Penile cancer: the decisions you may face

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Is Brachytherapy the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
   Why: A single standard does not mean a single choice; timing and trials are decisions too.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (EAU-ASCO Collaborative Guideline on Penile Cancer 2023), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (primary tumour), which of the standard options do you recommend and why?
   Why: Guideline options include: Organ-sparing treatment where feasible (glansectomy, glans resurfacing, wide local excision, laser or brachytherapy); partial or total penectomy reserved for extensive tumours.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Is Sentinel lymph node biopsy the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
   Why: A single standard does not mean a single choice; timing and trials are decisions too.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (EAU-ASCO 2023; NCCN Guidelines: Penile Cancer), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (clinically node-negative, intermediate or high-risk primary), which of the standard options do you recommend and why?
   Why: Guideline options include: Dynamic sentinel node biopsy (or modified inguinal lymphadenectomy where unavailable); observation only for low-risk primaries.

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• InPACTPhase 3NCT02305654200 peopleevidence 47
  Tests Paclitaxel / nab-paclitaxel, Cisplatin, Ifosfamide
  Penile squamous cell carcinoma with inguinal lymph node involvement: a Bayesian multi-arm trial randomising between immediate inguinal node dissection, neoadjuvant paclitaxel, ifosfamide and cisplatin (TIP) then surgery, and neoadjuvant cisplatin chemoradiotherapy then surgery, with a second randomisation to prophylactic pelvic node dissection or surveillance in high-risk patients, and overall survival as the primary endpoint

  No headline result recorded yet.

1. Between Paclitaxel / nab-paclitaxel, Cisplatin and Ifosfamide, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in InPACT, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline (NCCN Guidelines: Penile Cancer), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (node-positive), which of the standard options do you recommend and why?
   Why: Guideline options include: Radical inguinal lymphadenectomy; pelvic lymphadenectomy and adjuvant chemotherapy or chemoradiation for extensive disease; neoadjuvant TIP for bulky or fixed nodes (InPACT is testing the sequence).
7. Am I a candidate for Paclitaxel / nab-paclitaxel, Cisplatin, Ifosfamide, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
8. How do the results of InPACT apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Cisplatin, Paclitaxel / nab-paclitaxel, Pembrolizumab and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. For my situation (metastatic or recurrent), which of the standard options do you recommend and why?
   Why: Guideline options include: Cisplatin-based chemotherapy (TIP); checkpoint inhibitors in trials or where approved for tumour-agnostic indications; palliative radiotherapy.
6. Am I a candidate for Cisplatin, Paclitaxel / nab-paclitaxel, Pembrolizumab or related drugs, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.