Penile Cancer Symptoms, Causes, Treatment and Prevention

Penile cancer, or penis cancer, is a rare but serious condition that affects the skin and tissues of the penis. Understanding its symptoms, causes and treatment options is crucial for early detection and effective management. Our urologic cancer specialists have the expertise and experience to effectively treat patients who have been diagnosed with penile cancer.

Penile cancer occurs when malignant cells form in the tissues of the penis. It is most commonly a type of skin cancer known as squamous cell carcinoma, which begins in the flat cells lining the penis. Although rare, it can have significant physical and emotional impacts on those affected. It occurs most often in older men, with a little more than 1,000 new cases diagnosed in the U.S. every year.

Penile Cancer Symptoms

Recognizing the early signs is vital for prompt diagnosis and treatment. Common symptoms include:

• Changes in skin color or thickness: The skin of the penis may appear thicker or change color.
• Lumps or growths: Unusual lumps or growths on the penis, particularly on the glans or under the foreskin, may indicate cancer.
• Sores or ulcers: Persistent sores or ulcers that do not heal can be a warning sign.
• Foul-smelling discharge: A foul-smelling discharge from under the foreskin may occur.
• Bleeding: Unexplained bleeding from the penis is a potential symptom.
• Rash or bumps: A rash or small bumps on the penis can also be indicative of penile cancer.

If you experience any of these symptoms, it is important to consult a health care professional for further evaluation.

Causes and Risk Factors

The exact cause of penile cancer is not fully understood, but several risk factors have been identified:

• Human papillomavirus (HPV): HPV infection is a significant risk factor. Vaccination against HPV can reduce this risk.
• Smoking: Tobacco use increases the likelihood of developing penile cancer.
• Poor hygiene: Inadequate cleaning, especially in uncircumcised men, can lead to conditions like smegma buildup, increasing cancer risk.
• Phimosis: A condition where the foreskin cannot be fully retracted over the glans, leading to hygiene issues.
• Age: Most common in men over the age of 50.
• Lichen sclerosus: A skin condition that can cause scarring and increase cancer risk.

Diagnosis 

Diagnosing typically involves several steps:

1. Physical examination: A doctor will examine the penis for any abnormalities.
2. Biopsy: A small tissue sample may be taken for laboratory analysis to confirm the presence of cancer cells.
3. Imaging tests: Tests such as MRI, CT or PET scans may be used to determine the extent of cancer spread.

Early detection is crucial for successful treatment, so seeking medical advice if symptoms are present is essential.

Stages of Penile Cancer

The cancer is classified into stages based on its spread:

• Stage 0: Cancer is only in the top layer of skin.
• Stage I: Cancer has spread to connective tissue but not to lymph nodes.
• Stage II: Cancer has spread to deeper tissues.
• Stage III: Cancer has spread to nearby tissues and regional lymph nodes.
• Stage IV: Cancer has spread (metastasized) into the pelvis and non-regional lymph nodes or to distant parts of the body.

Understanding the stage helps determine the most appropriate treatment plan.

Treatment Options

Treatment options depends on the stage and location of the cancer. Early stages are more curable. There may be a combination of surgery approaches using the expertise of urologic oncologists and dermatologists. Systemic therapy or radiation therapy may be given to reduce the risk of recurrence. In the advanced setting, most of the treatment is systemic therapy, with radiation and surgery used to help alleviate symptom burden.

Treatment options include:

• Surgery: The primary treatment for this type of cancer, which may involve removing part or all of the penis (penectomy) depending on the cancer's extent. A key goal is tissue preservation while ensuring adequate cancer surgery. For some superficial tumors, a dermatologist may perform Mohs surgery, which is a precise surgical technique that may be used in certain circumstances.
• Radiation therapy: Radiation therapy can benefit some patients by helping to prevent cancer recurrence. Radiation can also serve as an alternative treatment for well-selected patients at risk of extensive tissue removal.
• Medical therapy: Some early-stage malignancies can be treated with topical chemotherapy — a cream applied directly to the skin. Traditional chemotherapy drugs are also available to treat penile cancers that have spread to the lymph nodes and other parts of the body or prior to or after surgery to reduce the risk of recurrence. There is ongoing research regarding immunotherapy and targeted therapies for those who do not respond to chemotherapy.

Participation in clinical trials may also be an option for some patients, offering access to new treatments. *Link to trials page here*

Prevention

While not all cases can be prevented, certain measures can reduce risk:

• HPV vaccination: Vaccination against HPV can significantly lower lower the risk. HPV vaccination is most effective when given before potential exposure — usually in the early teens, but can be administered up until the age of 45. Talk to your doctor regarding your HPV risk. HPV vaccinations are available from your primary care doctor or clinician or at any Froedtert Pharmacy location.
• Good hygiene: Regular cleaning, especially for uncircumcised men, can prevent conditions that increase cancer risk.
• Avoid tobacco: Quitting smoking reduces the risk of many cancers.
• Regular check-ups: Routine medical examinations can help detect early signs of cancer.