Patient education › Penile cancer
Penile cancer
Penile cancer is rare, and it is one of the cancers where delay does the most damage. Most of that delay is embarrassment rather than anything medical, which is worth naming plainly.
Walk in prepared
If you have been putting off this appointment, preparing for it privately beforehand can make it much easier to have the conversation.
Dr. Weiner uses WellPrept to help patients gather their records and write down their questions ahead of time. It is free, takes about ten minutes, and you do not need to be his patient to use it. If you are seeing another urologist, or preparing for a second opinion anywhere, it works just as well.
Organize your records and questions before you sit down. Free, and yours to keep whichever doctor you see.
A sore or lump that does not heal
Almost all penile cancers are squamous cell carcinomas, arising from the skin-type cells covering the penis. They usually appear on the glans or the foreskin as a lump, an ulcer, or a thickened patch that does not settle. Pain, discharge, bleeding or odour tend to be features of disease that has been present for a while.
There is also a pre-cancerous stage, sometimes called penile intraepithelial neoplasia, which can look like a persistent red or scaly patch. It is very treatable, and it is exactly the sort of thing that gets attributed to irritation or thrush for months.
Delay is the enemy here. Overall survival is around fifty per cent, but that average hides an enormous split: it exceeds eighty-five per cent when the lymph nodes are clear, and drops sharply once they are involved. Almost nothing else you can do matters as much as being seen early. If a lesion has not resolved in a few weeks, it needs looking at, not another cream.
What raises the risk
HPV infection is involved in a large share of cases. Phimosis, where a tight foreskin cannot be retracted, raises risk substantially, partly because it both promotes and conceals disease. Smoking raises risk several-fold. Lichen sclerosus, a chronic inflammatory skin condition, carries a real risk of cancer developing over time and deserves proper follow-up. Chronic inflammation, poor hygiene and HIV are all associated. Neonatal circumcision is associated with lower rates, though the same protection is not seen when circumcision is done in adulthood.
Diagnosis
A biopsy is essential. Nothing is treated as cancer without one, and nothing suspicious should be dismissed without one. HPV and HIV status are usually assessed too, because both can affect the outlook and the plan. Imaging, typically MRI or ultrasound of the penis and cross-sectional imaging of the abdomen, pelvis and chest, is used to judge depth and to stage.
Preserving the penis where it is safe
Early and pre-cancerous disease can often be treated without removing much at all: topical chemotherapy or immune creams, laser treatment, wide local excision often with circumcision, removal of the surface of the glans, or Mohs surgery. Radiation, including brachytherapy, is an option for selected small tumours and requires circumcision first.
The honest trade-off is that penis-preserving treatment has a meaningfully higher rate of the cancer coming back locally than amputative surgery does, even though overall survival is comparable for early tumours. That is manageable, but only if you are willing and able to attend close follow-up, since the whole approach depends on catching a recurrence early. When the tumour invades the deeper erectile tissue, or a clear margin and a functional result cannot both be achieved, partial or total penectomy becomes necessary.
Sexual function and quality of life are affected considerably more by amputative surgery than by penis-preserving approaches. This is a legitimate part of the decision, and worth raising explicitly rather than hoping it will be covered.
The lymph nodes matter more than the tumour
If you take one thing from this page, take this. Whether cancer has reached the lymph nodes in the groin is the strongest predictor of long-term survival in penile cancer, stronger than the size or appearance of the original tumour.
A normal examination is not enough
A meaningful proportion of men whose groins feel entirely normal already have microscopic cancer in those nodes. That is why, for anything beyond the earliest tumours, guidelines recommend actively assessing the nodes on both sides rather than waiting to see whether something becomes palpable. Waiting until nodes can be felt produces worse survival than acting early.
There are two ways to do it. A dynamic sentinel node biopsy uses a tracer and dye to identify the first node the area drains to, and removes only that, which is far less morbid. Its accuracy depends heavily on the team doing it regularly, which is why it belongs at centres that perform a reasonable volume. A full inguinal lymph node dissection removes the nodes on both sides and is more definitive but carries more complications, particularly with wound healing and leg swelling.
Why both sides
Lymphatic drainage from the penis crosses over, so disease on one side frequently involves nodes on the other. Assessment is done bilaterally for that reason. If several nodes are involved, or cancer has spread outside a node capsule, deeper pelvic nodes are addressed as well.
A palpable lump is not automatically cancer
Between a third and a half of palpable groin nodes in this setting turn out to be inflammatory rather than malignant. A needle biopsy is often the cleanest way to settle it, though for high-risk primary tumours surgery may proceed without waiting.
When more is needed
For bulky or node-positive disease, chemotherapy before surgery is the preferred approach, and combination platinum-based regimens are standard. Immunotherapy has entered the picture for advanced disease. Radiation is used adjuvantly for node-positive disease and for positive margins, and palliatively. Because penile cancer is so rare, high-quality randomized evidence is genuinely thin, which is one reason clinical trial participation is actively encouraged.
Worth asking out loud
This is a rare cancer, and where you are treated matters. Ask directly.
About the diagnosis
- Has this been biopsied, and what did it show?
- What stage and grade is it?
- Has my HPV status been checked?
- How deep does it go on imaging?
About treating the tumour
- Can this be treated without removing part of the penis?
- What is the trade-off in recurrence risk if we preserve tissue?
- What will this mean for sexual function and appearance?
- What happens if the margin is not clear?
About the lymph nodes
- Do my groin nodes need to be assessed even though they feel normal?
- Is sentinel node biopsy available here, and how many do you do a year?
- Will both sides be assessed?
- What happens if nodes are positive?
About where to be treated
- How many penile cancers does this centre treat a year?
- Would referral to a higher-volume centre be reasonable?
- Is there a clinical trial I should consider?
- What psychological and sexual health support is available?
Sources and further reading
This page was written for patients and reviewed by Dr. Weiner. It reflects current professional guidelines, which are written for clinicians. The patient-facing versions below are free and often easier to read.
- NCCN Guidelines for Patients: Penile Cancer, National Comprehensive Cancer Network.
- Penile cancer, Urology Care Foundation.
- Urology Care Foundation, the AUA's patient education arm.
- NCCN Guidelines for Patients, free plain-language versions of the treatment guidelines.
This is general education, not medical advice. It cannot account for your imaging, your pathology, your other health conditions or what matters to you. Take it to your own doctor and work through it together. If anything here conflicts with what your urologist has told you, raise it with them directly rather than assuming either of us is wrong.
Last reviewed September 2026 by Adam B. Weiner, MD.