Is Penile Cancer Deadly?

Penile cancer can be deadly, but catching and treating it early has the best results; more than 80% of people who get a localized penis cancer diagnosis are still alive after five years.

Penile cancer occurs when cells in the penis grow out of control. 

Almost all penile cancers start in skin cells of the penis: 

• Squamous cell carcinoma
  • Accounts for about 95% of penile cancers 
  • Can occur anywhere on the penis
  • Develops from flat skin cells called squamous cells
• Melanoma 
  • Tends to grow and spread quickly
  • Most often occur in sun-exposed skin and rarely on the penis
  • Develops from melanocytes, which are cells that produce the brownish color in the skin that helps protect it from the sun. 
• Basal cell carcinoma (also known as basal cell cancer) 
  • Slow-growing and rarely spreads to other parts of the body
  • Only makes up a small portion of penile cancers
• Adenocarcinoma (Paget disease of the penis)
  • Very rare type of penile cancer 
  • Develops from sweat glands in the skin of the penis
• Sarcoma
  • Accounts for a small number of penile cancers
  • Develops from blood vessels, smooth muscle, or other connective tissue cells of the penis

Symptoms of penile cancer include: 

• Skin changes
  • Usually occur on the glans (tip) of the penis or on the foreskin (in uncircumcised men), but can also be on the shaft
    • An area of thicker skin 
    • Changes in skin color
    • A lump 
    • Ulcer (sore) that may bleed
    • Reddish, velvety rash under the foreskin
    • Small, crusty bumps
    • Flat, bluish-brown growths
    • Discharge (fluid) with a foul odor or bleeding under the foreskin
• Swelling
  • Often at the tip of the penis
  • May be difficult to pull back the foreskin
• Lumps under the skin in the groin area
  • Occurs if the cancer spreads to the lymph nodes in the groin

The exact cause of penile cancer is unknown, though it is sometimes associated with other conditions. 

Risk factors for developing penile cancer include: 

• Human papillomavirus (HPV) infection
• Not being circumcised
• Phimosis
• Smegma
• Smoking and other tobacco use
• UV light treatment of psoriasis
• Age
  • About 80% of penile cancers are diagnosed in men over age 55
  • The average age at diagnosis is 68
• Acquired immunodeficiency syndrome (AIDS) 

Penile cancer is diagnosed with a physical exam, patient history, and tests such as: 

• Biopsy
  • Incisional biopsy
  • Excisional biopsy
  • Lymph node biopsy
    • Fine needle aspiration (FNA)
    • Surgical biopsy
• Imaging tests
  • Computed tomography (CT) scan
    • CT-guided needle biopsy
  • Magnetic resonance imaging (MRI) scan
  • Ultrasound
  • Chest X-ray to check if the cancer has spread to the lungs

Treatment for penile cancer may include one or more of the following: 

• Surgery 
  • Circumcision 
    • Removes foreskin and some nearby skin may be done if cancer is localized to the foreskin
    • Also done prior to radiation therapy to the penis because radiation can cause swelling and tightening of foreskin
  • Simple excision
    • Removes tumor and some nearby skin
  • Wide local excision 
    • Removes tumor along with a larger amount of normal tissue around it (wide margins) to make it less likely cancer cells are left behind
    • A skin graft may be taken from another part of the body and used over the area if there is not enough skin remaining
  • Mohs surgery (microscopically controlled surgery)
    • May be used instead of wide local excision 
    • Removes one layer of skin at a time, samples are checked for cancer, and the process is repeated until there are no cancer cells in the skin sample
    • Process can be slow but can leave more tissue intact 
  • Glansectomy
    • Used for small tumors on the tip of the penis (glans) 
    • Skin grafts may be needed to rebuild the glans after surgery
  • Partial or total penectomy
    • Removal of part of all of the penis
    • Used to treat penile cancer that is deep inside the penis
    • In advanced cases, the scrotum and testicles are removed as well (emasculation) and patients must take testosterone supplements for the rest of their lives
  • Lymph node surgery
    • If cancer has grown deep inside the penis, nearby lymph nodes in the groin may need to be removed
  • Sentinel lymph node biopsy (SLNB)
    • Inguinal lymphadenectomy (groin lymph node dissection)
  • Pelvic lymph node surgery
• Radiation therapy 
  • External beam radiation therapy
  • Brachytherapy (internal radiation)
  • Interstitial radiation
  • Plesiobrachytherapy
• Local treatments (other than surgery) 
  • Laser ablation uses a beam of laser light to destroy (ablate) cancer cells
  • Cryosurgery (cryoablation or cryotherapy) works similarly to laser ablation but uses liquid nitrogen to freeze and kill the cancer cells
  • Topical treatments
  • Topical chemotherapy
    • 5-fluorouracil (5-FU) cream 
    • Imiquimod cream
  • Photodynamic therapy (PDT) uses special drugs and laser light to treat cancer near the surface of the penis
• Chemotherapy 
  • Cisplatin
  • Fluorouracil (5-FU)
  • Paclitaxel (Taxol)
  • Ifosfamide (Ifex)
  • Mitomycin C
  • Capecitabine (Xeloda)
  • These drugs may also be used in combination: 
    • Cisplatin plus 5-FU
    • TIP: paclitaxel (Taxol), ifosfamide, and cisplatin (“platinum”)

Penile cancer can be deadly, but it is a rare cancer, and when diagnosed and treated in early stages the prognosis is generally good. 

Life expectancy for penile cancer is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis. 

Penile cancer 5-year survival rates:

• Localized (no sign the cancer has spread outside the penis): 82% 
• Regional (cancer has spread outside the penis to nearby structures or lymph nodes): 50% 
• Distant (cancer has spread to distant parts of the body such as the lungs): 12%