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Some very early-stage, low-grade penile cancers, especially carcinoma in situ (CIS, where the cancer is only in the top layers of the skin) can be treated with techniques other than surgery. These include radiation therapy (described in Radiation Therapy for Penile Cancer), laser ablation, cryotherapy, and putting drugs right on the skin of penis to kill the cancer cells (called topical therapy). These treatments may be called penile sparing techniques. Of all the treatments available, they tend to cause the least damage to the penis. But again, they can only treat small cancers that haven't spread deeply into the penis or to other parts of the body.
The doctor uses a beam of laser light to destroy (ablate) cancer cells. This can be useful for squamous cell carcinoma in situ (CIS) and for very thin or shallow basal cell carcinomas. It also may be used for men who refuse surgery.
Drugs are used so the patient sleeps and doesn't feel pain while laser treatment is done. It leaves a shallow wound that heals over a few months, just like any other skin wound. Careful follow-up is needed to check healing and watch for signs that the cancer has come back. Laser treatment can be repeated if the cancer comes back.
While not used as often as laser ablation, cryosurgery works much the same way, but uses liquid nitrogen to freeze and kill the cancer cells. It may also be called cryoablation or cryotherapy. It's useful for some verrucous penile cancers and carcinoma in situ (CIS) of the glans.
Drugs are used to numb the skin of the penis for this treatment. Treatment is often repeated a couple of times in the same office visit. After the dead area of skin thaws, it will swell, blister and crust over. The wound may drain fluid for a while and take a couple months to heal. It can leave a pale scar.
Topical chemotherapy means that a cancer-killing drug is put right on the skin instead of taken as a pill or injected into a vein. The drug used most often to treat penile cancer this way is 5-fluorouracil (5-FU). It's a cream that's put on at home twice a day for several weeks.
When put right on the skin, 5-FU kills cancer cells in the top layers of skin, but it can't reach cancer cells that have grown deeply into the skin or spread to other organs. For this reason, treatment with 5-FU is mostly used for pre-cancers or carcinoma in situ (CIS).
Because the chemo doesn't spread throughout the body, the side effects often seen with systemic chemotherapy do not happen with topical chemotherapy. Still, treatment with 5-FU cream makes the treated skin red and very sensitive for a few weeks. Other topical medicines or creams can help relieve this.
Careful follow-up is needed to watch for signs that the cancer has come back.
Imiquimod is a drug that's sometimes used as a cream to treat CIS of the penis. It causes the immune system to react to the cancer and destroy it. It's put on the skin about 3 to 7 times a week for many weeks, but schedules can vary. It can irritate the skin, which can be severe in some people, but can be treated. It can also cause flu-like symptoms, but this isn't common.
PDT is not widely used for penile cancer, but may be an option in some cases. This treatment uses special drugs and laser light to treat cancer near the surface of the penis. See Photodynamic Therapy for details on how this treatment works.
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Baumgarten AS, Fisher JS, Lawindy SM, et al. Penile sparing surgical approaches for primary penile tumors: preserving function and appearance. Transl Androl Urol. 2017;6(5):809-819.
Cancer Research UK. Penile cancer: Other treatments. 4/2016. Accessed at www.cancerresearchuk.org/about-cancer/penile-cancer/treatment/other-treatments on May 30, 2018.
Filonenko E, Kaprin A, Alekseev B, Urlova A. Own experience in treatment of patients with penile cancer using photodynamic therapy. Biomed Res Int. 2015;2015:245080. doi: 10.1155/2015/245080. Epub 2015 Mar 5.
Korzeniowski MA, Crook JM. Contemporary role of radiotherapy in the management of penile cancer. Transl Androl Urol. 2017;6(5):855-867.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Penile Cancer, Version 2.2018 -- March 26, 2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/penile.pdf on May 30, 2018.
Last Revised: June 25, 2018