Penile cancer research

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that

• We can be sure they work
• We can be sure they work better than the treatments that are available at the moment
• They are known to be safe

First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.

Tests in patients are called clinical trials. There are 4 phases of clinical trials. This is fully explained in the trials and research section. If you are interested in taking part in a clinical trial, click the button on the left of your screen to visit our searchable database of clinical trials recruiting in the UK. If there is a trial you are interested in, print off that page and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team. The database also has information about closed trials and trial results. There tend to be fewer trials for rare cancers. This is because there are fewer people to take part in the trials.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these potential new treatments cannot be used as standard therapy for cancer of the penis.

Infection with the human papilloma virus (HPV) is a known risk factor for penile cancer. As part of the EORTC chemotherapy trial, the researchers will examine cancerous tissue removed during surgery to check for HPV infection. They will also look for any changes the virus may have caused to the DNA of the cells.

Teenage girls are starting to receive HPV vaccines to prevent cancer of the cervix. It is possible that if HPV vaccines are used widely in the future, in men as well as women, they may also provide some protection against other cancers, including penile cancer.

In 2005, doctors in the Netherlands reported on a 10 year study of men who'd had sentinel lymph node biopsy. There were some false negative results when they first started using it. This means that the sentinel node didn’t have any cancer cells, but they missed cancer cells in other nodes. In 2001, they improved the way they carried out sentinel node biopsy and had no false negatives after that. So they didn't miss any cancer spread after they improved their technique.

The study also reported an improvement in survival in men who didn't have any symptoms of cancer spread, but were found to have cancer cells in their lymph nodes after sentinel node biopsy. They wouldn’t normally have had their lymph nodes removed at the time of surgery.

Doctors in the UK have started doing sentinel node biopsy. They will be monitoring the men who have it to find out how successful it is. The results are encouraging and they have had very few false negative results so far.

It is important that surgeons have special training before they can do sentinel node biopsies. This means that the technique isn't available everywhere.

Total glans resurfacing is being tested for men who have carcinoma in situ (CIS). It is helpful when other treatments such as chemotherapy creams or laser therapy have not worked well or have caused scarring. The top layer of tisse is removed from the glans or tip of the penis, which is then covered by a partial thickness skin graft. Results so far are very encouraging.

Photo dynamic therapy or PDT is an experimental treatment. It uses a chemical which makes skin cells more sensitive to light. Doctors may use it to treat in situ cancers of the penis, including erythroplasia of Queyrat or Bowens disease. These are pre cancerous conditions which means they can develop into cancers. They affect the squamous cells of the penis on the glans under the foreskin.

You have a circumcision before you have PDT to your penis.

When you have the PDT the doctor will put some anaesthetic cream on the area to be treated. Your doctor will remove any crusted skin and apply a cream containing the light sensitising chemical. The cream stays on for between 3 and 6 hours. Your doctor will then shine a very strong light onto the area for up to 45 minutes. This light kills any cells that have absorbed the light sensitising drug.

After the treatment the treated skin will be more sensitive to light, both bright daylight and indoor lighting. You will need to protect the area from light for 36 hours. You also need to keep the area clean and dry, but after 36 hours you can bathe or shower as normal. The area will probably form a scab, which usually falls off after about 3 weeks.

You can usually have this treatment as an outpatient and you can have the treatment more than once.

We know that the stage of penile cancer is an important factor in predicting how well men with penile cancer will do. Treatment with surgery or radiotherapy can cure many early stage cancers of the penis. For cancers of the penis that have spread to the surrounding tissue (locally advanced cancer) or to another part of the body (metastatic cancer), treatment is more difficult. Because so few men get advanced cancer of the penis, it is hard to find the best treatment by using randomised controlled trials.

A phase 2 trial named EORTC 30992 looked at whether giving a combination of chemotherapy may be helpful for men with advanced penile cancer. The men on this trial had a combination of 2 chemotherapy drugs, cisplatin and irinotecan, before going on for possible treatment with surgery. The results did not show that many of the men got much benefit from the combined chemotherapy, but more research is needed into giving this type of treatment before surgery.

The Penile TPF trial is looking at adding the drug docetaxel to the standard chemotherapy drugs cisplatin and fluorouracil for locally advanced or metastatic cancer of the penis. The trial is for men whose cancer cannot be removed. The treatment aims to shrink the cancer with the hope that some men could then have surgery. The researchers want to find out how well this treatment works and whether it is better than cisplatin and 5FU alone.