GUIDELINES ON PENILE CANCER:

CHEMOTHERAPY – QUALITY OF LIFE

EUROPEAN ASSOCIATION OF UROLOGY,
2016
Agung Adhitya
CHEMOTHERAPY IN NODE (+) AFTER RADICAL INGUINAL
LYMPHADENECTOMY

 Italy 1979 - 1990 adjuvant chemotherapy

after surgery DFS 84%  vincristine,
bleomycin, and methotrexate
 Cisplatin, 5-fuorouracil + paclitaxel or
docetaxel  19 patients  DFS 52.6%
 Compared node(+)  after surgery with or
without adjuvant radiotherapy  DFS 39%
 Adjuvant chemotherapy is recommended.
CHEMOTHERAPY WITH FIXED OR RELAPSED INGUINAL NODES

 Cisplatin  response rate 25-50%

 Paclitaxel, cisplatin, and ifosfamide 
response rate 15/30 patients
 Cisplatin + 5-fuorouracil + taxane 
response rate of 44%
 Docetaxel  response rate 38.5%
 Support the use of neoadjuvant
chemotherapy  fixed, unresectable nodal
disease  cisplatin, taxane
PALLIATIVE CHEMOTHERAPY IN ADVANCED AND RELAPSED
DISEASE

 140 penile SCC  metastases +

(Eastern Cooperative Oncology Group)
ECOG > 1  response rates 25% -
100%  few sustained responses and
long-term survivors.
 Second-line chemotherapy (paclitaxel)
 response rate < 30%.
 Benefit  combining cisplatin +
gemcitabine.
GUIDELINES FOR CHEMOTHERAPY IN PENILE CANCER PATIENTS
FOLLOW-UP
 Early detection of recurrence
 Local recurrence not significantly reduce
long-term survival if successfully treated
 Detection and management of treatment
related complications
 Local or regional nodal recurrences within 2
years of primary treatment
 Intensive follow-up  2 years
 Less intensive follow-up  5 years
WHEN AND HOW TO FOLLOW-UP

 Negative inguinal nodes after local treatment

 physical examination of the penis and the
groins for local and/or regional recurrence
 Histology from the glans  confirm disease-
free status  laser ablation or topical
chemotherapy
 Positive inguinal nodal metastases  CT or
MRI  3-monthly intervals fo first 2 years
 Regular follow-up stopped after 5 years  self
examine
RECURRENCE OF THE PRIMARY TUMOUR
 Local recurrence first 2 years up to 27%
 penis-preserving modalities
 Partial penectomy  risk recurrence 4-
5%
REGIONAL RECURRENCE

 Most local recurrence at first 2 years

 Highest regional recurrence 9%
surveillance
 Lowest regional recurrence 2.3% 
modified inguinal lymphadenectomy
 Had surgical treatment for lymph node
metastases without adjuvant  19%
GUIDELINES FOR FOLLOW-UP IN PENILE CANCER
CONSEQUENCES AFTER PENILE CANCER TREATMENT

 Sexual dysfunction, voiding problems

and cosmetic penile appearance  QOL
SEXUAL ACTIVITY AND QUALITY OF LIFE AFTER LASER
TREATMENT

 Swedish  laser treatment penile CIS

 58/67 surviving & 46 participated 
mean age 63  decrease in some
sexual practices
 CO2 laser treatment  224 patients
reported no problems
SEXUAL ACTIVITY AFTER GLANS RESURFACING

 7/10 patients questionnaires [IIEF-5]

 6 month follow-up no ED
 Sensation at tip of their penis no different
after surgery
 Erections 2-3 weeks after surgery
 6/7 patients active intercouse 3 months
later
 5/7 patients felt their sex life improved
SEXUAL ACTIVITY AFTER GLANSECTOMY

 68 patients
 79% felt not decline in spontaneous
erection, rigidity, and penetrative capacity
after surgery
 75% reported recovery of orgasm
 12 patients had ‘normal’ sexual activity
1 month after surgery
SEXUAL FUNCTION AFTER PARTIAL PENECTOMY

 IIEF questionnaire 18 patients (mean age 52

years)
 72.2% continued to have ejaculation every
intercouse
 66.7% the same frequency and quality intercouse
 55.6% patients erectile function allowed
intercourse.
 50% ashamed their small penis and missing
glans
 33.3% satisfied with their sex life
QUALITY OF LIFE AFTER PARTIAL PENECTOMY

 GHQ-12 (General Health Questionnaire)

and HAD scale (Hospital Anxiety and
Depression
 Scale)  no significant levels of anxiety
and depression  Social activity
remained same after surgery.
SPECIALISED CARE
 Possible to cure almost 80% of penile
cancer patients at all stages
 Organ-preserving treatment should be
offered
 Psychological support is very important
for penile cancer patients.
THANK YOU