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