Penile cancer: A rare but serious condition.
What is penile cancer?
Penile cancer (medically: penile carcinoma) is a rare tumor disease of the male genital tract. In Switzerland, about 80 men develop it annually, while in Germany there are around 800 cases per year[1][8]. At the time of diagnosis, over 40% of patients are 75 years or older[1]. In most cases, it is a squamous cell carcinoma that primarily develops on the glans penis and foreskin[1][6].
Although penile cancer has a superficial location and thus early detection would be possible, many cases are diagnosed only in advanced stages due to shame[2][8]. The tumor usually progresses slowly and primarily metastasizes lymphogenously via the inguinal lymph nodes[1][2].
Risk factors
Several factors can increase the risk of developing penile carcinoma:
- Phimosis: If the foreskin cannot be fully retracted, personal hygiene is difficult and possible skin changes remain undetected[1][8].
- Chronic inflammation of the penis, often caused by poor hygiene[1][4].
- HPV infection: Approximately 50% of penile cancer cases are associated with high-risk HPV types 16 and 18[3][8].
- Smoking: Tobacco use increases the relative risk by 5.9-fold, dose-dependently[4].
- Certain skin conditions such as erythroplasia of Queyrat or Bowen's disease[1][6].
Early circumcision in childhood can offer some protection and reduces the risk by a factor of 3 to 10[4]. Penile cancer occurs less frequently in countries or cultural circles where childhood circumcisions are common[7].
Symptoms and warning signs
Early detection of penile cancer is crucial for successful treatment. The following symptoms should be taken seriously:
- Cauliflower-like skin changes on the glans[1].
- Hardening or swelling of the glans or foreskin[1][7].
- Non-healing red patches or ulcers[6].
- Discharge or bleeding from the penis[1][7].
- Enlarged lymph nodes in the groin[6].
Diagnosis
If penile cancer is suspected, a thorough physical examination is performed first. To confirm the diagnosis, a tissue sample (biopsy) is taken and examined under a microscope[6][10]. Imaging techniques such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) help to assess the spread of the tumor and possible metastases[8][10].
The diagnosis is supplemented by the TNM classification, which describes the size of the tumor (T), the involvement of lymph nodes (N), and the presence of distant metastases (M)[10].
Treatment options
The primary goal of therapy is the complete removal of the tumor while preserving the penis and its function as much as possible[8]. Treatment depends on the stage of the disease, the size and location of the tumor, and the patient's general health.
Early stages and superficial tumors
- Topical therapy: Creams with 5-fluorouracil or imiquimod can be used for precancerous conditions and superficial tumors[3][6]
- Laser treatment: Smaller and superficial tumors can be removed with a laser while preserving the foreskin[8]
- Radiation therapy: Radiation therapy is possible, especially for small tumors, either from the outside or as brachytherapy (internal radiation)[3][6]
Advanced stages
- Partial resection: For larger tumors on the glans, it must be removed, but urination is still possible through the remaining penile stump[8]
- Penectomy: For extensive tumors, complete removal of the penis may be necessary. The urethra is then rerouted to the perineum and reconstructed there[8]
- Lymph node dissection: If the inguinal lymph nodes are affected, they and the nearest ones are removed[1][10]
- Chemotherapy: Systemic chemotherapy can be used for inoperable tumors or metastases[6][8]
After major surgery, it is possible to reconstruct a functional penis using the patient's own tissue[3].
Prevention and early detection
The following measures are recommended for the prevention of penile cancer:
- Regular intimate hygiene to reduce the risk of chronic inflammation and infections[4]
- HPV vaccination for boys aged 9-14 can reduce the risk of HPV-related cancers[3]
- Treatment of phimosis by circumcision if the foreskin cannot be retracted[7]
- Self-examination for early detection of skin changes on the penis[4]
- Regular urological check-ups starting at age 45[7]
Conclusion
Penile cancer is rare, but its potentially serious consequences should not be underestimated. Early diagnosis and treatment significantly improve the prognosis and often allow for organ-preserving therapies. Therefore, men should pay attention to changes in their penis and see a urologist promptly if they notice anything unusual. Overcoming feelings of shame can be life-saving in this situation.
Since 2020, Germany has had an S3 guideline for the diagnosis, therapy, and follow-up of penile carcinoma for the first time, based on the latest scientific findings and establishing a uniform standard of care for this rare tumor disease[5].
Sources:
[1] Symptoms and treatment of penile cancer (penile carcinoma) https://www.krebsliga.ch/ueber-krebs/krebsarten/peniskrebs-peniskarzinom
[2] Penile carcinoma – Uro-oncology – eMedpedia | springermedizin.de https://www.springermedizin.de/emedpedia/detail/uroonkologie/peniskarzinom?epediaDoi=10.1007%2F978-3-662-54652-9_74
[3] Penile cancer – German Cancer Society https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/andere-krebsarten/peniskrebs.html
[4] Penile cancer (penile carcinoma) – Prevention https://www.gesundheits-lexikon.com/Krebs/Peniskrebs-Peniskarzinom/Praevention
[5] New: S3 guideline on penile carcinoma published (08/26/2020) https://www.urologenportal.de/pressebereich/pressemitteilungen/aktuell/neu-s3-leitlinie-zum-peniskarzinom-erschienen-26082020.html
[6] Penile cancer – Kidney and urinary tract diseases – MSD Manuals https://www.msdmanuals.com/de/heim/nieren-und-harnwegserkrankungen/krebs-der-nieren-und-des-urogenitaltrakts/peniskrebs
[7] Penile carcinoma: a great taboo – Ärzte Zeitung https://www.aerztezeitung.de/Medizin/Peniskarzinom-ein-grosses-Tabu-272225.html
[8] Urology: Penile tumors – University Hospital Würzburg https://www.ukw.de/urologie/schwerpunkte/krebsbehandlung-des-urogenitaltraktes/penistumoren/
[9] Penile cancer: risk factors, symptoms and treatment – ALTA Klinik https://www.alta-klinik.de/urologie/peniskrebs/
[10] Penile cancer (penile carcinoma) – Asklepios Clinics https://www.asklepios.com/konzern/diagnosen/nieren-unterkoerper/unterkoerper/peniskarzinom
[11] [PDF] Penile cancer – German Cancer Aid https://www.krebshilfe.de/infomaterial/Patientenleitlinien/Peniskarzinom_Patientenleitlinie_DeutscheKrebshilfe.pdf
[12] Penile cancer – Decided against cancer https://www.entschiedengegenkrebs.de/erkrankungen/peniskrebs/
[13] [PDF] Penile cancer – Guideline program Oncology https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Patientenleitlinien/Peniskrebs_Patientenleitlinie_1680013.pdf
[14] Penile carcinoma – DocCheck Flexikon https://flexikon.doccheck.com/de/Peniskarzinom
[15] Penile cancer treatment – Mannheim University Hospital https://www.umm.de/uro-onkologisches-zentrum/leistungsspektrum/peniskrebs/peniskrebs-behandlung/
[16] Penile carcinoma: Information & Penile cancer specialists https://www.leading-medicine-guide.com/de/erkrankungen/tumoren/peniskrebs
[17] Penile cancer | Health portal – Gesundheit.gv.at https://www.gesundheit.gv.at/krankheiten/krebs/hoden-prostatakrebs/peniskrebs.html
[18] Penile cancer / penile carcinoma – Causes, treatment | KSW https://www.ksw.ch/gesundheitsthemen/peniskrebs-peniskarzinom/
[19] Penile cancer – University Hospital Zurich https://www.usz.ch/krankheit/peniskrebs/
[20] Penile carcinoma https://www.uniklinikum-jena.de/urologie/Informationen%20f%C3%BCr%20Patienten/Krankheitsbilder/Peniskarzinom.print
[21] Penile carcinoma – Guideline program Oncology https://www.leitlinienprogramm-onkologie.de/leitlinien/peniskarzinom
[22] Treatment options for penile cancer https://www.st-katharinen-hospital.de/kliniken/urologie/urologische-krebserkrankungen/peniskrebs/behandlungsoptionen
[23] [PDF] S3 guideline diagnostics, therapy and follow-up of penile carcinoma https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Peniskarzinom/Version_1/LL_Peniskarzinom_Kurzversion_1.0.pdf
[24] S3 guideline diagnostics, therapy and follow-up of penile carcinoma https://register.awmf.org/de/leitlinien/detail/043-042OL
[25] [PDF] Patient guideline penile cancer consultation version https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/2021-12-14_PLL_Peniskrebs_Konsultationsfassung.pdf
[26] [PDF] Penile carcinoma – Munich – LMU Hospital https://cdn.lmu-klinikum.de/0738d9876e78d743/50a3986ba3fc/CCCM_SOP_Peniskarzinom_210601_Internet.pdf
[27] Clinic for Urology and Pediatric Urology – UKS | Penile cancer https://www.uks.eu/kliniken-einrichtungen/urologie-kinderurologie/urologie-und-kinderurologie/schwerpunkte/peniskrebs
[28] Penile carcinoma – The Urology – eMedpedia | springermedizin.de https://www.springermedizin.de/emedpedia/detail/die-urologie/peniskarzinom?epediaDoi=10.1007%2F978-3-642-41168-7_20
[29] Penile cancer: Clinic for Urology – Charité – University Medicine Berlin https://urologie.charite.de/behandlungsangebot/peniskrebs
[30] [PDF] S3 guideline diagnostics, therapy and follow-up of penile carcinoma https://register.awmf.org/assets/guidelines/043-042OLl_S3_Peniskarzinom_2020-08.pdf
