Management of the Primary Lesion

Significant progress in surgical techniques, laser therapy, and patient selection has resulted in preservation of function and (or) form in the majority of cases of penile cancer. Centers in the UK have described the results of more conservative/

reconstructive surgical strategies.5,6 Laser therapy has become an excellent treatment strategy for low-stage lesions (i.e. Tis, T1) and has been shown to maintain quality of life.5 Brachytherapy is also an alternative strategy for organ preservation with encouraging results from a few centers of excellence. A recent report from Toronto and Ottawa describes the delivery of 60 Gy over 4-5 days7 using either continuous low-dose rate or pulse dose rate intratumoral radiotherapy. Cause-specific survival at 10 years was 83.6%. Ten of the sixty-seven cases required penectomy for local recurrence (8 cases) or tissue necrosis (2 cases). Urethral stenosis occurred in 9%. These data raise the need for a randomized trial of brachytherapy versus surgery in the management of the primary lesion in terms of efficacy and quality of life outcomes. Such a study would require collaboration between clinicians and a willingness for patients to undergo randomization to the two different modalities.

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