Penile cancer is a rare malignancy that forms in the tissues of the penis, most often on the glans (the tip) or the foreskin. In the United States, it affects fewer than 1 in 100,000 men each year and accounts for less than 1% of all cancers in men. An estimated 2,260 new cases will be diagnosed in 2026, with roughly 450 deaths. Despite its rarity, understanding the warning signs matters because early detection dramatically improves outcomes.
The vast majority of penile cancers are squamous cell carcinomas, meaning they start in the flat skin cells that line the surface of the penis. Several subtypes exist, with the “usual” type making up 48 to 65% of cases. Less common subtypes include basaloid, warty, verrucous, and papillary carcinomas.
Early Signs and Symptoms
The first sign is usually a visible change on the skin of the penis. It most commonly appears on the glans or foreskin, though it can develop on the shaft. These changes can look quite different from person to person and may include:
- An area of skin becoming thicker or changing color
- A lump or firm nodule
- An ulcer or sore that may bleed
- A reddish, velvety rash under the foreskin
- Small, crusty bumps or flat, bluish-brown growths
- Foul-smelling discharge or bleeding under the foreskin
One important detail: these sores or lumps usually don’t hurt. The absence of pain can lead men to delay seeking medical attention, sometimes for months. Swelling at the end of the penis or difficulty retracting the foreskin can also signal a problem. If the cancer spreads, it typically reaches the lymph nodes in the groin first, which may feel like firm lumps under the skin.
What Causes It
No single factor causes penile cancer, but several risk factors significantly raise the odds.
HPV Infection
Human papillomavirus (HPV) plays a substantial role. Studies have found HPV present in roughly 46 to 48% of penile cancer cases, with HPV types 16 and 18 being the most common strains involved. High-risk HPV subtypes are detected in up to 40% of cases overall, with the highest rates appearing in the warty and basaloid subtypes of squamous cell carcinoma. HPV vaccination, now widely recommended for adolescents regardless of sex, reduces the risk of these infections.
Phimosis and Foreskin Hygiene
Phimosis, a condition where the foreskin cannot be fully pulled back over the glans, is a well-established risk factor. The tight foreskin traps a buildup of smegma (a mixture of dead skin cells and oils) and creates an environment of chronic irritation and repeated inflammation. Over time, this can promote cancerous changes. A systematic review and meta-analysis found that the protective effect of childhood circumcision against invasive penile cancer is largely explained by eliminating phimosis. Men who were circumcised but had no history of phimosis showed no additional benefit compared to uncircumcised men without phimosis.
Other Risk Factors
Smoking, age (most cases occur in men over 50), a weakened immune system, and treatment with ultraviolet light therapy for conditions like psoriasis also increase risk. Penile cancer is much more common in parts of Asia, Africa, and South America than in North America or Europe, likely reflecting differences in circumcision rates, HPV prevalence, and access to healthcare.
How It’s Diagnosed
If a doctor suspects penile cancer based on a physical exam, the next step is a biopsy. This involves removing a small piece of tissue from the affected area under local anesthesia. You won’t feel pain during the procedure, and most men go home the same day. A pathologist then examines the tissue under a microscope to confirm whether cancer cells are present and, if so, what subtype.
If cancer is confirmed, imaging tests (such as CT scans or MRIs) help determine whether it has spread beyond the penis. Doctors stage the cancer based on three factors: how deeply the tumor has grown into penile tissue, whether it has reached nearby lymph nodes in the groin, and whether it has spread to distant organs. These staging details directly shape treatment decisions.
Survival Rates by Stage
Survival depends heavily on how far the cancer has spread at diagnosis. Based on data from men diagnosed between 2015 and 2021:
- Localized (cancer confined to the penis): 79% five-year survival rate
- Regional (spread to nearby lymph nodes): 57% five-year survival rate
- Distant (spread to other organs): 10% five-year survival rate
The overall five-year survival rate across all stages combined is 65%. The stark difference between localized and distant disease underscores why early detection is so critical. A skin change that lingers for more than a few weeks warrants a medical evaluation, even if it doesn’t hurt.
Treatment Options
Treatment depends on the size, location, and stage of the cancer. The trend in recent decades has shifted toward preserving as much of the penis as possible whenever the cancer allows it.
Organ-Sparing Approaches
For smaller, earlier-stage tumors, several techniques can remove the cancer while saving most or all of the penis. These include laser therapy (which destroys surface-level tumors with focused light), a specialized surgical technique that removes tissue one thin layer at a time and checks each layer for cancer cells before proceeding, and glansectomy, which removes only the tip of the penis. A systematic review of organ-sparing surgery found that while local recurrence rates are somewhat higher than with amputation, overall survival is generally the same. Many men who undergo these procedures are still able to urinate standing up, and a significant number retain sexual function.
The key requirement for any organ-sparing approach is confirming that the surgical margins are clear of cancer cells during the operation. Careful patient selection matters: these techniques work best for tumors that haven’t invaded deeply into the penile tissue.
Partial or Total Amputation
For larger or more advanced tumors, partial penectomy (removing part of the penis) or, less commonly, total penectomy may be necessary. Surgeons aim to leave enough length for urination and, when possible, some degree of sexual function. If cancer has spread to the groin lymph nodes, those are typically removed in a separate procedure.
Radiation and Chemotherapy
Radiation therapy is sometimes used for early-stage cancers as an alternative to surgery, or after surgery to target remaining cancer cells. Chemotherapy is generally reserved for advanced or metastatic cases where surgery alone isn’t enough. These treatments can be combined depending on the individual situation.
Life After Treatment
The physical and psychological impact of penile cancer treatment varies widely depending on what was done. Men who had organ-sparing surgery often recover relatively quickly and maintain near-normal function. Those who had partial or total amputation face more significant adjustments, both physically and emotionally. Changes to urination, sexual function, and body image can all affect quality of life, and specialized support from urologists and mental health professionals is a normal part of the recovery process.
Follow-up appointments are essential regardless of the treatment used. Organ-sparing surgery carries a higher chance of local recurrence, so regular physical exams of the treated area and groin lymph nodes continue for years. Catching a recurrence early keeps treatment options open and survival rates favorable.