Follow-up/Toxicity

Question 1

How should penile cancer pts who rcv definitive therapy be followed?

Answer 1

Penile cancer pts treated with penectomy with nodal dissection can be followed q6 mos for 2 yrs, then q12 mos for an additional 3 yrs. Pts treated with penile-sparing therapy or those who did not undergo LND should be followed q3 mos for yrs 1–2, then q6 mos for an additional 3 yrs. (NCCN 2018)

Question 2

What are the main acute side effects of RT for penile cancer?

Answer 2

Urethral mucositis, edema, and RT dermatitis are experienced by nearly all pts during RT for penile cancer. Secondary infection is another common acute side effect.

Question 3

What are the main late effects from RT for penile cancer?

Answer 3

Telangiectasia, superficial necrosis, urethral stricture, fistula formation, meatal stenosis, dyschromia, and sterility are all common long-term toxicities from RT for penile cancer.

Question 4

What doses are associated with an increased risk of urethral strictures?

Answer 4

Doses >60 Gy increase the risk of urethral stenosis and fibrosis.

Question 5

What are the side effects from inguinal node dissection?

Answer 5

Side effects from inguinal LND include LE edema, wound complications, and DVT.

Question 6

How is urothelial carcinoma of the prostatic urethra treated?

Answer 6

TURP + BCG. LRs treated with cystoprostatectomy +/– urethrectomy.

Question 7

What unique pathologic factors confer additional risk of recurrence in urothelial carcinoma of the prostate?

Answer 7

Acinar invasion and stromal invasion.

Question 8

How is urothelial carcinoma of the prostate with acinar invasion treated?

Answer 8

Radical cystoprostatectomy +/– urethrectomy OR TURP + BCG with cystoprostatectomy +/– urethrectomy for salvage.

Question 9

How is urothelial carcinoma of the prostate with stromal invasion treated?

Answer 9

Radical cystoprostatectomy +/– urethrectomy +/– neoadj chemo. Consider adj chemo if no neoadj chemo given. (NCCN 2018)