Managing Penile Cancer: Integrating Tissue Preservation, Energy-Based Therapeutics, and Surgical Reconstruction

A major paradigm shift has occurred recently in the clinical management of penile cancer with the acceptance of alternative “penile-preserving” management strategies that achieve acceptable oncologic outcomes without enduring historical norms of penile disfigurement or emasculation. These new strategies acknowledge the purpose of retaining aspects of penile function and accordingly quality of life. Such conservative therapeutic strategies include topical chemotherapy, laser ablation, Mohs micrographic surgery, glansectomy, glans resurfacing, wide local excision, partial penectomy, and radiotherapy. Phallic-reconstructive strategies have also been developed to include local surgical closure with skin flaps, skin grafting, and neophalloplasty. All of these techniques can be readily applied in the risk-informed patient after establishing disease risk variables and applying close surveillance and prompt action for possible disease recurrence.