What is penile cancer?
Penile cancer is rare cancer which occurs on the foreskin, the glans (head of the penis), or the skin of the penile shaft.
How common is penile cancer?
Penile cancer is a rare cancer. Within Australia, the incidence rate of penile cancer is 0.8 cases per 100,000 people (approximately 103 cases per year). These incidence rates are similar in Europe and the United States.
What are the risk factors for penile cancer?
The causes of penile cancer remain unclear, however there are some factors which may increase the risk, these can include-
Human Papilloma Virus (HPV): approximately 6 out of 10 penile cancers are a result of an HPV infection. HPV types 16 and 18 are more commonly associated with penile and cervical cancer.
Age: the average age of penile cancer diagnosis is 60 years of age, although younger men under 40 can also be diagnosed.
Other risks can include, being uncircumcised, poor penile cleaning and hygiene practices, tobacco smoking, exposure to UV radiation, HIV/AIDS and skin conditions such as psoriasis.
What are the signs & symptoms of penile cancer?
There can be a range of signs and symptoms of penile cancer which may be experienced, these can include-
- A sore or growth on the glans or head of the penis, the shaft or the foreskin
- A firm lump under the foreskin
- A smelly, offensive discharge under the foreskin
- Colour changes to the skin of the penis, including the foreskin
- Pain or swelling on the shaft or tip of the penis
- A persistent rash on the penis that won’t go away
How is penile cancer diagnosed?
There are several steps involved in the diagnosis of penile cancer.
1.Physical examination: usually this is attended by a GP to assess for changes and abnormalities.
2. Blood tests: to examine both red and white bloods cells, tumour markers and platelets.
3. Biopsy: a small sample of tissue is collected by biopsy and sent to a pathologist for examination.
4. Ultrasound: an ultrasound is used to produce imagery of the surrounding area to assess for changes inside the body.
5. CT, MRI & PET scanning: these diagnostic machines provide high powered imaging to assist the medical specialist team understand the extent of the cancer and if the cancer has spread to surrounding tissue or lymph nodes.
How is penile cancer treated?
The treatment for penile cancer will depend on the test results and the decision of the medical team, usually a Urologist and a Medical Oncologist.
Below is a summary of the different treatment types that may be used for penile cancer. Some of these can be given alone, or in a combination according to the type and spread of the cancer.
1. Surgery: this is the main treatment for penile cancer. The cancerous tumour and some surrounding skin (margin) are removed in a surgical operation by a Urologist.
2. Laser treatment: can be used if the tumour size is small.
3. Radiation therapy: attacks and destroys cancer cells using radiation waves.
4. Chemotherapy: can be used to shrink or slow tumours.
5. Other treatment options can include photodynamic therapy and liquid nitrogen.
Preventing penile cancer
Whilst there is no definitive way to prevent penile cancer, there are some risk factors that can be managed.
These include- reducing exposure to UV radiation and smoking cessation.
For men with a foreskin, ensure the area is kept clean and maintain good hygiene practices.
Vaccination against HPV (if eligible) will also reduce this risk. HPV vaccination in Australia is approved for males aged 9-26 years of age (free for 12-25 year olds).
Expert Opinion from leading Australian Urologists-
Dr Justin Chee (Distinguished Urologist specialising in reconstructive urology & penile cancer management).
Dr David Homewood (Urology research registrar & PhD candidate at the University of Melbourne).
Professor Niall Corcoran (Urological surgeon and research scientist).
Penile cancer, is a rare but devastating disease, impacting both physical health and psychological well-being. Whilst it accounts for less than 1% of male cancers in developed countries (1 in 100,000 men), it has devastating consequences, often resulting in significant physical and emotional morbidity due to the natural progression of disease and therapeutic management.
The rarity of penile cancer contributes to limited awareness and possible delays in diagnosis, with some cases only identified at an advanced stage. Late-stage diagnosis not only limits treatment options but also leads to worse outcomes, making early detection paramount.
Centralised management at tertiary centres is critical to improving outcomes in penile cancer. Specialised centres are equipped with multidisciplinary teams experienced in urologic oncology, offering comprehensive care that combines a mixture of management options including surgery, radiotherapy, chemotherapy and supportive therapies tailored to each case.
Tertiary centres also support access to reconstructive options, psychosocial support, and participation in clinical trials, all of which are essential for managing this multifaceted condition.
A centralised approach ensures that patients benefit from the latest advances in care and underscores the importance of streamlined referral pathways to facilitate early intervention and optimal management.
Acknowledgement
Real Men’s Health would like to thank the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP) for assisting in the development of this article.
You can read more about the important work ANZUP does here.
