Topical treatment
When the cancer is diagnosed at its earliest stage while it is still confined to the skin surface, it may be treated with a topical anti-cancer agent such as 5-fluorouracil.
Radiation
Radiation treatment is also reserved for selected patients whose cancers are small and have yet to penetrate deeper than the surface of the skin. Two radiation treatment approaches are available. External beam radiation aims the radiation like a tightly focused flashlight beam on the tumor. Several treatments are usually required. Brachytherapy involves creating a radioactive mold which is placed over the penis and worn for 12 hours a day for a week. These treatments are also applied to men who refuse surgical interventions and as a palliative therapy for those whose cancer has metastasized.
Chemotherapy
There are a variety of drugs that are administered intravenously in patients whose cancers have metastasized beyond local lymph nodes and the pelvic area. Some chemotherapies are combined with radiation treatments.
Surgery
The goal of surgery is to remove the cancer and the threat it poses. In the instance of small, well-defined tumors that are confined to the prepuce, only the tumor and a little extra tissue are removed. A technique called microsurgery in which the surgeon uses a microscope to distinguish normal cells from malignant cells at the edge of the incision can minimize the amount of tissue being removed adjacent to the tumor. Laser surgery has also been used in these cases.
More adjacent tissue is removed when the tumors are larger than 1.5 cm, a little over half an inch. Studies have shown that when only the tumors and minimal amounts of adjacent tissue are removed, up to half of the cancers recur. When the cancer involves a substantial portion of the head of the penis and has started down the shaft, a partial amputation is recommended.
Removal of any less substantially raises the risk of recurrence and a second operation. Penectomy (amputation) and radical penectomy (amputation plus removal of lymph nodes in the groin) are the preferred surgeries when the cancer shows evidence of extensive spread.
