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Radiation therapy uses high-energy rays or particles to destroy cancer cells. It can be used to treat penile cancer in these ways:

• It can be used to treat some smaller penile cancers instead of surgery.
• If the cancer has spread to many lymph nodes , radiation may be used after surgery to remove the lymph nodes to try to reduce the risk the cancer will come back.
• It can be used when surgery isn't an option.
• Radiation can be used for advanced cancer to try to slow the growth of the cancer or to relieve symptoms it causes.
• It can be given along with chemo before surgery to help shrink the tumor and make it easier to remove with less damage to the penis.
• Men at high risk of cancer coming back in nearby lymph nodes might get radiation to those nodes to help lower this risk. (Not all experts agree that this works.)

For uncircumcised men who are going to get radiation to the penis, the foreskin is removed first. They're circumcised because radiation can cause swelling and tightening of the foreskin, which could lead to other problems.

There are 2 main ways to get radiation therapy for penile cancer: external beam and brachytherapy.

External beam radiation therapy

The most common way to get radiation therapy is from carefully focused beams of radiation aimed at the tumor from a machine. The treatment is a lot like getting an x-ray, but the radiation is much stronger. The treatments don't hurt. Each one lasts only a few minutes, but the set-up time – getting you into place for treatment – usually takes longer. Treatments are usually given 5 days a week for 6 weeks or so.

A wax or plastic block or mold may be used to hold the penis in the exact same position for each treatment. Shields may be used to protect the groin and testicles.

Brachytherapy

For brachytherapy, a radioactive source is placed into or next to the penile tumor. The radiation travels only a short distance, so nearby healthy tissues don’t get much radiation. The patient stays in the hospital, often on bed rest, for this type of treatment. A soft tube, called a Foley catheter, is put through the penis and into the bladder to drain out urine while brachytherapy is done. There are 2 ways to get brachytherapy for penile cancer.

Interstitial radiation

In this method, hollow needles are first put into the penis in the operating room. Pre-drilled plastic templates lock onto both ends of the needles to hold them in place. The needles are kept in for several days. Tiny pellets of radioactive materials are put into the needles to treat the tumor. The pellets can be left in the needles for different lengths of time. They may be put in many times a day to release radiation. After the treatment is over, all the pellets are taken out and the needles are removed.

Plesiobrachytherapy

This type of brachytherapy puts the radiation source close to (but not into) the tumor. In this method, a plastic cylinder is fitted around the penis. Then another cylinder holding the radiation source is placed on top of the first cylinder. Another way to do this is to make a sponge-like mold of the penis and put the radioactive material into hollowed-out spaces in the mold. Treatment is usually given for several days in a row.

This treatment can only work for tumors near the surface of the penis. It's not often used in the US.

Possible side effects of radiation therapy

The main drawback of radiation therapy is that it can destroy or damage nearby healthy tissue along with the cancer cells. The skin in the treated area often becomes red and sensitive. There may be patches of skin that are oozing and tender. For some, the skin may even peel. For a while, you may feel a burning sensation when you urinate. The area may also swell for a time.

Patients treated with brachytherapy will find their side effects tend to be worst about 3 weeks into treatment and last after treatment is finished. It can take up to 12 weeks to heal.

If external beam radiation is used, the side effects tend to slowly start during treatment and then get better over time after radiation is stopped. Most go away over a couple of months.

Over time, men treated with radiation may notice the skin of the penis has become darker or less elastic. They may be able to see tiny web-like blood vessels (called telangiectasia).

Good hygiene and skin care are key to keeping the area from getting infected.

Some less common but more serious side effects can include:

• Some of the skin or tissue at the end of the penis might die (called necrosis).
• The urethra (the tiny tube that carries urine out of the penis) might become narrow from scar tissue (called stenosis), leading to problems urinating.
• An abnormal opening (fistula) might form between the urethra and skin, which could result in urine leaking out through the opening.

Radiation to the shaft of the penis might affect a man’s ability to have erections. But in cases where the tumor has not grown beyond the glans, radiation is directed only at the tip of the penis, so erections should not be affected.

In many cases, the function and appearance of the penis slowly goes back to normal in the months and years after radiation therapy.

Other possible side effects of radiation to the pelvic area and groin lymph nodes include tiredness, nausea, or diarrhea.