Prevention and early diagnosis and treatment of penile cancer and Peyronie's disease: key points of men's health care

Peyronie's Disease

Peyronie's disease, also known as fibrous cavernosum, is more common in middle-aged men. It is mainly caused by fibrosis between the corpora cavernosa and the tunica albuginea, leading to the replacement of normal elastic connective tissue with vitreous degeneration or fibrous scarring, resulting in single or multiple plaques on the dorsal or lateral sides of the penis. Because the plaques lose elasticity, the penis curves during erection. Although the lesion is localized, it should be taken seriously because the plaques can cause erectile pain, penile curvature deformity, and weak erections distal to the lesion.

[Non-surgical Treatment]

(1) Vitamins: High-dose oral vitamin C, 200 mg twice daily for 6 months. Oral diethylstilbestrol and potassium iodide can be used as adjunctive therapy.

(2) Anti-fibrotic drugs: Potassium para-aminobenzoate, 9-12 g daily, divided into several oral doses, for 9 months. (2) Cortisone acetate 25 mg plus procaine 1 ml, intramuscular injection every other day, 15-20 times as one course of treatment. Hyaluronidase 50-100 units/day, intramuscular injection.

(3) Drugs inhibiting connective tissue hyperplasia: Cortisone acetate suspension 25 mg, intradermal injection, 1-2 times per week, 4 times as one course of treatment; Dexamethasone 6 mg and 1% procaine 1 ml, local injection, 1-2 times per week, 12 times in total, with significant efficacy for early lesions.

(4) Histamine iontophoresis: 1% histamine suspension gel is applied to the surface of penile induration, and low-voltage direct current is applied once a day for 10-15 minutes each time, 20 times as one course of treatment. (5) Ultrasound therapy: 115 watts/cm² for 5 minutes each time, every other day, 12 times for one course of treatment. Diathermy or ultraviolet irradiation can be used as adjunctive therapy to improve symptoms.

(6) Audio physiotherapy: 20-80 minutes each time, 1-2 times per week, 10 times for one course of treatment.

(7) Local radiotherapy: 39 mCv/kg (150 roentgens) per dose, twice a week, 2 weeks for one course of treatment, which can soften and absorb the induration.

[Surgical Treatment] When penile curvature or deformation persists for more than one year during erection or when plaque calcification occurs, surgical treatment is required to remove the induration. The purpose is not only to remove the lesion, but more importantly, to straighten the penis. However, the surgical effect of this disease is not good, and the disease is prone to recurrence after surgery.

Penile Cancer

In my country, penile cancer is a relatively common malignant tumor, and it once ranked first among male malignant tumors. With the continuous improvement of people's living standards and healthcare levels, the incidence of this disease is currently showing a downward trend.

The vast majority of penile cancers occur in individuals with phimosis or redundant foreskin. In some ethnic groups, males undergo circumcision at 10 days of age, and penile cancer is almost nonexistent. Those who undergo circumcision in childhood also rarely develop penile cancer. Therefore, penile cancer is caused by the long-term accumulation of smegma under the foreskin, leading to irritation, and is a preventable tumor.

Pathologically, penile cancer is mainly squamous cell carcinoma, with basal cell carcinoma and adenocarcinoma being rare. Due to the toughness of the penile fascia and tunica albuginea, except in late-stage cases, penile cancer rarely invades the corpus spongiosum and does not affect urination. Lymphatic metastasis is extremely common, and it can spread to the groin, thigh, and iliac lymph nodes. Once the cancer invades the corpus cavernosum, it easily spreads hematogenously, potentially metastasizing to the lungs, liver, bones, and brain. It is most common in patients aged 40-60 years with phimosis or redundant foreskin. It initially presents as a hard lump or erythema, a small raised mass, or a persistent ulcer, but is often overlooked due to the covering effect of smegma. Later, bloody discharge flows from the foreskin opening. The tumor may protrude from the foreskin opening or penetrate the foreskin, appearing cauliflower-like, with surface necrosis and malignant exudate. If the tumor continues to grow, it can invade the entire penis and corpus spongiosum. Enlarged nearby lymph nodes are often present at the time of diagnosis.

Diagnosis of penile cancer is not difficult. However, due to patient complacency, neglect, or embarrassment, diagnosis and treatment are often delayed. 15%–30% of patients seek medical attention one year after onset. When balanitis, chronic ulcers, eczema, etc., are difficult to differentiate from tumors, a biopsy should be performed. Enlarged inguinal lymph nodes are not necessarily a sign of metastatic cancer. Metastatic cancer is often hard, non-tender, and does not shrink even after resection of the primary lesion and antibiotic treatment. The femoral lymph nodes located on the medial side of the point where the saphenous vein enters the femoral vein are "sentinel nodes," and in most cases, they are the earliest site of metastasis for penile cancer, which should be taken seriously.

[Prevention and Treatment Methods]

(1) Promote hygiene awareness and strengthen preventive measures: Those with phimosis or redundant foreskin should undergo circumcision; those who have not undergone circumcision should frequently retract and clean the foreskin to prevent smegma from irritating the glans penis; actively treat chronic balanitis, which is the main measure to prevent penile cancer. Early detection, early diagnosis, and early treatment of penile cancer are crucial.

Appropriate physical exercise can enhance physical fitness. Strengthen nutrition and eat more aquatic products such as turtles, soft-shelled turtles, mussels, and eels to aid in disease recovery. (2) Surgical treatment: For small tumors confined to the foreskin, circumcision may be sufficient. Penile cancer generally requires partial penectomy, cutting at least 2 cm above the cancerous lesion. If the remaining penis prevents standing urination and sexual intercourse, total penectomy should be performed, moving the urethra to the perineum. For patients with lymph node metastasis, bilateral inguinal lymph node dissection should be performed 2-6 weeks after primary lesion resection to control infection.

(3) Radiotherapy: Radiotherapy can be used for early-stage penile cancer or in young patients. Some experts advocate for initial radiotherapy followed by surgery if it fails. However, radiotherapy is not always effective, and high doses may cause urethral stricture.

(4) Chemotherapy: Bleuracil has good efficacy against penile cancer and can be used in conjunction with surgery and radiotherapy.