A serious surgery for a serious cancer
Penile cancer is considered a rare disease in the US, but the American Cancer Society estimates about 2,050 new cases in 2023 and about 470 deaths. Squamous cell cancer is the most common type.
Penile cancer symptoms
If you see changes at the tip of your penis or on the foreskin–if you’re not circumcised–watch them carefully. If the changes persist or grow, see your primary care provider. Penile cancer also occurs on the shaft, but less often than at the tip.
These are the changes to watch for:
- Thicker skin in an area
- Different skin color
- A lump
- A sore that might bleed
- Crusty bumps
- Flat, bluish brown growths
- If uncircumcised, a reddish, velvety rash under the foreskin
- Smelly discharge or bleeding under the foreskin
Protection
You can take steps to reduce your risk of penile cancer.
- Get circumcised.
- The human papilloma virus (HPV) causes about half of all cases of penile cancer. Get the HPV vaccination to decrease your risk.
- Use condoms when having sex.
- Don’t smoke.
- If you have phimosis (your foreskin is hard to retract), consider getting a circumcision.
- Regularly and thoroughly clean your penis and foreskin.
Penile cancer treatment
Penile cancer, like all cancer, is diagnosed and treated in stages from 0 to IV. Low numbers are early stages and are easier to treat than high numbers.
In fact, stage IV cancer is very difficult to cure, and the American Cancer Society suggests that men in stage IV consider participating in a clinical trial of new treatments.
Most penile cancer treatment involves surgery, but there are many treatments besides penectomy, which means the partial or complete removal of the penis. The National Cancer Institute publishes extensive and easy-to-understand information on penile cancer treatment.*
If cancer is only skin deep, wide local excision may be possible for you. This procedure doesn’t impair sexual function as much as glansectomy and rebuilding the urethra.
If cancer is only at the tip (the glans), the surgeon performs a glansectomy and removes only the tip, then uses a skin graft on the tip. The Journal of Urology reports that skin grafts (glanuloplasty) following partial penectomy seem to be safe and offer “high functional and cosmetic outcomes.”
In partial penectomies, the surgeon tries to leave as much tissue as possible to allow the patient to still urinate standing up.
Complete penectomies remove the entire penis, including the root, which goes into the pelvis. Penile cancer is aggressive, especially in the later stages. Having a complete penectomy does not guarantee you will survive five years or that the disease will not recur. There is more hope for men who become aware of the disease at an early stage.
Some men choose penile cosmetic reconstruction to restore appearance, or phalloplasty. The neophallus is constructed from a flap of skin from various places on the patient’s body, each with advantages and drawbacks. It is attached using microsurgical techniques. A device for erection, if the man so chooses, can be inserted several months after the phalloplasty, although this is a challenging operation. Long-term complications are common following phalloplasty.
The surgeon also removes lymph nodes to determine how far the cancer has spread.
If surgery is indicated for you, be sure to choose a surgeon with a lot of experience.
Life after penectomy
The Journal of Urology published a study in 2020 asking 20 men who had had partial (17) or complete (3) penectomies about their sexual and urinary function post-surgery. Ninety percent of the patients reported overall satisfaction with the outcome.
Another study after partial penectomy and inverted urethral flap reconstruction saved the patients from disfiguring surgery and preserved their health-related quality of life. Men who undergo partial penectomy have a higher recurrence rate than those with total penectomies. Even so, the study authors cite two reasons in support of partial penectomies: the patients can still have total penectomies after recurrence, and the status of the lymph nodes at the time of initial treatment is a significant indicator of survival and progression of the disease.
Urinating
The sphincter muscle, which starts and stops urination, is close to the bladder and is usually not affected in penectomies. With partial penectomies, you can usually stand when urinating. With complete penectomies, the surgeon reroutes your urethra to your perineum (the space between your scrotum and anus) for the purpose of urination. You then sit to urinate from a hole behind your scrotum.
Having sex
Did you know that having an orgasm is not dependent on having a penis? Some men report that following even total penectomy, they had orgasms. After re-educating their genital sensitivity and their mindset they learned that stimulation of the scrotum, the skin behind the scrotum, and the area around the surgical scars can trigger orgasm. Fantasies, erotic pictures, and stories influence readiness for orgasm, as well.
A study published in 2022, which reviewed other studies, looked specifically at the effects of partial penectomy on sexual function, including erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. The authors concluded that sexual function decreases after partial penectomy, but many men continue to have satisfying sex lives anyway. The essentials associated with adequate satisfaction after surgery include greater penile length after surgery and younger patients with lower anxiety levels about the surgery.
Partial penectomies help eliminate the cancer. If you have an early diagnosis so that the amount of penile cancer is low, if you have more penile length following surgery, and if you are young, you can often retain erectile function after surgery.
The American Cancer Society suggests various ways to have sex after cancer, not just penile cancer. It advises that different modalities, such as therapy or devices, help you figure out what is possible.
Total penectomies eliminate intercourse, but many other options are available. Remember that your largest sex organ is your brain.
Lymphedema
During your surgery, the surgeon removes lymph nodes in your groin. The lymph nodes drain fluid from the lower part of your body into the bloodstream. Without lymph nodes, the normal drainage of your legs is often interrupted, resulting in swelling of the legs and feet, a condition called lymphedema. Unfortunately this is common after inguinal lymph node dissection but it is necessary to remove the lymph nodes in the case of intermediate and advanced penile cancer. But this condition can be managed.
Living as a survivor
Surviving penile cancer is a significant accomplishment, but it takes a toll. Be aware that your life will change. You are probably worried that cancer will return. The American Cancer Society has specific steps to take to safeguard your health and your healthcare documents.
Recurrence
Penile cancer is likely to recur, especially if you had organ-sparing surgery (OSS). OSS at MD Anderson Cancer Center includes the following procedures:
- wide local excision (including glans resurfacing [removing some or all skin on the glans and replacing it with a skin graft] after circumcision)
- partial or total glansectomy (removing the glans, or tip, of the penis)
- laser therapy (destroying cancer cells no deeper than the skin with laser light)
- OSS combined with laser therapy
A study published in 2017 of over 1,500 patients suggested that for stage I and II cancer, “organ sparing surgery” has a higher rate of recurrence, but even with recurrence, overall survival rates were about the same as men who had had total penectomies. In other words, for stage I and II, survival from penile cancer didn’t depend much on whether the patient had organ sparing, partial, or total penectomy.
A 2020 review of studies confirmed this 2017 conclusion.
Patient selection for organ-sparing surgery for penile squamous cell cancer is highly important: the tumor must be local (not metastasized) and must be in stage I or II. Furthermore, frequent follow-up is necessary.
What does seem to matter, as far as survival after recurrence is concerned, is being older, being Black, and having stage T2 disease rather than T1.
The outlook
Penile cancer is devastating, for sure. But as with most illnesses, having information about symptoms, treatment, and outcome helps you manage it. Therapies and procedures for penile cancer are improving each year. Being armed with information helps you face reality and grants you more control over your future.
Bottom line – if you see something growing on the tip of your penis or on the foreskin, get it checked out early. Do not delay or you risk losing something dear.
* PDQ® Adult Treatment Editorial Board. PDQ Penile Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <05/12/2023>. Available at: https://www.cancer.gov/types/penile/patient/penile-treatment-pdq. Accessed <08/16/2023>. [PMID: 26389255]