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Dr. Roach: Surgery is standard treatment for penile cancer

Keith Roach
To Your Health

Dear Dr. Roach: What can you tell me about cancer of the penis? I can’t seem to find information.

S.S.

Dear S.S.: Cancer of the penis is quite rare in industrialized nations, accounting for less than 1% of all cancers in men. By contrast, it is quite common in parts of Africa, Asia and South America, where it can account for 10% to 20% of all cancers.

One risk factor is phimosis, an inability to retract the foreskin. Circumcision decreases risk of penile cancer, but careful lifelong hygiene (thus avoiding phimosis) reduces the risk of penile cancer to the same level as seen in circumcised men. Human papillomavirus is another risk factor, found in 30% to 50% of penile cancers. HIV infection and tobacco use are other risk factors.

Dr. Keith Roach

Surgery is the standard treatment for cancer of the penis. The goal of treatment is to preserve as much of the penis as possible in order to maintain sexual and urinary function. There are alternative treatments, including topical medications, radiation and laser treatment. Finding a cancer center with experience in treating penile cancer would be ideal. With only about 2,000 cases per year in the U.S., even many urologists have limited experience.

Dear Dr. Roach: As a person suffering from celiac disease, I must be careful with every morsel I put into my mouth. That includes medications, and I am having difficulty finding a list of gluten-free drug manufacturers. I called my pharmacist and was told to ask my doctor. My doctor didn’t seem to have the answers, either. I even consulted a Physicians Desk Reference but could not locate gluten-free medications or manufacturers. Surely someone has the information handy. Can you help me?

L.N.

Dear L.M.: The Food and Drug Administration says this on its website: “Based on information available to the Agency, we are aware of no oral drug products currently marketed in the United States that contain wheat gluten or wheat flour intentionally added as an inactive ingredient. We would expect any such product, if it existed, to include wheat gluten or wheat flour in the list of ingredients in its labeling.”

Bills have been introduced in both the House and Senate to require manufacturers to label whether their medications contain gluten. Currently, the FDA recommends manufacturers use the following label: “Contains no ingredient made from a gluten-containing grain (wheat, barley, or rye).” I looked up the official prescribing information for some newer medications, but unfortunately was unable to find a single medication that contained this statement as part of their package insert, so I strongly support the proposed bills.

In the meantime, I’d recommend contacting the manufacturers directly to be 100% sure the medications contain no gluten, although it seems the risk is small.

You can read what the FDA says about gluten here: tinyurl.com/FDA-gluten. I also recommend this site for more information: tinyurl.com/gluten-meds.

Dear Dr. Roach: I have a deviated septum and chronic seasonal allergies. I’m glad I read your recent column on oxymetazoline in nasal sprays. I promptly discarded my nasal spray, which contained that active ingredient. I’ve used a different spray that has phenylephrine hydrochloride 1%. Is this safe to use?

J.N.

Dear J.N.: Phenylephrine is a nasal decongestant, and all of these may cause the same problem, called rhinitis medicamentosa, if used too long or too frequently. They are safe and effective only if used for no more than a few days. Nasal steroids are the most effective treatment for chronic seasonal allergies, but there are alternatives available from your family physician, internist or ENT specialist.

Readers may email questions to ToYourGoodHealth@med.cornell.edu