Surgical Treatment of T3 or T4 Penile Squamous Cell Carcinoma — Surgically Resectable Disease
Clinical Scenario
This protocol addresses patients with locally advanced penile squamous cell carcinoma (T3 or T4) in whom the disease remains surgically resectable. Resectability is the key eligibility criterion that determines entry to this pathway.
Disease Characteristics
Locally advanced (T3–T4) disease with confirmed resectability. T3 tumours are characterised by obvious involvement of the corpora cavernosa. The extent and location of tumour infiltration directly inform the choice of surgical approach within this population.
Treatment Approach — Partial Overview
Management is surgical, with the scope of resection tailored to tumour extent. The approach spans penile-preserving procedures with reconstruction through to more radical surgery for larger or more invasive lesions. The complete decision algorithm — including the specific criteria that determine which procedure is appropriate — is available in the full protocol.
References
- Locally advanced disease (T3–T4)
- Resectable disease
- For cT3 patients with obvious involvement of the corpora cavernosa, partial amputation is standard.
- Extensive partial amputation with wide margins or total penectomy with perineal urethrostomy is the standard advisable treatment.
- Offer partial penectomy – with or without reconstruction – to patients with invasion of the corpora cavernosa (T3) and those not willing to undergo organ-sparing surgery or not willing to comply with strict follow-up.
- Offer total penectomy with perineal urethrostomy to patients with large invasive tumours not amenable to partial amputation.
- Radical amputation and diversion of urination with a perineal urethrostomy is reserved for those patients in whom a resection with a safe margin would result in the inability to void standing upright or without wetting the scrotum.
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