U-M Cancer Center Urologist Jeffrey Montgomery, M.D., M.H.S.A. joins MCancerTalk to bring patients and families an update on the latest innovations in the treatment of penile cancer.
Penile cancer is the least common urologic cancer. It occurs in fewer than one in 100,000 men in the U.S., resulting in about 300 deaths annually. Although the disease is rare, top institutions like Michigan are aggressively pursuing new treatment options to offer patients better outcomes than ever before.
Surgery: then and now
Until about a decade ago, patients diagnosed with penile cancer had few good options. Partial or total removal of the penis was thought to be the only method to ensure that all of the cancer had been removed. This surgical approach had a dramatic impact on patient’s urinary and sexual function.
Today we’re able to offer organ-sparing options by relying on pathology during surgery. In the past, pathology (the analysis of tissue to identify cancer cells) took place after surgery to determine if all of the cancer had been removed. Now, pathologists are on-site during the procedure to analyze tissue samples in real time. Surgeons use this information to remove just enough tissue to eradicate the cancer, and no more.
This approach spares more of the penile tissue. It also makes reconstruction a more possible option. In many cases, plastic surgeons can join the surgical team during the same operation to perform reconstructive procedures, using the patient’s own surrounding penile tissue, along with skin grafts.
Improvements in lymph node dissection
Understandably, newly-diagnosed patients tend to focus on the specifics of penile surgery. But an equally significant and potentially riskier procedure usually follows – the removal or dissection of the groin-area lymph nodes as a cancer staging and therapeutic procedure.
Again, advances in surgery have made this step far less invasive. When there are indications that the cancer may have spread, lymph nodes must be removed from both sides of the groin. In the past this meant making two incisions – each up to ten inches long – posing the risk of complications ranging from fluid build-up in the surgical field to the breakdown of the wounds to infection. Today, surgeons at the University of Michigan perform minimally-invasive node dissections assisted by the DaVinci robot. Four small incisions are made at points lower on each thigh, through which small robotic arms are used to remove the tissue. This lowers the risk of complications and reduces the patient’s hospitalization time approximately in half, making recovery much easier.
Until recently, this procedure required positioning the robot on one side for one dissection, then repositioning the robot to remove nodes on the other side. Here at Michigan, we’ve developed a better way. We position the robot coming over the patient’s head, so no repositioning is required. That means less time in the operating room.
The best strategy: find it early
Penile cancer usually appears as a mass or ulcer on the penis. When evaluated promptly by a urologist, treatment can begin right away and the outlook is very promising. Unfortunately, too often patients are embarrassed or fearful and ignore these growths, hoping they will heal on their own. When they do share their concerns, providers are not always experienced in recognizing such a rare form of cancer.
To be safe, seek help for any suspicious mass or lesion on the penis. With prompt diagnosis and care, patients can be optimistic about surviving penile cancer. Today’s surgical procedures can cure the disease even if it has spread to the lymph nodes. For patients with advanced disease, additional strategies like chemotherapy and radiation therapy can further improve patient outcomes.
Take the next step:
- Learn more about penile cancer treatment at the U-M Comprehensive Cancer Center Multidisciplinary Urologic Oncology Clinic.
- Find detailed information about penile cancer from the American Cancer Society.
- Visit the National Cancer Institute’s gateway on penile cancer.
At the U-M Multidisciplinary Urologic Oncology Clinic our patients are cared for by nationally recognized experts – urologists, medical oncologists, radiation oncologists and pathologists – as well as nurse practitioners and physician assistants who specialize in the treatment of bladder cancer. Each member of our team is committed to the best possible treatment for our patients.
The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.