Rare diagnosis of penile cancer causes higher mortality rates and stigma
On both the patient and physician sides, there are some stigmas. Patients with penile cancer are mostly middle-aged to older men. Something is amiss with the penis, and it is a private area. We don’t often discuss these topics among men. As a result, this causes humiliation and a delay in obtaining medical help.
I’d say that when a man is married, it usually comes to his attention because his wife brings it up to him. He is then pressured to do something about it, to investigate what’s going on, and to seek medical help. As a result, many people have a tendency to deny it or believe that it will go away.
Then there’s the fact that this is a rare sickness among physicians. You’re more likely to treat a rash with a range of various topical remedies [or] oral antibiotics if you suspect it’s caused by something viral, fungal, or bacterium. Because it’s so uncommon and because it’s on the penis, doctors may be hesitant to treat it, touch it, or take tissue from this area. They’re at a loss for what to do if the procedure doesn’t improve in weeks or months.
They’ll be ready to refer the patient to someone else at some point. So, I believe that the common denominator of this stigma is that there are patient-related difficulties such as humiliation and shame, which cause a delay in definite diagnosis. Then there are delays in diagnosis caused by physicians. When you add the patient and physician delays together, you obtain an actual diagnosis delay. Patients frequently do not show for a year after something has gone wrong in the penis, at least 6 months, but a year is not uncommon.
What are some examples of advancements in this field that have aided in the management of penile cancer patients’ quality of life?
I believe there have been some improvements in the delivery of surgery and radiotherapy in recent years. For example, organ-sparing or penile-preserving surgery is now considerably more prevalent in men with early malignancies. We know that we can control the tumour and that we don’t need as broad a negative margin as we previously believed. As a result, we have the option of excluding the penis. More cosmetic-like end outcomes can be attained through collaborations with plastic surgeons. There are instances where interstitial brachytherapy, a type of radiation, can be used to preserve the penis and avoid the need for an amputative operation.
From the standpoint of the original tumour, earlier detection when tumours are smaller means you may not need to lose the penis using either a penile-preserving or radiation-based procedure. The other benefit of earlier diagnosis is that we may be able to reduce problems in individuals who require inguinal staging but do not have palpable adenopathy by using innovative procedures such as dynamic sentinel lymph node biopsy. Radio-labeled tracers guide this technique, which targets and removes draining lymph nodes. Technology has greatly aided us in implementing this method of removing only a limited number of lymph nodes, potentially lowering the complication risk for patients.
We also use laparoscopic and robotic surgery to perform less invasive procedures. So, rather than making a single large incision, we’re instead making a number of little incisions and removing the lymph nodes from beneath the skin, potentially reducing skin issues. The International Penile Advanced Cancer Trial (InPACT) may give vital evidence regarding how advanced penile cancer patients should be handled in the future.
We intend to discover more about the role of surgery alone in this condition, if combining chemotherapy or chemoradiotherapy with surgery improves outcomes, and which of the two regimens delivers greater outcomes or has fewer side effects. This is a trial that will take place all over the world. It is the first of its kind. I’m excited to be a co-leader on this trial and contribute to the field’s direction in regards to a trial like this. The trial is presently enrolling patients, and we needed to recruit 200 people from throughout the world.
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