Radiation therapy for penile cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is sometimes used to treat penile cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Chemotherapy may be given along with radiation therapy (called chemoradiation).

Radiation therapy is given for different reasons. You may have radiation therapy to:

• destroy the cancer cells in the body
• treat early stage penile cancers instead of surgery
• shrink a tumour before surgery (called neoadjuvant therapy)
• destroy cancer cells left behind after surgery to reduce the risk that the cancer will come back (recur) (called adjuvant therapy)
• relieve pain or control the symptoms of advanced penile cancer (called palliative therapy)

Radiation therapy may be offered to men who wish to keep the penis, who don’t want to have surgery or who cannot have surgery. Although radiation therapy allows a man to keep his penis, the risk of the cancer coming back is higher than if the penis is removed by surgery. Radiation therapy appears to be most effective in men who have tumours that have not grown into the corpus carvernosum, are located on the head (glans) of the penis and are less than 4 cm in size. Circumcision is done before any radiation therapy is given unless you are already circumcised. Circumcision allows the tumour to be fully exposed to the radiation treatment. Radiation therapy also can cause the head of the penis to become inflamed. This can lead to phimosis (foreskin that does not pull back fully).

A lead shield may be used to minimize radiation exposure to the testicles in men who wish to keep their ability to produce children (fertility).

Brachytherapy is often used to treat small, early stage penile cancers (smaller than 4 cm) instead of surgery. Brachytherapy is internal radiation therapy. It uses a radioactive material called a radioactive isotope. It is placed right into the tumour or very close to it. Radioactive materials can also be placed in the area where the tumour was removed. The radiation kills the cancer cells over time. Brachytherapy is usually given over 4 to 7 days. You remain in bed at the hospital while the radiation is delivered.

A catheter is inserted into the urethra before brachytherapy is given. This helps the doctor to feel exactly where the urethra is while inserting the radioactive material. The catheter is left in place until the treatment is finished to allow the urine to drain.

There are 2 different ways that brachytherapy can be given:

Interstitial brachytherapy for penile cancer uses hollow, thin needles. A radioactive source is placed into the needles, which deliver radiation directly to the tumour.

Plesiobrachytherapy for penile cancer uses a plastic cylinder that is placed around the penis, followed by a cylinder containing radiation.

External beam radiation therapy is also used to treat penile cancers. It may be used to treat small, early stage penile cancers (smaller than 4 cm) instead of surgery. External beam radiation therapy may also be used to treat lymph nodes before surgery to reduce their size and make them easier to remove. It may be used after surgery to reduce the risk that the cancer will come back.

During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it.

External beam radiation therapy is usually given once a day, 5 days a week. The number of treatments will depend on the size of the tumour and type of penile cancer. Generally, treatment is given for about 4 to 6 weeks. A mould or special device is often used to keep the penis in place during each treatment.

Side effects can happen with any type of treatment for penile cancer, but everyone’s experience is different. Some men have many side effects. Other men have few or none at all.

During radiation therapy, the healthcare team protects healthy cells in the treatment area as much as possible. But damage to healthy cells can happen and may cause side effects. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after radiation therapy. Sometimes late side effects develop months or years after radiation therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of radiation therapy will depend mainly on the size of the area being treated, the specific area or organs being treated, the total dose of radiation and the treatment schedule. Some common side effects of radiation therapy used for penile cancer are:

• skin problems
• fatigue
• nausea
• diarrhea
• difficulty passing urine
• reduced blood flow to the penis
• blood clots
• narrowing of the urethra
• radiation necrosis
• lymphedema
• erectile dysfunction
• fertility problems
• fistula

Tell your healthcare team if you have these side effects or others you think might be from radiation therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about radiation therapy and side effects of radiation therapy. To make the decisions that are right for you, ask your healthcare team questions about radiation therapy.