Results and Quality of Life

Penile Cancer

Penile cancer is a tumor with a lower prevalence compared to other types of cancer of the male reproductive system such as prostate and testicular cancer. In Spain about 450 new cases are diagnosed each year.

There are different subtypes of penile cancer, mainly based on histology, i.e. the cells that produce it. The most frequent is squamous cell carcinoma, which comprises around 50-60% of penile cancer cases. This can be more or less aggressive, depending on the cellular grade, i.e. a squamous penile cancer can be caused by cells with a grade 1 or cells with a grade 3, which are more aggressive and therefore more likely to produce metastasis and more malignant growth, bearing in mind that they are all malignant lesions.

Our specialists in uro-oncology will evaluate each particular case and provide individualized treatment with great surgical specialization, guaranteeing excellence in the care of each patient.

There are several principles to adhere to when performing penile cancer treatment. First of all, we must perform a complete resection of the tumor and try to leave it clean, preserving the penis as much as we can. The treatment will be carried out in compliance with all the oncological criteria, that is, removing the tumor completely or with the intention of removing the tumor completely, leaving no margin, but being as conservative as we can so that the patient, both aesthetically, psychologically and functionally, is not affected.

In premalignant lesions, such as carcinoma in situ, which can develop into penile cancer, some type of topical treatment such as 5-fluorouracil or imiquimod, or lasers such as CO2 laser or others can be used. Before carrying out these treatments, a biopsy must be done to confirm that it is a carcinoma in situ and that there is no more advanced tumor. If so, a topical or laser treatment can be performed. The disadvantage of these treatments is that they require very close follow-up, as they are more likely to relapse. In case of relapse it would be necessary to evaluate whether to repeat this treatment or to perform surgery.

As for surgery, there are different options depending on where the tumor is located. If it is in the foreskin, with circumcision the margins remain clean. If the tumor is on the glans penis, Mohs surgery is performed, which consists of cutting layers that are sent to the pathologist until the pathologist tells us that one of them is clean and that there is no tumor. Other times, with a lesion that is on the glans or foreskin but circumcision is not enough, the lesion is resected with a safety margin. A sample of this margin can be sent to the pathologist, even during the surgery itself, so that he can tell us if it is clean or not. If it is clean, the surgery is finished and, if it is affected, we continue cutting more.

Sometimes, the lesion does not allow removal of the lesion alone and therefore a glandectomy must be performed, that is to say, the glans is removed, but the rest of the penis is preserved with the possibility of urinating through the tip of the penis with a urethra that opens there. In tumors that are more advanced, or that infiltrate more, is when a partial penectomy or a radical penectomy must be considered, which consists of removing a piece of the penis beyond the glans penis or the entire penis. We always try to make penectomy as infrequent as possible.

Fortunately, most men consult early when they notice a penile lesion and this means that most patients can be treated without penectomy.

In advanced cases, in which the penile cancer has affected the lymph nodes, surgery must be performed to remove the inguinal nodes. In much more advanced cases, platinum-based chemotherapy is considered, similar to those used in bladder or lung cancer, but it is true that patients with a metastatic penile tumor do not have good survival or response to chemotherapy treatments.