Penile Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 09/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with penile cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for penile cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For penile cancer, this team often includes a surgeon, a doctor called a urologist who specializes in urinary tract problems, a medical oncologist, and a radiation oncologist. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

The most common types of treatments for penile cancer include surgery, radiation therapy, and chemotherapy. Descriptions of these treatments are listed below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. 

Patients may have concerns whether their treatment could affect their sexual health and fertility. Talk with your doctor about these topics before treatment begins. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for penile cancer because there are different treatment options. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue, called a margin, during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The surgical oncologists who treat penile cancer are usually urologists who have special training in cancer surgery.

Surgery for penile cancer is usually done while a patient receives local or general anesthesia, depending on the patient’s preference and the doctor’s recommendations. Local anesthesia is injected to numb the area where the surgery is being done. General anesthesia makes a person unconscious and blocks any pain during surgery, leaving little or no awareness or memory of the procedure. The types of surgery that may be used for penile cancer are described below.

Laser therapy. Laser therapy is the use of a very powerful beam of light to destroy cancer cells. Laser therapy may be an option for some patients with early-stage penile cancer, including:

  • Tis and small T1 squamous cell carcinoma of the penis

  • Small T2 tumors, when the patient does not want to have an excision (see below)

A disadvantage of laser therapy is that it can be difficult for the doctor to determine how far the cancer has spread.

Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and peel. This procedure will sometimes leave a scar. More than 1 freezing may be needed.

Circumcision. Circumcision (see Risk Factors and Prevention) is generally used if the cancer is only on the foreskin.

Excision. An excision is a removal of the tumor and some surrounding healthy tissue using a scalpel or other surgical tool. Sometimes the surgeon may remove a larger area of healthy tissue around the tumor to make sure that all the cancer is removed. Sometimes, a skin graft is needed to cover the area where the skin was removed. A skin graft uses skin from another part of the body to close the wound and reduce scarring.

Mohs surgery. This technique is used to remove the cancer that can be seen on the surface of the penis. In addition to the tumor, a small amount of healthy tissue around the edge is removed to make sure that no cancer is left behind. During the procedure, each small piece of tissue is examined under a microscope until all of the cancer is removed. This is most often used for a small tumor that is only on the surface of the penis. This procedure can be more expensive than an excision.

Penectomy. This is the surgical removal of part or all of the penis. It is the most common and effective procedure to treat penile cancer that has grown inside of the penis. Because this is disfiguring surgery, it is important to determine whether it is needed or if removing only the cancer is possible. If a penectomy is needed to treat the cancer effectively, a partial rather than total penectomy is a better option if the cancerous tissue and a 2 cm margin of healthy tissue can be removed while leaving enough length of the penis for the patient to urinate naturally. When this is not possible, a total penectomy is performed, which is the removal of the entire penis. The surgeon will then tunnel the urinary tract underneath the scrotum, meaning the patient will urinate in a sitting position.

Lymph node dissection. Removal of the lymph nodes in the groin and/or pelvis is often performed to find out the stage (see Diagnosis) or to treat penile cancer. This may be done even if there are no signs that the cancer has spread to the lymph nodes. If the groin lymph nodes are enlarged prior to surgery, then surgery to remove these lymph nodes is generally more extensive. While removing groin lymph nodes on both sides is common, removing deeper lymph nodes in the pelvis is generally only done if cancer is found in the groin lymph nodes. Removing the lymph nodes when the cancer has spread to the lymph nodes, but not anywhere else, can get rid of the cancer and lymph node surgery can increase the likelihood of cure. However, when the lymph nodes in both the groin and the pelvis are removed on the same side of the body, there is often severe swelling called lymphedema in the leg on that side of the body. This can cause significant discomfort and infections that often come back. When making such a treatment decision, you and your doctor should carefully weigh the benefits of removing any cancer that may have spread to lymph nodes with the risk of side effects from the surgery.

Overall, the possible side effects of surgery depend on the stage of disease and the type of procedure, among other factors. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have and how they can be managed. 

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. For penile cancer, radiation therapy can be focused on the tumor in the penis and/or directed at the lymph nodes in the groin and sometimes the pelvis, to destroy any cancer cells that have spread there.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. In addition, radiation therapy can increase the risk of developing other cancers in the future. If radiation therapy is focused on the groin, there is a risk of lymphedema in the leg(s) because of damage to the lymphatic channels that drain fluid from the legs. Most side effects go away soon after treatment is finished, although lymphedema can be an ongoing condition.

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles of treatment given over a set period of time. For example, a treatment cycle may last 3 weeks and the treatment plan may be made up of 4 cycles of 3 weeks each, which is 12 weeks total.

There are 2 types of chemotherapy that may be used for penile cancer: topical chemotherapy and systemic chemotherapy.

Topical chemotherapy

For small noninvasive cancers, or “carcinoma in situ,” lower doses of chemotherapy can be used on the surface of the skin. Such drugs include fluorouracil (5-FU) or imiquimod (Aldara).

Systemic chemotherapy

Systemic chemotherapy is given directly into the bloodstream to reach cancer cells throughout the body. Chemotherapy for penile cancer is generally given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

Chemotherapy is often recommended after surgery for penile cancer when surgical removal of pelvic lymph nodes revealed cancer in more than 1 of the nodes. Chemotherapy also may be given before surgery when the doctor is concerned that the tumor in the penis may be too large to be completely removed with surgery or that the cancer has spread to the regional lymph nodes and that removing the lymph nodes by surgery may be difficult. In that setting, chemotherapy may be used to shrink the cancer so it can be completely removed. Penile cancer that cannot be removed with surgery is sometimes treated with a combination of chemotherapy and radiation therapy. If the cancer has not spread beyond the pelvis, chemotherapy and/or radiation therapy may be given to destroy enough of the cancer to make surgery is possible. Chemotherapy is also used for penile cancer that has spread to other parts of the body (see "Metastatic penile cancer," below).

Systemic drugs for penile cancer include:

  • Bleomycin (Blenoxane)

  • Cisplatin (available as a generic drug)

  • Docetaxel (Taxotere)

  • Gemcitabine (Gemzar)

  • Ifosfamide (Ifex)

  • Methotrexate (multiple brand names)

  • Paclitaxel (Taxol)

Not all of these drugs are readily available for people with penile cancer. They may only be available as part of a clinical trial. Because penile cancer is uncommon, there have been fewer studies of chemotherapy and other drugs for penile cancer than there are for more common cancers. As a result, there is no strong evidence that chemotherapy for penile cancer helps patients live longer or improves their quality of life. Therefore, the decision to use systemic chemotherapy for penile cancer is not simple. When chemotherapy is used, there is general agreement among cancer specialists that drug combinations that include cisplatin and involve 2 or 3 drugs work better than a single drug, but this has not been proven in clinical trials. Other combinations being studied include cisplatin, ifosfamide, and paclitaxel and cisplatin, fluorouracil, and either paclitaxel or docetaxel. 

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, mouth sores, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished. However, some side effects can be permanent or show up in the future; these are called late effects. For instance, chemotherapy may increase the risk of cardiovascular disease and of other cancers, called secondary cancers, in the future.

Learn more about the basics of chemotherapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Metastatic penile cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Metastatic penile cancer is generally incurable, but there are treatments that can help shrink the cancer and relieve symptoms to make you more comfortable. Your treatment plan may include a combination of surgery, radiation therapy, and chemotherapy. Chemotherapy for penile cancer that has spread to other parts of the body is used to shrink the cancer and prevent it from growing or spreading for as long as possible. Palliative care is also important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, chaplains, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place, called a local recurrence, nearby, called a regional recurrence, or in another place, called a distant recurrence. The risk of recurrence depends on several factors, including the type of penile cancer and how much the cancer has grown and spread.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the therapies described above such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as despair, disbelief, or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for most people, advanced cancer is difficult to discuss. It is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns so that they can provide care that is consistent with your wishes. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life by addressing both physical discomfort and emotional distress. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.