Editing EAU & ASCO: Penile Cancer 2023 (section)

==== Treatment of invasive disease confined to the glans (cT1/T2) ====

* <span style="color:#ff0000">'''Treatment choice depends on tumour size, histology, stage and grade, localisation and patient preference.</span>
** <span style="color:#ff0000">'''When feasible, small and localised invasive lesions should receive organ-sparing treatment.'''</span>
*** <span style="color:#ff0000">'''Organ-sparing surgery associated with higher recurrence rates than amputative surgery''' </span>
* <span style="color:#ff0000">'''Foreskin tumours'''</span>
** <span style="color:#ff0000">'''Treated by ‘radical’ circumcision.''' </span>
* <span style="color:#ff0000">'''Glandular and coronal tumors'''</span>
** <span style="color:#ff0000">'''Non-surgical options'''</span>
*** <span style="color:#ff0000">'''External beam radiotherapy and brachytherapy'''</span>
**** Can be given as external radiotherapy with a minimum dose of 60 Gy combined with a brachytherapy boost or as brachytherapy alone
****Brachytherapy has been studied only for lesions < 4 cm hence its use should be limited to tumours not exceeding this size
****In the few studies comparing surgical treatment and radiotherapy, results of surgery were slightly better.
****Complications of radiotherapy for penile cancer
*****Meatal/urethral stenosis
*****Glans necrosis
*****Late fibrosis of the corpora cavernosa
*****Pain with sexual intercourse
*****Dysuria
****Local recurrence after radiotherapy can be salvaged by surgery
*** '''Laser ablation'''
**** '''Option for smaller invasive lesions (likely best limited to T1 tumours)'''
***** Laser therapy of small lesions has been reported but the risk of invasive disease must be recognized, and the recurrence risk is high, possibly as a result of the limited tissue penetration depth of laser ablation. 
**<span style="color:#ff0000">'''Surgical options</span>'''
*** <span style="color:#ff0000">'''Wide local excision (and circumcision)'''</span>
**** '''Lesions located on the corona or glans, limited in size, may be treated with wide local excision which should include a margin of clinically normal-appearing skin around the tumour and surrounding erythema</span>'''
****Additional circumcision is advised in glandular tumours.
*** <span style="color:#ff0000">'''Glansectomy (with or without reconstruction)'''</span>
**** '''Patients with tumours confined to the glans and prepuce that are not eligible for wide local excision or glans resurfacing are good candidates for glansectomy'''
****'''Split-thickness skin graft is commonly used to reconstruct a neo-glans'''
*****Poor candidates for graft application:
******Poor vascular function
******Diabetes
******Immunosuppression,
******Previous radiation to the groin area
*** <span style="color:#ff0000">'''Amputation'''
**** '''Reserved for more advanced disease'''