Penile cancer, medically known as penile carcinoma, is a rare malignant tumor of the penis. The tumor usually develops on the glans or the foreskin and originates in the outermost layer of skin, the squamous epithelium. In about 95 percent of cases, it is a so-called squamous cell carcinoma. Basal cell carcinomas, malignant melanomas, or soft tissue tumors are less common.
In Germany, about 800 men are diagnosed with penile cancer each year, predominantly among older men. The disease often develops from precancerous lesions—that is, benign changes in the mucous membrane—which can progress into a malignant tumor over time. Typical early-stage forms include leukoplakia or erythroplakia—whitish or reddish changes on the glans or foreskin.
If penile cancer remains untreated, the tumor can invade deeper tissue layers or the urethra. Cancer cells can spread through the lymphatic system to the inguinal lymph nodes and form metastases. However, if the disease is detected early, the chances of a cure are very good, especially in early-stage cases.
The development of penile cancer is multifactorial, meaning that several factors can interact. Genital hygiene plays an important role. Sebum (smegma) can accumulate under a tight or non-retractable foreskin. This substance can cause chronic irritation and inflammation, which increase the long-term risk of penile cancer. Men with a tight foreskin (phimosis) are therefore at particularly high risk.
Recurrent inflammation of the glans or foreskin can also contribute to the development of malignant changes. Infection with human papillomavirus (HPV) is considered another key risk factor. In particular, the high-risk types HPV 16 and 18—which can also cause cervical cancer—are closely linked to the development of penile cancer.
Other risk factors include:
- Chronic inflammation or skin conditions in the genital area
- Smoking, as tobacco introduces carcinogenic substances into the bloodstream
- Untreated genital warts (condylomas)
- Previous radiation therapy in the pelvic area
- A weakened immune system
The risk can be reduced through consistent intimate hygiene and, if necessary, circumcision. The HPV vaccine also offers effective protection against certain types of cancer-causing viruses.
Symptoms and early signs of penile cancer
Penile cancer often causes no pain in the early stages and is therefore frequently detected late. A warning sign is visible changes to the glans or foreskin, which may manifest as swelling, hardening, skin changes, or small lumps. In some cases, there may be a foul-smelling discharge or minor bleeding.
In advanced stages, the tumor can invade the urethra or deeper layers of tissue. Swelling of the inguinal lymph nodes is common and may indicate metastasis. Affected individuals may then notice palpable lumps in the groin area or one-sided swelling of the leg due to lymphedema.
Men should have any new skin changes on the penis examined by a doctor, especially if they persist for more than two weeks. The earlier the diagnosis is made, the better the chances of recovery.
Penile cancer is typically diagnosed through a combination of a physical examination, a tissue biopsy, and imaging tests. The initial suspicion of penile cancer often arises from visible or palpable changes on the glans or foreskin. For example, men may notice small lumps, hardened areas, or areas that are slow to heal, which may indicate a condition.
The urologist begins with a detailed medical history, which involves discussing symptoms, previous medical conditions, and possible risk factors. This is followed by a physical examination of the penis, foreskin, and groin area. During this examination, the urologist also checks whether the lymph nodes are enlarged—a sign of possible metastasis.
To confirm the diagnosis, a tissue sample (biopsy) is taken. The tissue is examined under a microscope to determine whether malignant cells are present and to identify the type of tumor. This examination also provides information on how deeply the tumor has already invaded the surrounding tissue.
To assess the spread of the disease, imaging techniques such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) are used. These methods can detect metastases in the lymph nodes or other organs. Ultrasound is particularly well-suited for evaluating the inguinal lymph nodes. A CT or MRI scan helps determine the exact tumor stage and plan treatment.
The results of all examinations are then evaluated using the international TNM classification system. This system describes the size of the primary tumor (T), lymph node involvement (N), and the presence of distant metastases (M). This staging is crucial for selecting the appropriate treatment and for determining the prognosis.
An MRI machine can produce detailed images of internal soft tissue without risk © IEDNlab | AdobeStock
Treatment for penile cancer depends on the tumor stage, the extent of the disease, and the patient’s overall health. The goal is to completely remove the tumor while preserving as much healthy tissue as possible.
In very early stages, local treatment may be sufficient. Superficial tumors are removed through surgery or laser therapy. In some cases, circumcision—the surgical removal of the foreskin—is sufficient if the tumor is confined to this area.
If the tumor has invaded deeper into the tissue, partial or complete removal of the penis (penectomy) is necessary. Doctors distinguish between a partial penectomy, in which only part of the penis is removed, and a complete penectomy, which is performed when the tumor is very advanced. In some cases, the penis can be reconstructed later using the patient’s own tissue.
If the tumor has already spread to the lymph nodes, the affected lymph nodes in the groin and, if necessary, in the pelvis are surgically removed. Chemotherapy may also be used to destroy any remaining cancer cells or to reduce the tumor size prior to surgery. In advanced stages, radiation therapy may also be necessary. Penile carcinomas are considered radiation-sensitive, so radiation therapy can help control tumor growth and alleviate symptoms.
In specialized centers, organ-preserving surgery is increasingly being performed today to maintain patients’ quality of life. Thanks to modern surgical techniques, sexual function can be preserved in many cases. However, close follow-up care is essential to detect a recurrence of the tumor at an early stage.
The course of penile cancer depends heavily on the stage at which the disease is detected. Doctors use the TNM classification system to stage the disease. It describes the size of the primary tumor (T), whether lymph nodes are involved (N), and whether metastases are present in other organs (M). This classification is crucial for treatment planning and prognosis.
In early stages, the tumor is confined to the surface of the skin or to the mucous membrane of the glans or foreskin. In these cases, local or organ-preserving surgery is often sufficient to completely remove the cancer. The chances of recovery are very good in these cases, and many patients can be completely cured.
In advanced stages, the tumor invades deeper tissue layers or spreads via the lymphatic system to the inguinal lymph nodes. If metastases are detected in the lymph nodes or in distant organs, the condition is referred to as metastatic penile carcinoma. In these cases, a combination of treatments is necessary, including surgery, chemotherapy, and radiation therapy.
The chances of a cure depend primarily on the tumor size, lymph node status, and tissue type. If the cancer is detected early and completely removed, the five-year survival rate is over 85 percent. If, on the other hand, the tumor has already spread to lymph nodes or other organs, the survival rate drops significantly. Consistent follow-up care is also crucial for long-term success, as penile cancer can recur in some cases.
An important factor in the prognosis is the experience of the treatment team. Patients benefit significantly when treatment is provided at specialized urology centers that use modern diagnostic and surgical techniques.
After successful treatment, regular follow-up care is crucial for the early detection of recurrences or new tumors. In the first two years following treatment, follow-up examinations are typically conducted every three months, then every six months, and later once a year. Follow-up care includes a physical examination, an ultrasound scan of the inguinal lymph nodes, and, if necessary, imaging procedures such as CT or MRI.
Following a partial or complete penile amputation, the psychological and physical strain on many patients is significant. For this reason, psychological counseling or sex therapy is also part of follow-up care. In some cases, the penis can be reconstructed using the patient’s own tissue. Modern surgical techniques also often make it possible to preserve the urethra, so that urination can still be performed while standing.
Many men report that they are able to lead a largely normal life after successful treatment. It is important to be open about the condition, undergo regular medical checkups, and maintain a healthy lifestyle that includes avoiding nicotine. Good intimate hygiene also remains important after treatment to prevent recurrent inflammation and irritation.
Penile cancer cannot always be prevented, but certain measures can significantly reduce the risk. Good genital hygiene plays the most important role in this regard. Men should regularly retract the foreskin and carefully clean the area underneath to prevent smegma buildup. This practice reduces chronic inflammation, which can have carcinogenic effects over the long term.
In cases of a tight foreskin (phimosis), it is advisable to consult a urologist and, if necessary, have the foreskin surgically removed. This procedure, known as circumcision, significantly reduces the risk of developing penile cancer.
In addition, the HPV vaccine offers effective protection against certain human papillomaviruses that are involved in the development of penile cancer. The Standing Committee on Vaccination now also recommends the HPV vaccine for boys aged 9 to 14. A high vaccination rate can significantly reduce the number of HPV-related cancers in the long term.
How do I recognize penile cancer, and when should I see a doctor?
Penile cancer is suspected when changes occur on the glans or foreskin that persist over an extended period. These include hardening, small lumps, non-healing sores, or foul-smelling discharge. Recurrent inflammation of the glans or foreskin may also indicate an early stage of the disease. If such symptoms occur, you should see a urologist immediately. The earlier penile cancer is diagnosed, the better the chances of recovery.
German Cancer Aid, Information Sheet “Penile Cancer – Early Detection and Treatment,” 2024.
How is penile cancer diagnosed?
The diagnosis of penile cancer involves several steps. First, the doctor examines the penis and palpates the inguinal lymph nodes to detect any metastases in the lymph nodes. The doctor then takes a tissue sample (biopsy) to confirm the suspicion histologically. Imaging techniques such as ultrasound, CT, or MRI help determine the extent and stage of the disease. For superficial tumors, local treatment is usually sufficient; in advanced stages, more extensive surgical treatment is required.
Onkopedia Guideline “Penile Carcinoma,” DGHO 2020.
How is penile cancer treated?
The treatment of penile cancer depends on the tumor stage. In early stages, the tumor can often be completely removed through local surgery or laser therapy. However, if the cancer has invaded deeper tissue layers, a partial or complete amputation of the penis may be necessary. If metastases are detected in the lymph nodes, the lymph nodes in the groin region are also removed. In advanced stages, chemotherapy or radiation therapy is also used.
What are the chances of recovery from penile cancer?
Penile cancer is a rare disease that offers very good chances of recovery when diagnosed early. In many cases, superficial tumors can be completely cured. The earlier treatment begins, the greater the chance that the tumor will not invade deeper into the tissue or form metastases. In advanced stages, the prognosis depends on the extent of the disease and the lymph node status.
AWMF S3 Guideline “Diagnosis, Treatment, and Follow-up of Penile Cancer” (032/059OL), 2023.
Can penile cancer return after treatment?
Even after successful surgical treatment, close follow-up is necessary. Recurrent inflammation of the glans or new changes to the penis should be evaluated by a doctor, as tumor cells may form again in rare cases. Regular checkups involving ultrasound and physical examinations are therefore important. In cases of organ-preserving surgery, particular attention is paid to the glans and foreskin during follow-up care, as this is where recurrences occur most frequently.
What can be done to prevent penile cancer?
The most effective prevention involves good genital hygiene and avoiding chronic irritation. Men with phimosis should consider circumcision to prevent inflammation of the glans or foreskin. In addition, the HPV vaccine significantly reduces the risk of developing penile cancer.
Robert Koch Institute – HPV Vaccination Recommendation for Boys, 2024.
