Penile cancer starts in or on the penis. Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other parts of the body. To learn more about how cancers start and spread, see What Is Cancer?

About the penis

The penis is the external male sex organ. It's also part of the urinary system. It's made up of many types of body tissues, including skin, nerves, smooth muscle, and blood vessels.

Survival rates are a way for doctors and patients to get a general idea of the outlook for people with a certain type and stage of cancer. Some people want to know the statistics for people like them, while others may not find them helpful, or may even not want to know them.

When discussing cancer survival statistics, doctors often use the 5-year survival rate. The 5-year survival rate is the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many of these patients live much longer than 5 years.

Relative survival rates compare the survival of people with the cancer to the survival of similar people without the cancer. Since some people will die of causes other than cancer, this is a better way to see the impact of cancer on survival.

To get 5-year penile cancer survival rates, doctors have to look at men who were treated at least 5 years ago. Improvements in treatment since then probably means a better outlook for men diagnosed with penile cancer today.

Survival rates are typically based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any man’s case. Many other factors may affect a man’s outlook, such as their age and overall health, and how well the cancer responds to treatment. Your doctor knows your situation best and can tell you how the numbers below might apply to you.

The rates here are based on the stage of the cancer when it's first diagnosed. When looking at survival rates, it’s important to understand that the stage of a cancer does not change over time, even if the cancer progresses. A cancer that comes back or spreads is still referred to by the stage it was given when it was first found and diagnosed, but more information is added to explain the current extent of the cancer. (And of course, the treatment plan is adjusted based on the change in cancer status.)

Because penile cancer is not common, it's hard to find accurate survival rates based on the TNM stage of the cancer. The numbers below come from the National Cancer Institute’s SEER database, looking at more than 1,000 men diagnosed with penile cancer between 1988 and 2001.

• For cancers that are still confined to the penis (like stage I and II cancers), the 5-year relative survival rate is around 85%.
• If the cancer has spread to nearby tissues or lymph nodes (like stage III and some stage IV cancers), the 5-year relative survival rate is around 59%.
• If the cancer has spread to distant parts of the body, the 5-year relative survival rate is about 11%.

Penile cancer is rare in this country, so it's hard to study. Still, research on penile cancer is being done in many university hospitals, medical centers, and other institutions around the world. Most experts agree that treatment in a clinical trial should be considered for any type or stage of penile cancer. This way men can get the best treatment available now and may also get the new treatments that are thought to be even better. The new and promising treatments discussed here are only available in clinical trials.

Drugs to treat penile cancer

Doctors are also looking at different chemotherapy drugs to treat penile cancer, especially later-stage cancers and those that don't respond to or come back after treatment.

Learning more about the gene changes linked to penile cancer might help guide use of targeted therapies. Targeted therapy is a term used for drugs that target certain cell changes and signals that are needed for a cancer to develop and keep growing. Targeted therapies might sometimes work when standard chemo drugs don’t, and they tend to have different (and often less severe) side effects from most standard chemo drugs.

But it’s not yet clear how useful these or other targeted drugs might be for penile cancer. Early results suggest some benefit, but more research is needed.

Treating lymph nodes

At this time, there's no known best way to treat penile cancer that has spread to nearby lymph nodes. International studies are looking at how to best combine surgery, radiation, and chemo, as well as the best order in which to use these treatments.

Another research interest is finding good ways to find even tiny bits of cancer in the lymph nodes. Studies are looking at imaging tests like PET scans, MRIs, and ultrasound to find affected nodes. This would help direct treatment and potentially improve treatment outcomes.

If you have possible symptoms of penile cancer you should go to a doctor. A physical exam will be done and you might also need some tests to find out what's causing your symptoms.

Medical history and physical exam

The doctor will talk to you about your medical history and the details of your symptoms, like when they started and if they've changed. You'll also discuss any possible risk factors you have.

The doctor will also look at your genital area carefully for possible signs of penile cancer or other health problems. Penile lesions (sores) usually affect the skin on the penis, so a doctor often can find cancers and other problems by looking closely at the penis. The doctor may look at and feel the lymph nodes in your groin to see if they are swollen.

If symptoms and/or the exam suggest you might have penile cancer, other tests will be needed. These might include a biopsy and imaging tests.

Biopsy

A biopsy is the only sure way to know if a change is penile cancer. To do this, a small piece of tissue is taken from the changed area and sent to a lab. There, it's looked at with a microscope to see if it contains cancer cells. The results are usually available in a few days, but may take longer in some cases There are many ways a biopsy can be done:

Incisional biopsy

For an incisional biopsy only a part of the changed area is removed. This type of biopsy is often done for lesions that are big, ulcerated (the top layer of skin is missing or the lesion appears as a sore), or that appear to grow deeply into the penis.

These biopsies are usually done with local anesthesia (numbing medicine) in a doctor’s office, clinic, or outpatient surgical center.

Excisional biopsy

In an excisional biopsy, the entire lesion is removed. This type of biopsy is most often used if the lesion is small, such as a nodule (lump) or plaque (raised, flat area).

These biopsies are usually done in a hospital or outpatient surgical center. Local anesthesia (numbing medicine) or general anesthesia (where you are asleep) may be used.

Lymph node biopsy

If the cancer has spread deep within the penis, nearby lymph nodes usually will need to be checked for cancer spread. This is done to help find the stage (extent) of the cancer after the diagnosis. These lymph nodes can be checked either with fine needle aspiration or by doing surgery to remove them.

Fine needle aspiration (FNA): To do this type of biopsy, the doctor puts a thin, hollow needle right into the lymph node and uses a syringe to pull out cells and a few drops of fluid. Local anesthesia may be put into the skin over the node to numb the area first.

If the enlarged lymph node is deep inside your body and the doctor can’t feel it, imaging methods such as ultrasound or CT scans can be used to guide the needle into the node.

This type of biopsy is often done to see if enlarged lymph nodes contain cancer. It's not used to sample lesions on the penis itself. This procedure can be done in a doctor’s office or clinic.

Surgical biopsy: In some cases, the lymph nodes are not checked with FNA, but instead surgery is done to remove one or more lymph nodes. These surgical lymph node biopsies, which include sentinel lymph node biopsy and lymphadenectomy, are described in Surgery for Penile Cancer.

To learn more, see Testing Biopsy and Cytology Specimens for Cancer.

Imaging tests

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. If the doctor thinks the cancer has spread, then one or more of these tests may be used to help find the stage of the cancer.

Computed tomography (CT)

A CT scan uses x-rays to make detailed cross-sectional images of your body. It can show how big the tumor is and can also help see if the cancer has spread to lymph nodes or other parts of the body.

CT-guided needle biopsy: CT scans can be used to guide a biopsy needle into an enlarged lymph node or other area that might be cancer spread. To do this, you stay on the CT table while a doctor moves a biopsy needle through your skin and toward the mass. CT scans are repeated until the needle is inside the mass. A biopsy sample is then removed and sent to be checked under a microscope.

Magnetic resonance imaging (MRI)

Like CT scans, MRIs show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays.

MRI pictures are better if the penis is erect. The doctor might inject a hormone-like substance called prostaglandin into the penis to make it erect.

Ultrasound

Ultrasound uses sound waves to make pictures of internal organs or masses. It can be useful to find out how deeply the cancer has spread into the penis. It can also help find enlarged lymph nodes in the groin.

This test is painless and does not expose you to radiation. For most ultrasound exams, the skin is first lubricated with gel. Then a technician moves the transducer over the skin of the penis.

Chest x-ray

An x-ray might be done to see if the cancer has spread to the lungs.

* The following additional categories are not listed on the table above: 

• TX: Main tumor cannot be assessed due to lack of information.
• T0: No evidence of a primary tumor. The N categories are described in the table above, except for:
• NX: Regional lymph nodes cannot be assessed due to lack of information.

The signs and symptoms below don’t always mean a man has penile cancer. In fact, many are more likely to be caused by other conditions. Still, if you have any of them, see a doctor right away so their cause can be found and treated, if needed. The sooner a diagnosis is made, the sooner you can start treatment and the better it is likely to work.

Skin changes

The first sign of penile cancer is most often a change in the skin of the penis. This is most likely to be on the glans (tip) of the penis or on the foreskin (in uncircumcised men), but it can also be on the shaft. These changes may include:

• An area of skin becoming thicker
• Changes in the skin color
• A lump
• An ulcer (sore) that might bleed
• A reddish, velvety rash under the foreskin
• Small, crusty bumps
• Flat, bluish-brown growths
• Smelly discharge (fluid) or bleeding under the foreskin

Sores or lumps from penile cancer usually don't hurt, but they might. You should see a doctor if you find any kind of new growth or other abnormality on your penis, even if it's not painful. Any change that doesn't get better in about 4 weeks, or gets worse, should be checked by a doctor.

Swelling

Swelling at the end of the penis, especially when the foreskin is constricted, is another possible sign of penile cancer. It may be harder to draw back the foreskin.

Lumps under the skin in the groin area

If the cancer spreads from the penis, it most often travels first to lymph nodes in the groin. This can make those lymph nodes swell. Lymph nodes are collections of immune system cells. Normally, they are bean-sized and can barely be felt at all. If they're swollen, the lymph nodes may feel like smooth lumps under the skin.

But swollen lymph nodes don’t always mean that cancer has spread there. More commonly, lymph nodes swell in response to an infection. The skin in and around a penile cancer can often become infected, which might cause the nearby lymph nodes to swell, even if the cancer hasn’t reached them.

The American Cancer Society estimates for penile cancer in the United States for 2018 are:

• About 2,320 new cases of penile cancer diagnosed
• About 380 deaths from penile cancer

For statistics related to survival, see Survival Rates for Penile Cancer.

Penile cancer is rare in North America and Europe. It's diagnosed in less than 1 man in 100,000 each year and accounts for less than 1% of cancers in men in the United States. Penile cancer is much more common in some parts of Asia, Africa, and South America.

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.

A risk factor is anything that affects your chance of getting a disease like cancer. Different cancers have different risk factors. Some cancer risk factors, like smoking or sun exposure, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many, doesn't mean that you will get the disease. On the other hand, some men who develop penile cancer have no known risk factors.

Scientists have found certain risk factors that make a man more likely to develop penile cancer.

Human papillomavirus (HPV) infection

Human papillomavirus (HPV) is a group of more than 150 related viruses. They are called papillomaviruses because some of them cause growths called papillomas (more commonly called warts). Different HPV types cause different types of warts in various parts of the body. Certain HPV types can infect the genital organs and the anal area, causing raised, bumpy warts called condyloma acuminata (or just condylomas).

Other HPV types have been linked with certain cancers. For example, infection with some types of HPV appears to be an important risk factor for penile cancer. In fact, HPV is found in about half of all penile cancers.

HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. HPV can be spread during sexual activity – including vaginal, anal, and oral – but sex doesn’t have to occur for the infection to spread. All that's needed is skin-to-skin contact with an area of the body infected with HPV. Infection with HPV can also spread from one part of the body to another. For example, infection may start in the penis and then spread to the anus.

HPV infection is common. In most men, the body clears the infection on its own. But in some, the infection doesn't go away and becomes chronic. Over time, chronic infection, especially with certain HPV types, can cause some types of cancer, including penile cancer. Men who are not circumcised may be more likely to get and stay infected with HPV.

To learn a lot more, see our HPV section.

Not being circumcised

Circumcision removes all (or part) of the foreskin. This procedure is most often done in infants, but it can be done later in life, too. Men who were circumcised as children may have a much lower chance of getting penile cancer than those who were not. In fact, some experts say that circumcision as an infant prevents this cancer. The same protective effect is not seen if circumcision is done as an adult.

The reason for the lower risk in circumcised men is not entirely clear, but it may be related to other known risk factors. For example, men who are circumcised can’t develop the condition called phimosis, and they don’t accumulate material known as smegma (see the next section). Men with smegma or phimosis have an increased risk of penile cancer. The later a man is circumcised, it's more likely that one of these conditions will occur first.

In weighing the risks and benefits of circumcision, doctors consider the fact that penile cancer is very uncommon in the United States, even in uncircumcised men. Although the American Academy of Pediatrics has stated that the health benefits of circumcision in newborn males outweigh the risks, it also states these benefits are not great enough to recommend that all newborns be routinely circumcised. In the end, decisions about circumcision are highly personal and often depend more on social and religious factors than on medical evidence.

Phimosis and smegma

Uncircumcised men with certain conditions are at higher risk for penile cancer.

Phimosis

In men who are not circumcised, the foreskin can sometimes become tight and difficult to retract. This is known as phimosis. Penile cancer is more common in men with phimosis. The reason for this is not clear, but it might be related to the build-up of smegma or from inflammation that results from phimosis.

Smegma

Sometimes secretions can build up underneath an intact foreskin. If the area under the foreskin isn’t cleaned well, these secretions build up enough to become a thick, sometimes smelly substance called smegma. Smegma is more common in men with phimosis, but can occur in anyone with a foreskin if the foreskin isn't retracted regularly to clean the head of the penis.

In the past some experts were concerned that smegma might contain compounds that can cause cancer. Most experts now believe that smegma itself probably doesn’t cause penile cancer. But it can irritate and inflame the penis, which can increase the risk of cancer. It might also make it harder to see very early cancers.

Smoking and other tobacco use

Men who smoke and/or use other forms of tobacco are more likely to develop penile cancer. Tobacco users who have HPV infections have an even higher risk. Tobacco use exposes your body to many cancer-causing chemicals. These harmful substances are inhaled into the lungs, where they are absorbed into the blood, or they're absorbed through mouth tissues into the blood. They can travel in the bloodstream throughout the body to cause cancer in many different areas. Researchers believe that these substances damage genes in cells of the penis, which can lead to penile cancer.

UV light treatment of psoriasis

Men who have a skin disease called psoriasis are sometimes treated with drugs called psoralens and then an ultraviolet A (UVA) light source. This is called PUVA therapy. Men who have had this treatment have been found to have a higher rate of penile cancer. To help lower this risk, men being treated with PUVA now have their genitals covered during treatment.

Age

The risk of penile cancer goes up with age. In the US, the average age of a man when he is diagnosed is about 68. About 4 out of 5 penile cancers are diagnosed in men over age 55.

AIDS

Men with AIDS have a higher risk of penile cancer. This higher risk seems to be linked to their weakened immune system, which is a result of this disease. But it might also be linked to other risk factors that men with HIV (the virus that causes AIDS) are more likely to have. For example, men with HIV are more likely to smoke and be infected with HPV.

The exact cause of most penile cancers is not known. But scientists have found that it's linked with a number of other conditions. Research is being done around the world to learn more about how these risk factors might cause cells of the penis to become cancer.

For instance, research has shown that normal cells control themselves by making substances called tumor suppressor gene products to keep them from growing too fast and becoming cancers. Two proteins (E6 and E7) made by high-risk types of human papillomavirus (HPV) can block the way tumor suppressor gene products work in cells. This allows the cells to start growing out of control, which might make them more likely to become cancer.

Tobacco use has been linked to penile cancer. It creates cancer-causing chemicals that spread throughout the body and can damage the DNA inside cells, such as the cells of the penis. DNA is the chemical in our cells that makes up our genes. (Genes control how our cells grow and divide.) When DNA damage affects the genes that control cell growth, it can lead to cancer.

See Genetics and Cancer to learn more about the complex link between genes and cancer.

The large variations in penile cancer rates throughout the world suggest that many penile cancers can be prevented. The best way to reduce the risk of penile cancer is to avoid known risk factors. (See Risk Factors for Penile Cancer.) But some men with penile cancer have no known avoidable risk factors, so it’s not possible to prevent this disease completely..

Circumcision

In the past, circumcision (removing the foreskin on the penis) was suggested as a way to lower penile cancer risk. This was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. But in some studies, the protective effect of circumcision wasn't seen after factors like smegma and phimosis were taken into account. Still, some experts have said that circumcision prevents penile cancer.

In the US, the risk of penile cancer is low even among uncircumcised men. Men who aren’t circumcised can help lower their risk of penile cancer by practicing good genital hygiene.

Genital hygiene

Perhaps the most important factor in preventing penile cancer in uncircumcised men is good genital hygiene. Uncircumcised men need to pull back (retract) the foreskin and clean the entire penis. If the foreskin is constricted and hard to retract (this is called phimosis), a doctor may be able to prescribe a cream or ointment that can make it easier to do so. If this doesn’t work the doctor may cut the skin of the foreskin in a procedure called a dorsal slit to make retraction easier.

HPV infection

HPV is very common, so having sex with even one other person can put you at risk. A man can have an HPV infection for years without any symptoms, so the absence of visible warts can’t be used to tell if someone has HPV. Even when someone doesn’t have warts (or any other symptom), he (or she) can still be infected with HPV and pass the virus to somebody else.

To earn a lot more about HPV, including what you can do to help prevent it, see the HPV section of our website.

Tobacco use

Tobacco use also increases penile cancer risk, so not using any form of tobacco might lower that risk. Quitting tobacco or never starting to use it in the first place is a good way to reduce your risk of many diseases, including penile cancer.

There are no widely recommended screening tests for penile cancer, but many penile cancers can be found early, when they're small and before they have spread to other parts of the body.

Almost all penile cancers start in the skin, so they're often noticed early. Cancers that start under the foreskin may not be seen as quickly, especially if a man has phimosis (constriction of the foreskin). Some penile cancers cause symptoms that could also be caused by a disease other than cancer.

Even if a man sees or feels something abnormal, he may not recognize it as something that needs medical attention right away. You should see a doctor if you find a new redness, growth, or other change in your penis, even if it's not painful. Things like warts, blisters, sores, ulcers, white patches, or other abnormal areas need to be checked by a doctor. Most are not cancer, but they may be caused by an infection or some other condition that needs to be treated.

Some men avoid going to the doctor for lesions (changes) on their penis. In fact, many put off seeking treatment for a year or more after they first notice the problem. Don't let embarrassment or fear keep you from having these changes checked. Most penile cancers are easy to treat in the early stages.

If a cancer is found early, it can often be removed with little or no damage to the penis. But if it's not diagnosed until later, part of or all of the penis may need to be removed to treat the cancer. More advanced cancers are also more likely to require other, more invasive treatments, and may even be life threatening.