You will be cared for by a multi-disciplinary team of health professionals during your treatment for penile cancer, which may include a urologist, surgeon, radiologist, specialist nurses and allied health professionals, among others. Treatment will depend on the type of penile cancer you have, if the cancer has spread, your age and general health.
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. In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery.
Types of surgical procedures for treating penile cancer include:
- Circumcision – used when cancer is only on the foreskin. The foreskin of the penis is surgically removed.
- Simple excision – 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.
- 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.
- Partial or total glansectomy – removal of part or all of the head of the penis (the glans).
- Partial or total penectomy – Removal of part or all of the penis and reconstruction of the urethra.
- Lymph node surgery – you may need nearby lymph nodes in the groin to be removed to check for the spread of cancer.
Common side effects of surgery include erectile dysfunction, pain, discomfort, altered appearance, bleeding, trouble urinating, swelling, itching and lymphoedema if lymph nodes have been removed.
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. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.
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Other treatments for penile cancer
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 treatments are called penile sparing techniques and cause the least damage to the penis.
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. 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. 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.
- Brachytherapy – also known as internal radiation, it 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.
Scar tissue formation in the penis and urethra may cause problems urinating, while other side effects commonly experienced include sexual problems, fatigue, nausea and vomiting, skin reaction, loss of fertility, lymphoedema and the slight risk of developing other cancers in the future.
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It is usually given through a drip into a vein (intravenously) or as a tablet to swallow.
Common side effects of chemotherapy include fatigue, loss of appetite, nausea and vomiting, bowel issues such as diarrhoea, hair loss, mouth sores, skin and nail problems, increased chance of infections and loss of fertility.
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 and there is a slight risk of recurrence with this treatment, so you must have regular follow-up appointments.
Complementary therapies are designed to be used alongside conventional medical treatments and can increase your sense of control, decrease stress and anxiety, and improve your mood. Some examples include acupuncture, yoga, music therapy, counselling and hypnotherapy, among others.
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.
Side effects of treatment
The type of side effects that you may experience 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. Cancer can cause physical and emotional strain, so it’s important to look after your wellbeing.
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.
Fertility and intimacy
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.
Having penile cancer treatment can affect your self-confidence and the way you think about sex. Changes to the way your penis looks can cause embarrassment, depression and anxiety, and you may feel like avoiding sex. You and your partner may wish to have counselling to help understand the impact the treatment has had on your sexuality and explore other ways of enjoying intimacy.
Doctors will always try to give you the treatment that preserves as much of your penis as possible. If you have had early-stage cancer, treatment is unlikely to have any direct impact on your sex life.
After a partial penectomy, the remaining part of the penis can still become erect with arousal and penetration may be possible. While intercourse is not possible after a total penectomy, sexual pleasure still is. You may also be able to have a surgical reconstruction of the penis.
Once your treatment has finished, you will have regular check-ups to confirm that the cancer hasn’t come back, which involves ongoing tests, scans and physical examinations. For some people, penile cancer does come back after treatment, which is known as a recurrence.
If the cancer does come back, treatment will depend on where the cancer has returned in your body and may include a mix of surgery, radiation therapy and chemotherapy. In some cases of advanced cancer, palliative treatment will focus on managing any symptoms, such as pain, and improving your quality of life without trying to cure the disease.
Some useful questions to consider asking your doctor include:
- What type of penile cancer do I have?
- How far has the cancer spread? What stage of cancer do I have?
- Have you treated this type of cancer before?
- Can you recommend another doctor so I can get a second opinion?
- What are the treatment options for me? What do you recommend and why?
- What are the possible risks and side effects of my treatment? How will these be managed?
- What impact will the treatment have on my continence, sexual function and fertility?
- How long will the treatment take?
- Is this treatment covered by Medicare/private health insurance? Will there be extra expenses?
- Are there any complementary therapies that might help me?
- If the cancer comes back, how will I know?
- What are the possible benefits and risks to me joining this clinical trial? What is being tested and why? How many people will be involved in this trial?
Understanding Penile Cancer
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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.
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The information on this webpage was adapted from Understanding Penile Cancer - A guide for people affected by cancer (2021 edition). This webpage was last updated in June 2021.