Penile Cancer Treatment

Penile cancer is an uncommon malignancy that typically begins in the skin or mucous membranes of the penis. The majority of cases are squamous cell carcinomas, which develop in the thin, flat cells that make up the outermost layer of the skin. Although the exact cause is not always identifiable, several factors may increase the risk, including tobacco use, chronic infection with human papillomavirus (HPV), inadequate hygiene and phimosis, a condition in which the foreskin cannot be retracted over the head (glans) of the penis.

Early warning signs of penile cancer can include unusual discharge or bleeding from the penis, changes in the color or thickness of the penile skin, a lump under the foreskin or a sore that does not heal. Although the condition primarily affects men 50 and older, it can occur at any age. Because early detection is the key to effective treatment, any unusual changes in the penis should be promptly evaluated by a physician.

The diagnostic process for penile cancer typically includes a physical examination, imaging studies and a biopsy to confirm the presence of cancer cells. Staging tests may also be performed to help the physician assess the extent of the tumor and determine whether it has spread beyond the penis.

Treatment for penile cancer can vary depending on the size, location and stage of the tumor and the patient’s overall health. Options may include surgery, radiation therapy and chemotherapy.

Surgery for penile cancer

Surgery can be a highly effective treatment option for penile cancer, especially when the tumor is detected early and remains confined to the penis. The goal is to remove all cancerous tissues while preserving the patient’s urinary and sexual function, as well as the natural appearance of the organ when possible.

What does surgery for penile cancer involve?

Several surgical techniques may be used to treat penile cancer, including:

• Circumcision – If the patient is uncircumcised and the cancer is limited to the foreskin, a circumcision may be performed to surgically remove the affected tissue.
• Laser surgery – Using focused, high-energy light beams, the surgeon can precisely remove cancerous cells from the surface of the penis. This minimally invasive procedure may be considered for an early-stage or superficial penile tumor, allowing the surgeon to effectively treat the cancer while sparing nearby tissues and minimizing any bleeding.
• Cryotherapy – Using extreme cold, such as liquid nitrogen, the surgeon can freeze and destroy cancerous cells on the surface of the penis. This minimally invasive technique may be considered for a small, early-stage tumor, helping to preserve the surrounding healthy tissues.
• Mohs micrographic surgery – This highly precise, tissue-sparing technique involves surgically removing a thin layer of skin and immediately examining it under a microscope for evidence of cancer. The process is repeated until no cancer is found in the removed skin.
• Wide local excision – The surgeon will remove the penile tumor along with a slim margin of surrounding healthy tissue, which will be sent to a lab for microscopic analysis by a pathologist. If no cancer cells are found in the margin, further treatment may be unnecessary.
• Glans resurfacing or glansectomy – If the tumor is confined to the head of the penis, the surgeon may perform glans resurfacing to remove its outer layers of skin (epithelium and subepithelium), or a glansectomy to remove the entire glans, and then place a skin graft to reconstruct it.
• Partial penectomy – If the tumor is large or deep, the surgeon may remove the affected portion of the penis.
• Total penectomy – If the cancer is extensive, the entire penis may be removed, followed by a urinary diversion procedure to allow the patient to urinate through a newly created opening in the body.
• Lymph node dissection – If there is concern about local cancer spread, the surgeon may remove the inguinal lymph nodes in the groin.

What are the potential benefits of surgery for penile cancer?

Surgery may offer the potential to completely remove the penile tumor and reduce the risk of cancer spreading to other parts of the body, supporting the best possible clinical outcome. When performed in the early stages, certain procedures may also preserve penile function and appearance, which can have a positive impact on the patient’s quality of life. In some cases, the removal of nearby lymph nodes may be recommended to help the physician assess the extent of the cancer and guide additional treatment planning.

What is the recovery process like?

Recovery from penile cancer surgery can vary based on the specific procedure and the patient’s overall health. A relatively minor surgery, such as circumcision or local excision, may involve a brief recovery with minimal discomfort. On the other hand, a more extensive procedure, such as a partial or total penectomy, may require a longer recovery that involves wound care, catheter use, pain medications and rehabilitation. The patient may also receive support from urology, oncology and mental health specialists to address their physical and emotional needs. Follow-up visits will be important to monitor for signs of recurrence and manage any lingering side effects.

Radiation therapy for penile cancer

Radiation therapy is a nonsurgical treatment that uses high-energy beams to target and destroy cancerous cells. It may be used as a primary treatment for certain types of early-stage penile cancer, as an alternative to surgery in select cases or after surgery to reduce the risk of recurrence. Radiation therapy can also be beneficial in managing the symptoms of late-stage penile cancer or treating a tumor that has spread from the penis to nearby lymph nodes or other areas of the body.

External beam radiation therapy (EBRT) for penile cancer

EBRT involves the use of a linear accelerator (LINAC), a special machine located outside the patient’s body. The LINAC will generate powerful X-rays focused directly on the tumor.

Before external beam radiation therapy begins, the patient will participate in a planning session (simulation), which will involve imaging tests to help the physician precisely map the targeted area and fine-tune the treatment plan. Radiation therapy is typically administered in daily sessions, five days per week, over several weeks. During each session, the patient will lie on a special table while the LINAC rotates around their body, delivering the radiation beams to the tumor with pinpoint accuracy.

What are the potential benefits of external beam radiation therapy for penile cancer?

EBRT may be particularly beneficial for a patient with early-stage penile cancer who prefers to avoid surgery. It can also be used to shrink the tumor before surgery and make it easier to remove, or to address cancer spread to lymph nodes in the groin. In certain clinical scenarios, external beam radiation therapy can provide effective cancer control with minimal visible changes to the penis.

What are the possible side effects of external beam radiation therapy for penile cancer?

The side effects of EBRT for penile cancer can include:

• Skin irritation or redness at the treatment site
• General fatigue
• Swelling or soreness in the penis and groin area
• Pain or discomfort during urination
• Changes in sexual function
• Narrowing of the urethra (urethral stricture)

Most side effects of radiation therapy are manageable and improve after treatment ends, although some may require follow-up care.

What is the recovery process like?

Recovery from EBRT is usually gradual. The patient may continue their normal activities during treatment, although they may feel tired. Skin care, pain management and close follow-up with the oncology team can be helpful. Over time, any temporary swelling or irritation should subside. Regular monitoring will be needed to assess the effectiveness of treatment and manage any lingering side effects.

Internal radiation therapy for penile cancer

Internal radiation therapy, or brachytherapy, involves the surgical placement of a small radioactive source directly inside or near the tumor, allowing for the delivery of a high dose of radiation while minimizing exposure to the surrounding healthy tissues. Though generally used less often than EBRT for penile cancer, brachytherapy may be considered in select clinical scenarios or as part of a clinical trial. Typically, the procedure is performed in a hospital setting and may require anesthesia or sedation.

What are the potential benefits of internal radiation therapy for penile cancer?

Brachytherapy is a targeted form of radiation therapy that delivers a high dose of radiation directly to the tumor site, minimizing exposure to the surrounding healthy tissues and potentially reducing side effects. When appropriately selected, this approach can offer cancer control comparable to surgery while preserving both the function and appearance of the penis.

What are the possible side effects of internal radiation therapy for penile cancer?

The side effects of brachytherapy for penile cancer may include:

• Swelling or tenderness in the penis
• Painful urination
• Local tissue irritation or skin breakdown
• Urethral narrowing
• Erectile dysfunction

Rarely, long-term damage to penile tissue may occur, which could affect the function or appearance of the penis.

What is the recovery process like?

Recovery from brachytherapy usually involves a short hospital stay followed by rest and limited physical activity for several weeks. The patient may be advised to avoid sexual activity for a specified time. Follow-up visits will be important to assess healing and monitor urinary and sexual function. Supportive care and counseling may be helpful during recovery, particularly for managing side effects or emotional concerns.

Chemotherapy for penile cancer

Chemotherapy is a systemic treatment that uses powerful drugs to destroy rapidly dividing cells throughout the body. For penile cancer, chemo can be used in several ways, including:

• Before surgery to shrink the tumor and make it easier to remove
• After surgery to target any remaining microscopic cancer cells
• As the primary treatment for cancer that has spread from the penis to another part of the body
• In combination with radiation therapy to increase the overall effectiveness of treatment

What does chemotherapy for penile cancer involve?

Chemotherapy involves a customized combination of anticancer drugs, which may be administered intravenously or orally in cycles. Treatment may be given over several weeks or months, with a rest period after each cycle to allow the body time to recover. Common chemotherapy drugs used for penile cancer include:

• Cisplatin
• Fluorouracil (5-FU)
• Paclitaxel
• Docetaxel

The specifics of the treatment plan will be determined based on the stage and extent of the tumor and the patient’s overall health.

What are the potential benefits of chemotherapy for penile cancer?

Chemotherapy can offer several key benefits. These include:

• Improving the surgical outcome by shrinking the tumor beforehand, potentially allowing for a more conservative procedure or making a previously inoperable tumor resectable
• Lowering the risk of cancer recurrence
• Treating cancer that has spread from the penis to nearby lymph nodes or distant organs
• Reducing the symptoms of advanced or metastatic penile cancer and improving the patient’s quality of life

What are the possible side effects of chemotherapy for penile cancer?

Chemotherapy is an intensive treatment that can affect cancerous cells as well as healthy cells that naturally grow rapidly, such as those in the hair follicles, bone marrow and digestive tract. Damage to healthy cells can lead to a range of side effects, including:

• Fatigue and weakness
• Nausea and vomiting
• Diarrhea or constipation
• Hair thinning and hair loss
• Reduced appetite
• Increased risk of infection
• Mouth sores
• Numbness or tingling in the hands and feet (peripheral neuropathy)

These side effects can vary based on the specific drugs used and the patient’s tolerance, and many can be managed with supportive care during treatment.

What is the recovery process like?

Recovery from chemotherapy can take several weeks or longer, depending on the treatment intensity and duration. Some side effects may subside shortly after treatment ends, while others—such as fatigue and neuropathy—can take longer to resolve. Follow-up care will be essential to monitor the treatment response, manage lasting side effects and detect early signs of recurrence. Most patients gradually regain their strength and return to their normal activities over time, with appropriate support from their healthcare team.

Benefit from world-class care at Moffitt Cancer Center

The latest options in penile cancer treatment are available through Moffitt’s comprehensive Urologic Oncology Program. Our patients also have access to promising new therapies through closely monitored clinical trials. These important research studies allow participants to benefit from novel treatment approaches—such as radiosensitizers that can make penile cancer cells more vulnerable to radiation therapy—while oncologists compare their effectiveness to the current standard of care.

If you would like to learn more about penile cancer treatment, you can request an appointment with a specialist at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.