Radiotherapy for localised penile cancer

Radiotherapy

Radiotherapy is the use of high-energy x-ray beams to kill cancer cells. These cancer cells can be targeted from outside of the body (external beam radiotherapy) or from within the body (brachytherapy). Both types of radiotherapy can be used to treat penile cancer which is confined to the penis as an alternative to surgery. External beam radiotherapy can also sometimes be used to treat other areas of the body that may have been affected by penile cancer to reduce problematic symptoms.

Before both of these types of radiotherapy are performed the area to be treated will be identified by performing scans such as CT and MRI and ink marks applied to the target treatment area.

Men will also need to be circumcised (the foreskin surgically removed) prior to radiotherapy to reduce the chance of skin swelling and irritation which may affect the penis as a result of treatment.

Brachytherapy

This type of treatment can be used to treat penile cancer which is not greater than 4cm in size and can be performed using two possible methods.

Plesiobrachytherapy

This type of brachytherapy is used for superficial penile cancer. A special plastic mould is made in the shape of the penis. This can be fitted over the penis and small radioactive wires are then attached to the penile tissue around the cancerous area. Radiation is then administered via these wires. This type of treatment can be performed daily on an outpatient basis over several days.

Interstitial brachytherapy

Under a general anaesethic radioactive needles are positioned through the penis and small radioactive pellets then inserted near to the cancerous area. The pellets will emit radiation and kill cancer cells. The needles will need to stay in place for up to 7 days and men will need to stay in hospital during this time in a room with a period of limited mobility (bed rest). Children and pregnant women will not be allowed to visit them. The needles will be removed under a general anaesthetic once the treatment has finished.

To protect the urethra from becoming inflamed from the treatment and to allow  urine to pass freely from the bladder a urinary catheter (see below) will be inserted.

External beam radiotherapy

This treatment involves radiation being focused at areas of  cancer by a special machine. Treatment tends to be given over a six week period  in short doses (10-15 minutes). Beams of radiation are directed at the cancer and controlled by a computer.

For more information on radiotherapy in general from NHS Choices please click here

Catheters and catheter care

Catheter

A catheter is a plastic tube that drains urine from the bladder. It will be connected to a drainage bag. The catheter is held inside the bladder by a balloon that is inflated with sterile water following insertion. It will therefore not usually come out unless properly removed by deflating the balloon. The balloon of the catheter tends to rest over a sensitive area of nerves which may become irritated by its presence. This irritation may make a man feel as if he is bursting to pass urine and sometimes a small amount of urine may be expelled from around the catheter.

Tips

  • Unless instructed otherwise men can have a shower or bath with the catheter in place.
  • Do not use powders or lotions around the catheter or penis entry site.
  • If men find the catheter is leaking they should not place non sterile materials (such as tissues) around the penis.
  • It is very important to drink 2 – 3 litres of fluid daily to flush urine through. Water based drinks tend to prevent bacteria forming in urine which can lead to infection.
  • When emptying or connecting catheter bags men should always wash their hands thoroughly with soap and water before and after the procedure.
  • Do not pull or tug at the catheter.

Common side effects of radiotherapy

Fatigue

This may be caused by a combination of both treatment and travel. Getting small restful naps or taking a mild sedative medication may help. Some men find meditating can be beneficial.

Skin reactions

Radiotherapy can irritate the sensitive skin around the penis and sometimes reduce the blood supply to the penis  These symptoms tend to occur 2-3 weeks into external beam radiotherapy and 2-3 weeks after brachytherapy. Vitamin E supplements and topical creams can aid the healing process and these may be prescribed by the healthcare team. It is also advisable to keep areas that have been exposed to radiotherapy covered and protected from direct sunlight.

Problems passing urine

Radiotherapy can sometimes cause the tissue of the penis to become thicker. This may then lead to a narrowing or ‘stricture’ of the urethra which in turn can cause spraying of the urinary stream. If this occurs, a minor operation can be performed to widen the urethra to allow urine to pass more easily. Men can sometimes also be taught how to widen the urethra using specially designed plastic tubes (urethral dilatation) to reduce the chance of this occurring.
Disposable urinary funnels (see picture below) may be useful if the urinary stream is spraying and examples can be found on amazon.co.uk.

Male Funnel
Alternatively a similar device can be obtained on prescription. It is placed over the penis when urinating and it directs the spray. It is washable and can be taken anywhere.
GP’s will need to know that this is available from :
Beambridge Medical Ltd
It’s called a Male Funnel cost £12.37
Prescribing Code 6-35
Chemist’s PIP Code 262-5960
www.beambridgemedical.com

 

Erection problems

If the blood supply to the penis is reduced as a result of radiotherapy or the tissue has become thicker or less healthy men may
find it more difficult to obtain an erection. Sometimes this ability will slowly return as the body heals. Once treatment has finished it may also be possible to try oral medication such as Viagra to help improve erections (as directed or prescribed by the health care team).

 

Men should seek medical advice from their healthcare team if they experience:

 

  • Uncontrolled pain.
  • A high temperature and shaking or feeling as if a bad cold is present which could be a sign of infection
  • Prolonged swelling, redness or a foul smelling discharge on the penis which could indicate
    localised infection.
  • Difficulty in passing urine.

 

To read more about possible side effects of radiotherapy and how to manage them from NHS Choices please click here

To read personal stories of men who have been affected and treated for penile cancer please click here

Updated 26/1/17 Next review July 2017

 

References available on request.

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