Circumcision before RT for penile CA?

[RadOncLova]

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Older gentleman with numerous comorbidities (CVD on Coumadin), pT3N0 penile squam of the glans. Refuses penectomy and may even refuse partial.

So now I may be stuck giving RT. Not comfortably with brachy given urethral involvement and I'm going to have to cover inguinals anyway.

All guidelines that I can find recommend circumcision first. I believe it is due to the potential for swelling of foreskin possibly compromising blood supply to the penis.

Is this a must? What do I do if he refuses circumcision?

 

[Palex80]

I agree, sou should try to get him to have curcumcision. If he refuses, it's his call. Document it and still go ahead?