Local therapy for penile cancer provides robust survival and can preserve the penis functionally and cosmetically. Interventions must target the appropriate clinical stage. We reviewed studies regarding the primary therapy in penile cancer, from topical therapy to radical penectomy, and reconstructive techniques. Topical therapy (5-FU or Imiquimod) provides a robust oncologic response in patients with Ta or Tis disease. Multiple laser therapies are available for localized patients and those with low-grade T1 disease. There is a non-trivial risk of progression and nodal metastases in poorly selected patients. Wide local excision provides an oncologically sound option in patient with up to T1 disease; less evidence exists for Mohs microsurgery in the setting of penile cancer. Increasingly aggressive approaches include glansectomy and partial/radical penectomy, which provide 5- and 10-year cancer-specific survival rates of over 80%. Meticulous reconstruction is necessary for the durable function of the remaining penis. Preservation of voiding and sexual function occurs via penile skin grafting, glans resurfacing, creation of a functional penile stump, and phalloplasty with a penile implant. Perineal urethrostomy provides an alternative in pathology demanding extensive partial or radical penectomy, and a durable option for seated voiding. Clinical suspicion and timely diagnosis are paramount in terms of management as less-invasive options for earlier-stage disease develop.
阴茎癌局部治疗可提供可靠的生存获益，并在功能与外观上保留阴茎完整性。干预措施必须针对相应的临床分期。本文综述了从局部治疗到根治性阴茎切除术及重建技术的阴茎癌主要治疗方法。局部治疗（5-氟尿嘧啶或咪喹莫特）对Ta期或Tis期患者具有显著的肿瘤学疗效。多种激光疗法适用于局限性病变及低级别T1期患者。若患者选择不当，其进展和淋巴结转移风险不容忽视。扩大局部切除术为T1期及以下患者提供了可靠的肿瘤学治疗方案；莫氏显微手术在阴茎癌治疗中的证据尚不充分。更具侵袭性的治疗方式包括龟头切除术和部分/根治性阴茎切除术，其5年和10年癌症特异性生存率均超过80%。精细的重建手术对保留阴茎的持久功能至关重要。通过阴茎皮片移植、龟头表面重建、功能性阴茎残端成形术及阴茎假体植入术，可保留排尿与性功能。对于需要广泛部分或根治性阴茎切除术的病例，会阴部尿道造口术可作为替代方案，并为坐位排尿提供持久解决方案。随着早期疾病微创治疗方案的进展，临床警惕性与及时诊断对疾病管理至关重要。
肿瘤(癌症)患者之家