Cryotherapy and Photodynamic Therapy PDT

Cryotherapy offers another treatment option, but has been associated with meatal stenosis, severe inflammation, spontaneous bleeding, pain, and infection.16 EQ has also been managed with topical aminolevulinic acid (ALA) and PDT, but concern exists regarding the carcinogenic potential of this treatment.17 Stables and coworkers reported the use of topical ALA and PDT in four patients with EQ. Of two patients with localized disease, one had a complete response with no relapse at 36 months, but the second had a recurrence at 18 months despite an initial complete response. The two patients with extensive disease both had a reduction in disease burden, but required laser vaporization to complete the treatment.18

Axcrona and colleagues evaluated ALA and PDT in ten patients with CIS. Of these, five had CIS in isolation and five had previously undergone penile-preserving surgery for invasive disease but had residual concomitant CIS. Three of the ten were found to have residual disease confirmed on biopsy after a median follow-up of 20 months (range 15-36). They reported no loss of substance or fibrosis in the treated area, and the long-term cosmetic results were excellent. However, patients did report pain in the first week following treatment. The authors concluded that the therapy appeared promising in selected cases in combination with close follow-up.19

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