristics of the lesions. Frequently, a biopsy will be performed to confirm the malignancy of the lesion. Dr. Spiess prefers to use topical anesthesia over general anesthesia in his punch biopsies and sends the sample to specialized genitourinary pathologists. Imaging also reveals the presence and extent of metastatic spread of penile cancer. MRI scans are the best way to visualize the inguinal lymph nodes, but PET scans may also be used in multimodal imaging.

Surgical intervention for penile cancer depends on the tumor stage. For T0 tumors, or carcinoma in situ, topical chemotherapy is preferred. However, excision surgery, Mohs surgery, or laser ablation can also be performed for very small lesions. In general, for excision surgeries, urologists should achieve a tumor margin greater than 1 mm and send skin, deep, and urethral margin samples to GU pathology for analysis. For more aggressive and advanced T2/3 tumors, the inguinal lymph nodes should be excised at same time as penile resection in healthy patients. However, if an infected, fungating primary tumor is observed, it should be resected first before lymph node excision. Dr. Spiess recommends that urologists choose the surgical approach that they are most comfortable with performing, whether it be open or robotic. Additionally, the preoperative state of a patient is crucial. Diabetes, nutrition, smoking cessation, and other factors should be optimized to ensure favorable outcomes. Post operatively, surgical staples should stay in until the patient is completely healed, and patients should be encouraged to wear compression stockings.

The effectiveness of radiation therapy depends on the characteristics of individual tumors. Penile cancer tumors are usually radioresistant but radiation has been shown to limit retroperitoneal masses and are effective in shrinking HIV-positive tumors. Generally, radiation therapy provides symptomatic management but is not curative.

The final treatment option discussed was a total or partial penectomy. Total penectomy should only be reserved as the last resort after exhausting other options. Instead, a partial penectomy is preferred, as maximal tissue sparing can maintain feelings of masculinity and gender association and preserve mental health.

Resources

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Topics

Mohs Surgery Procedure Prep
Penectomy Procedure Prep
Penile Cancer Condition Overview
Penile Excision Surgery Procedure Prep
Learn about Urologic Oncology on BackTable Urology

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