male reproductive pp: penis, male urethra, testis

where does penile cancer most rare in

western countries

what type of cancer is less than 1% of all men

penile

what places is penile cancer common in

asia, africa, and south america (where circumcision is uncommon)

what is the most common etiology of penile cancer

presence of foreskin

where is penile cancer not seen in males

in males who are circumcised at infancy

what two things does penile cancer have relationship between

HPV and squamous penile cancer

what age does the CPC and American Academy of Pediatrics recommend females and males get the routine HPV vax

11-12

males and females both get the HPV vax when they are both _

sexually active

what is also related to anal cancer

HPV

who is penile cancer extremely rare in and why

circumcised jewish men; because they were circumcised at infancy

circumcision protective only if done in _

early life

number of US males circumcised in 1980

83%

number of US males circumcised in 2010

70%

number of US males circumcised in 2023

62%

why is the number of US males circumcised declining

because church attendance is declining

what percentage of white males are circumcised 

90%

what percentage of african american males are circumcised

70%

what percentage of hispanic males are circumcised

40%

what two type of men are circumcised

jewish and muslim

list 4 pros of circumcision

• decreases lifetime risk of UTIs 

• decreased risk HIV and HPV

• decreased risk of cervical cancer in women

• decreased risk of penile cancer

list 5 cons of circumcision

• painful

• risk of excessive bleeding

• reduced sexual sensitivity/satisfaction

• considered by some to be a human right's issue (let the boy decide)

• some feel it is “unnatural”

what is phimosis

narrowing of orifice due to foreskin overgrowth

what are two risk of penile cancer

phimosis and smegma

why does phimosis happen

because foreskin blocks the urethra

what is smegma

odoriferous secretion of sebaceous glands in genitalia which harbors germs

what two things of venereal disease are not shown to be associated with higher risk of penile cancer

gonorrhea and syphilis

what age is penile cancer common in

58 years

what are two prognostic factors of penile cancer

lymph node status and extent of primary lesion

what is the survival rate for penile cancer

5 year survival with negative regional nodes in 90% of pts

in penile cancer, greater nodal involvement = _

worse long term survival

what type is most penile cancers

squamous

on what anatomy part is most penile cancer found

foreskin or head of the penis

what is the most common route of spread of penile cancer

inguinal nodes

with penile cancer, if it spreads beyond inguinals, where else may it may spread

external iliac, obturator, and internal iliac pelvic nodes

is distant mets common in penile cancer

no

how does penile cancer present

phimosis obscures primary lesion

what two things does penile cancer present with

associated foul smell and secondary infection

penile cancer may have _ with local symptoms

small lesion

what are some local symptom of penile cancer

mass, ulceration, irritation, bleeding, pain, or discharge

what does the pt often present with while having penile cancer

presentation of denial, ignorance, neglect, or embarrassment

what is uncommon in penile cancer but common in urethral cancer

urethral obstruction 

inguinal nodes are palpable in _% of pts

40%

what is palpable in 40% of pts

inguinal nodes

half of the 40% palpable inguinal nodes are due to what rather than the tumor

inflammatory reaction

list the steps of diagnosis for penile cancer

biopsy and CT

what is penile cancer diagnosed from

biopsy

in penile cancer, what is CT useful for

evaluating lymph node status

most of penile cancer is _

well differentiated squamous

what are 4 results of penial cancer that is not squamous

bowen’s disease, paget’s disease, kaposi’s sarcoma, metastatic cancer to penis

what is bowen’s disease

squamous cell in situ of shaft and hairy skin of inguinal/suprapubic area

where is paget’s disease found

scrotum, inguinal folds, and perineal

what is secondary to AIDS

kaposi’s sarcoma

what is the mainstay tx for penal cancer

surgery

what else is available when disease is of low stage or if surgery is refused in penile cancer

less invasive options

what is superficial skin lesions treated with in penile cancer

topical chemotherapy, local excision, or rad therapy

example of topical chemotherapy

5-fluorouracil (5-Fu)

what are options of tx with penile cancer

interstitial implants, molds, contact orthovoltage, superficial, and megavoltage

when is systemic chemo only given for penile cancer

recurrent or mets disease

in penile cancer, what is popular for low stage disease

microscopically controlled tumor excision

what is used for skin cancers when cosmesis is a concern

Moh’s micrographic surgery

what is a pro of Moh’s micrographic surgery

minimal amount of normal skin is removed

what is a con of Moh’s micrographic surgery

requires special training and skill of surgeron

what are two huge challenges when tx penile cancer

set up and reproducibility

what are some examples of various accessories for positioning in penile cancer

box with water, wax tissue compensators

what position of pt in tx penial cancer

supine or prone

what position do you put the pt when treating inguinals in penile cancer

supine

what is the dose to the penis to avoid late tissue damage

200cGy

in penile cancer, what is pelvic nodes usually tx with

photons

in penile cancer, what is inguinals nodes usually tx with

electrons and bolus

what is the anterior port spare on penile cancer

rectum

in penile cancer, what is the dose if nodes are negative

5000cGy

in penile cancer, what is the dose for palpable nodes

6500-700cGy with reduction to 5000cGy

what is the daily dose per day for the pelvis/inguinals

180-200cGy

what is the survival rate for penile cancer

5 year survival bt 25-80% depending on stage and inguinal nodes involvment

what does an irradiating penis result in

brisk erythema, dry or moist desquamation, swelling of tissue of shaft

results of irradiating penis will subside _ weeks after tx

2

what are complications of penile treatment

risk of stricture at the meatus when high dose given, and distal penile or skin necrosis in up to 40% of pts

with pts with penile cancer, what can occur post tx typically a symptom of active disease in the lymphatics

lymphedema

what is penile carcinoma

the penis has been transformed into a solid mass

how many fields are there when treating pelvic and inguinal nodes

2

what does the water do when treating penile cancer

provides uniform dose distribution

what is peyronie’s disease

benign build up of plague withtin erectile tissue of penis

what do more severe cases of peyronie’s disease lead to

curvature of the penis

where is the direction of the penis curavture in peyronie’s disease

any direction, but more often superior

what is the cause of peyronie’s disease

unknown

what is used for peyronie’s disease to help control plaque build up and pain

XRT

what is the total dose for peyronie’s disease

3000cGy

what do men with urethral cancer present with

dysuria, hematuria, and urethral obstruction

is male urethral cancer rare

yes

there is correlation between urethral cancer and what else

chronic irritation and infections, venereal disease, and strictures

what are the 3 sections of the male urethra

prostatic urethra, bulbomembranous urethra, penile urethra

prostatic and bulbourethral may spread to what areas of urethra cancer

external iliac, obturator, and internal iliac nodes

penile urethra typically drains to what

inguinal nodes

what does the prognosis of urethral cancer depend on

location

cancer in the prostatic urethra has prognosis like the _

bladder

bulbomembranous urethra has a _ prognosis

worse

distal lesions have prognosis like _

penile cancer

what is urethral cancer natural history like

penile

what is the urethral cancer natural history of

low grade and slowly growing at primary site rather than spread to distance sites

what percent of male urethra cancers are moderately-differentiated squamous cell carcinoma

80%