Treatment for penile cancer
You will be cared for by a multi-disciplinary team of health professionals during your treatment for penile cancer. The team may include a urologist, a surgeon, a radiation oncologist (to prescribe and coordinate a course of radiation therapy), a medical oncologist (to prescribe and coordinate a course of systemic therapy which includes chemotherapy), a radiologist, specialist nurses and allied health professionals such as a dietitian, social worker, psychologist, physiotherapist and occupational therapist.
Discussion with your doctor will help you decide on the best treatment for your cancer depending on the type of penile cancer you have, if the cancer has spread, your age and general health. The main treatments for penile cancer include surgery, radiation therapy and chemotherapy. These can be given alone or in combination. Many people may have concerns about how the treatment could affect their sexuality and fertility. It is important to discuss these issues with your doctor before treatment begins.
Surgery is the main treatment for penile cancer. A surgeon will remove the tumour as well as some surrounding healthy tissue, called a margin. The extent and type of surgery depends on the location and the grade and stage of the tumour. Your surgeon will discuss the type of operation you may need. In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery.
Circumcision – Used when cancer is only on the foreskin. The foreskin of the penis is surgically removed.
Simple excision – The affected area of the penis and a small margin are removed surgically. If the tumour is small, the skin can be stitched back together.
Wide local excision – The tumour is removed along with a larger amount of normal tissue. If there is not enough skin left to cover the area, skin may be taken from another part of the body (a skin graft) to cover it.
Glans resurfacing – Used when the cancer is in situ and in only the top layer of skin. The surface tissue from the glans or head of the penis is removed. A skin graft may be needed to replace tissue removed.
Partial or total glansectomy – Removal of part or all of the head of the penis (the glans). The amount of tissue removed will depend on the extent of the cancer.
Partial or total penectomy – Removal of part or all of the penis and reconstruction of the urethra. In a total penectomy, the urethra is passed through to the perineum.
Lymph node surgery – You may need nearby lymph nodes in the groin to be removed to check for the spread of cancer. This may be done during penile surgery or at a separate time. There are four types of lymph node surgical procedures all of which need to be performed by a urologist:
- Dynamic sentinel lymph node biopsy to see if cancer cells have spread to lymph nodes near the penis. If positive, further surgery (dissection) is needed to remove more lymph nodes.
- Modified inguinal node dissection where some, but not all the lymph nodes in the groin, are removed. If positive, a full dissection will be performed.
- Radical inguinal node dissection. If lymph nodes in the groin are involved, all the nodes in this area will be removed.
- Pelvic lymph node dissection. If nodes are involved or a high risk of being involved, the pelvic lymph nodes will also be removed.
Some early-stage, low-grade penile cancers, especially carcinoma in situ (where the cancer is only in the top layers of skin), can be treated with techniques other than surgery. These include laser treatment, cryotherapy, radiation therapy and topical therapy. These treatments are called penile sparing techniques and cause the least damage to the penis. Discuss your options with your doctor.
If the cancer is very small and only on the surface of the penis, laser therapy may be used to kill cancer cells. Laser therapy uses powerful beams of light to destroy the cancer cells and can be used for tumours with lower staging instead of surgery.
Photodynamic therapy (PDT)
Photodynamic therapy uses special drugs, called photosensitising agents, along with light to kill cancer cells. The drugs only work after they have been activated or turned on by the light. In penile cancer the drugs are put on the skin and after a period of time, light is applied to the area. The procedure is usually painless and less invasive than surgery.
Cryosurgery uses liquid nitrogen to freeze and kill the cancer cells. The procedure may sting and cause slight discomfort. The treated skin will blister and peel over following days and may leave a scar. Sometimes several treatments are needed.
Radiation therapy (also known as radiotherapy) uses high energy x-rays to destroy cancer cells. The radiation comes from a machine outside the body. It may be used for penile cancer:
- to treat smaller penile cancers instead of surgery
- after surgery, to destroy any remaining cancer cells and stop the cancer coming back
- if the cancer cannot be removed with surgery
- at the same time as chemotherapy to help shrink the tumour before surgery to make it easier to remove with less damage to the penis
- if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of pain).
There are two ways to have radiation therapy for penile cancer:
External beam radiation therapy
This is the most common way to have radiation therapy for penile cancer and uses carefully focused beams of radiation aimed at the tumour from a machine. A course of radiation therapy needs to be carefully planned. During your first consultation session you will meet with a radiation oncologist. At this session you will lie on an examination table and have a CT scan in the same position you will be placed in for treatment. The information from this session will be used by your specialist to work out the treatment area and how to deliver the right dose of radiation. Radiation therapists will then deliver the course of radiation therapy as set out in the treatment plan.
Men who are not circumcised will have their foreskin removed first before radiation therapy begins. This is to stop swelling and tightening of the foreskin during treatment which could lead to further problems.
Radiation therapy does not hurt and is usually given in small doses to minimise side effects five days a week for a period of about six weeks. Each treatment only lasts a few minutes but there is also setting-up time. A plastic block or mould is used to hold the penis in the exact same position for each treatment and shields may be used to protect your groin and testicles.
Brachytherapy, also known as internal radiation, involves placing radioactive material inside your body either directly into the tumour or next to the tumour. It allows doctors to deliver higher doses of radiation to more specific areas of the body and usually has fewer side effects than external beam radiation.
Chemotherapy (sometimes just called “chemo”) is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or a combination of drugs. This is because different drugs can destroy or shrink cancer cells in different ways.
Your treatment will depend on your situation and stage of the tumour. Your medical oncologist will discuss your options with you.
Chemotherapy is usually given through a drip into a vein (intravenously) or as a tablet that is swallowed. Sometimes for low grade carcinoma in situ cancers, a cream can be applied topically.
Chemotherapy is commonly given in treatment cycles which may be daily, weekly or monthly. For example, one cycle may last three weeks where you have the drug over a few hours, followed by a rest period before starting another cycle. The length of the cycle and number of cycles depends on the chemotherapy drugs being given.
For low grade carcinoma in situ, lower doses of chemotherapy can be used on the skin in the form of a cream. The cream is applied often twice a day for several weeks to the affected area on the penis and does not cause the side effects people often have with intravenous or tablet chemotherapy. Circumcision is recommended before starting treatment. There is a slight risk of recurrence with this treatment so you must have regular follow-up appointments with your doctor.
Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.
You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.
For more information, visit Australian Cancer Trials.
Complementary therapies are designed to be used alongside conventional medical treatments (such as surgery, chemotherapy and radiation therapy) and can increase your sense of control, decrease stress and anxiety, and improve your mood.
Some Australian cancer centres have developed “integrative oncology” services where evidence-based complementary therapies are combined with conventional treatments to create patient-centred cancer care that aims to improve both wellbeing and clinical outcomes.
Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
Some complementary therapies and their clinically proven benefits are listed below:
acupuncture – reduces chemotherapy-induced nausea and vomiting; improves quality of life
aromatherapy – improves sleep and quality of life
art therapy, music therapy – reduce anxiety and stress; manage fatigue; aid expression of feelings
counselling, support groups – help reduce distress, anxiety and depression; improve quality of life
hypnotherapy – reduces pain, anxiety, nausea and vomiting
massage – improves quality of life; reduces anxiety, depression, pain and nausea
meditation, relaxation, mindfulness – reduce stress and anxiety; improve coping and quality of life
qi gong – reduces anxiety and fatigue; improves quality of life
spiritual practices – help reduce stress; instil peace; improve ability to manage challenges
tai chi – reduces anxiety and stress; improves strength, flexibility and quality of life
yoga – reduces anxiety and stress; improves general wellbeing and quality of life.
Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
Alternative therapies are therapies used instead of conventional medical treatments. These are unlikely to be scientifically tested and may prevent successful treatment of the cancer. Cancer Council does not recommend the use of alternative therapies as a cancer treatment.
If you have been diagnosed with penile cancer, both the cancer and treatment will place extra demands on your body. Research suggests that eating well and exercising can benefit people during and after cancer treatment.
Eating well and being physically active can help you cope with some of the common side effects of cancer treatment, speed up recovery and improve quality of life by giving you more energy, keeping your muscles strong, helping you maintain a healthy weight and boosting your mood.
You can discuss individual nutrition and exercise plans with health professionals such as dietitians, exercise physiologists and physiotherapists.
All treatments can have side effects. The type of side effects that you may have will depend on the type of treatment and where in your body the cancer is. Some people have very few side effects and others have more. Your specialist team will discuss all possible side effects, both short and long-term (including those that have a late effect and may not start immediately), with you before your treatment begins.
One issue that is important to discuss before you undergo treatment is fertility, particularly if you want to have children in the future.
Penile cancer and its treatment can sometimes lead to long-term, life-changing side effects. Your doctors will try to use penile-sparing treatments where possible but in some cases, this is not an option. Most men will still be continent (able to control urine flow) after surgery but if the surgery has removed part or all of the penis, how you urinate may change. If your urethra was reconstructed, you may have to sit down to urinate.
Common side effects may include:
Surgery – Erectile dysfunction, pain, discomfort, altered appearance, bleeding, trouble urinating, swelling, itching, lymphoedema if lymph nodes have been removed.
Radiation therapy – Scar tissue formation in the penis and urethra may cause problems urinating, sexual problems, fatigue, nausea and vomiting, skin reaction, loss of fertility, lymphoedema, slight risk of developing other cancers in the future.
Chemotherapy – Fatigue, loss of appetite, nausea and vomiting, bowel issues such as diarrhoea, hair loss, mouth sores, skin and nail problems, increased chance of infections, loss of fertility.
Having penile cancer treatment can affect your self-image and also your ability to have sex. Changes to how your penis looks can cause decreased interest in sex as well as embarrassment. Some men may worry that they won’t be able to satisfy their partner. Sometimes depression and
anxiety can make you want to avoid sex. You and your partner, if you have one, may wish to have counselling to help understand the impact the treatment has had on your sexuality and explore other ways of enjoying intimacy and sexual satisfaction. Ask your GP for a referral.
After a partial penectomy, the remaining part of the penis can still become erect with arousal and penetration may be possible. Intercourse, however, is not possible after a total penectomy. But sexual pleasure is still possible after a total penectomy so it’s important to talk to a counsellor, sex therapist or psychologist who can give you support and advice.
Surgical reconstruction of the penis might be possible after a total penectomy. Talk to your doctor to see if this might be an option for you.
This information is reviewed by
This information was last reviewed February 2021 by the following expert content reviewers: Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Dr Mikhail Lozinskiy, Consultant Urologist, Royal Perth Hospital, WA; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Prof Manish Patel, Urological cancer surgeon, University of Sydney, Westmead and Macquarie University Hospitals, Sydney, NSW; Walter Wood, Consumer; Dr Carlo Yuen, Urologist, St Vincent’s Hospital, Sydney, Conjoint Senior Lecturer UNSW.