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GUEST EDITORIAL
Year : 2006  |  Volume : 22  |  Issue : 4  |  Page : 337
 

Penile cancer: How best to treat?


Department of Urology, Christian Medical College, Vellore - 632004, India

Correspondence Address:
Ganesh Gopalakrishnan
Department of Urology, Christian Medical College, Vellore - 632004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.29120

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How to cite this article:
Gopalakrishnan G. Penile cancer: How best to treat?. Indian J Urol 2006;22:337

How to cite this URL:
Gopalakrishnan G. Penile cancer: How best to treat?. Indian J Urol [serial online] 2006 [cited 2019 Oct 16];22:337. Available from: http://www.indianjurol.com/text.asp?2006/22/4/337/29120


Most articles on penile cancer have not come from India. For a disease which is not uncommon in the Indian subcontinent, there are still no clear-cut guidelines on its management. While there is no doubt about how the primary lesion is to be treated, what has emerged is that the earlier mutilative procedures have been replaced with a more conservative approach and to the extent that penile conservation is feasible from the point of cancer control.

How best the inguinal nodes should be managed is still controversial. For a disease where cure is possible with inguinal lymphadenectomy, the hesitation to offer it universally to all patients appears overkill mainly because of its morbidity. This seems to be at variance with the philosophy of offering RPLND for stage I nonseminomatous germcell tumours - an operation of possibly greater magnitude.

To complicate matters further, our patients with penile cancer present late and once the primary lesion is treated do not return for follow-up. When they do it is often too late as the regional nodes become fixed and often fungate. And finally we do not have any randomized control studies to guide management.

The Editor of the IJU needs to be congratulated for deciding to bring out a symposium of the journal as a supplement devoted to penile cancer. Can the diagnosis of penile cancer be cast iron on pathology or are their mimics? What is the best test yet to identify if the inguinal node is positive for cancer? Or can we predict inguinal metastasis by looking at the grade and depth of invasion of the primary tumour? If the potential for cure is great and follow-up erratic can we offer prophylactic inguinal lymphadenectomy to all and overcome the complications by using the basic principles of plastic surgery. Is penile conservation possible and chemotherapy useful in those with advanced locoregional disease?

These are some of the issues that have been addressed in this supplement of the Indian Journal of Urology. I hope this supplement forms a platform for urologists to decide on how best to manage their patients with penile cancer and also hope this paves the way for future clinical trials in this potentially curable cancer.

I am gratefully indebted to the authors who have contributed to this issue. Their thoughtful opinion and insight I am sure will help us improve the care of patients with penile cancer.



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