Penile Cancer

What penile cancer is

Most penile cancers start in the flat squamous cells that cover the penis. They often begin as precancerous changes called penile intraepithelial neoplasia (PeIN), which can appear as red, velvety patches (erythroplasia of Queyrat) or crusted, scaly patches. Untreated, these can become invasive cancer that spreads to the lymph nodes in the groin and, later, to other organs.

Rare types include melanoma, basal cell carcinoma and sarcomas.

Risk factors

Symptoms

• a change in skin color or thickness on the glans or foreskin
• a lump, wart-like growth or sore that does not heal
• a red, velvety or bluish-brown flat patch
• bleeding from the penis or under the foreskin
• foul-smelling discharge under the foreskin
• difficulty pulling back the foreskin
• swollen lymph nodes in the groin
• in advanced disease, fatigue, weight loss and pain

Embarrassment often delays diagnosis. Many penile lesions are benign, such as genital warts, infections or eczema, but any lasting change should be examined.

Diagnosis

• physical examination of the penis and groin lymph nodes
• biopsy of the lesion: the only way to confirm cancer
• imaging: ultrasound or MRI to assess depth of invasion; ultrasound or CT of the groin lymph nodes; CT or PET-CT for spread in higher-risk cases
• sentinel lymph node biopsy or groin node dissection when nodes cannot be felt but the tumor is intermediate or high risk

Staging uses the TNM system and determines treatment.

Treatment

Treatment aims to remove the cancer while preserving as much function and appearance as possible. It is best delivered at specialist centers.

Precancerous and early cancers

• topical treatments: imiquimod or 5-fluorouracil cream
• laser ablation
• Mohs surgery or wide local excision
• glans resurfacing

Invasive cancer

• penile-preserving surgery: partial glansectomy, glansectomy, or partial penectomy with reconstruction
• total penectomy for large or deep tumors, with a new opening for urine (perineal urethrostomy)
• circumcision for tumors limited to the foreskin

Lymph nodes

• dynamic sentinel node biopsy or groin lymph node dissection, because spread to groin nodes is a key factor in outcome
• radiation and chemotherapy for node-positive disease

Advanced disease

• chemotherapy, often before surgery
• radiation therapy
• immunotherapy and clinical trials for advanced or recurrent cancer

Living after treatment

Sexual function, urination and body image may be affected. Reconstruction, counseling and sexual health support help. Regular follow-up checks for recurrence.

Outlook

When penile cancer is found before it spreads to the lymph nodes, survival rates are high, with 5-year survival around 80% or more for localized disease. Survival falls when lymph nodes or distant organs are involved, which is why early assessment of any persistent lesion matters.

Prevention

• HPV vaccination for boys and girls, recommended at age 11 to 12 and up to 26, and for some adults up to 45
• good genital hygiene, including cleaning under the foreskin
• treating phimosis and chronic balanitis
• stopping smoking
• safer sex to reduce HPV and HIV risk

Frequently asked questions

What are the early signs of penile cancer?

Early signs include a change in skin color or thickness, a sore, lump or wart-like growth, a red velvety patch, bleeding or foul-smelling discharge under the foreskin. Any change on the penis that has not healed within 4 weeks should be checked.

What causes penile cancer?

The main risk factors are HPV infection, a tight foreskin (phimosis), poor genital hygiene, smoking, lichen sclerosus and chronic inflammation. Most cases occur in men over 60.

Is penile cancer curable?

Yes, especially when found early. Small, early cancers can often be cured with topical treatment, laser or limited surgery that preserves the penis. Outcomes are worse once cancer spreads to the lymph nodes.

Can HPV vaccination prevent penile cancer?

HPV vaccination prevents infection with the HPV types responsible for many penile cancers, as well as genital warts and other HPV-related cancers. It is expected to reduce the risk of HPV-related penile cancer.