Penile cancer can develop anywhere on the penis and spread (metastasize) to nearby areas, as well as other body parts. About 95 percent of cases start in the flat skin or squamous cells, and the regions most often impacted are the foreskin (prepuce) and tip of the penis (glans). Untreated, most men with penile cancer die within three years, making early detection and treatment essential. A urologist can help with diagnosis, and an oncologist usually determines treatment once the cancer has been diagnosed and staged to determine its aggressiveness.
Treatment Options for Penile Cancer
Surgery, radiation, and chemotherapy are standard approaches for treating penile cancer. Additional methods, such as biologic therapies and radiosensitizers, are still in clinical trials. The main goal of all penile cancer treatments is to eliminate disease while maintaining as much as possible the the appearance and function of the penis.
Surgery
Surgery can be used for all stages of disease and is often performed when the cancer is located only on the skin and has not spread throughout the organ or to other parts of the body. There are several methods of surgery, including:
- Mohs microsurgery: This approach is used when the cancer is present only on the skin of the penis. A surgeon uses a scalpel to remove the tumor, one layer at a time, and a pathologist examines each layer under a microscope for the presence of cancer. This allows the least amount of tissue to be removed.
- Laser surgery: A focused beam of light is used, like a knife, to remove the cancerous tissue. This approach works for both lesions on the surface of the skin as well as larger tumors.
- Wide local excision: Cancerous and adjacent normal tissues are removed with either a scalpel or a laser.
- Cryosurgery: A special instrument freezes and destroys the abnormal tissue.
- Circumcision: If it is affected by cancer, all or part of the foreskin is removed.
- Amputation (penectomy): For more advanced cancers, part or all of the penis is removed. Sometimes, other nearby tissues—the prostate gland or lymph nodes—are removed as well to prevent the disease from spreading.
Chemotherapy or radiation therapy may also be performed after surgery to make sure all of the cancer cells have been killed.
Radiation Therapy
With radiation therapy, high-energy x-rays or other forms of radiation are used to kill cancer cells or prevent them from growing.
There are two main types of radiation therapy:
- External: when radiation is applied to the tumor using a machine outside the body
- Internal: when a radioactive substance is placed inside the body
The method used depends upon the type and stage of the penile cancer. Radiation therapy can be used for small lesions on the skin of the penis, or for larger lesions. Some choose this method in order to avoid surgery and preserve the shape and function of the penis.
Chemotherapy
Chemotherapy uses drugs, such as cisplatin, fluorouracil, bleomycin, and methotrexate, to kill the cancer cells or to stop them from growing. When taken by mouth or injected into a vein, the drugs pass into the bloodstream and eventually reach the cancer cells. For penile cancer in the early stages, topical chemotherapy—in the form of lotion, cream, or ointment—can be applied directly to the skin.
The method used will depend on how advanced the cancer is. Chemotherapy is sometimes combined with surgery or radiation therapy for a more aggressive and effective treatment.
Other Treatments for Penile Cancer
Biologic therapy encourages the body’s own immune system to fight the cancer. This experimental approach uses substances made by the body or manufactured therapies to boost the immune system or direct it to attack the cancer cells. In early-stage disease, biologic therapy may sometimes be applied directly on the skin.
Radiosensitizers are drugs that make cancer cells more sensitive to radiation therapy, which allows the treatment to kill more cells than radiation alone.
Prognosis for Penile Cancer
One scientific study found that when penile cancer was present in the penis, but had not spread to the lymph nodes, 80 percent of men were still alive five years after they were first diagnosed. When the cancer had moved to the lymph nodes, that survival rate dropped to 52 percent. When the cancer had metastasized to distant parts of the body, the five-year survival rate was 18 percent.
References
Sharp DS, Angermeier KW. (2011). Surgery of Penile and Urethral Carcinoma. Campbell-Walsh Urology, 10th. ed.
Barocas DA, Chang SS. (2010). Penile Cancer: Clinical presentation, diagnosis, and staging. Urol Clin of North Am. 37(3):343-352.
Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR. (2007). Incidence trends in primary malignant penile cancer. Urol Oncol. 25(5):361-7.
Lynch, DF. (2003). Cancer of the Penis. Holland-Frei Cancer Medicine. 6th edition.
