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Types of Cancer > Penile Cancer > NCI Resources

NCI/PDQ® Health professionals: Penile Cancer Treatment (PDQ®)

Affiliation: National Cancer Institute
Last Modified: July 21, 2010

TABLE OF CONTENTS


Purpose of This PDQ® Summary

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This PDQ® cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of penile cancer. This summary is reviewed regularly and updated as necessary by the PDQ® Adult Treatment Editorial Board.

Information about the following is included in this summary:

  • Risk factors.
  • Cellular classification.
  • Staging.
  • Treatment options by cancer stage.

This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ® Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either standard or under clinical evaluation. These classifications should not be used as a basis for reimbursement determinations.

This summary is available in a patient version, written in less technical language, and in Spanish.


General Information About Penile Cancer

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Statistics

Note: Estimated new cases and deaths from penile (and other male genital) cancer in the United States in 2010: 1

  • New cases: 1,250
  • Deaths: 310

Risk factors

Penile cancer is rare in most developed nations, including the United States, where the rate is less than 1 per 100,000 men per year. Some studies suggest an association between human papillomavirus (HPV) infection and penile cancer. 2 3 4 5 Observational studies have shown a lower prevalence of penile HPV in men who have been circumcised (odds ratio = 0.37; 95% confidence interval, 0.160.85). 6 Some, but not all, observational studies also suggest that male newborn circumcision is associated with a decreased risk of penile cancer. 7 8 According to published data, if the relationship is causal, the number needed to treat was about 909 circumcisions to prevent a single case of invasive penile cancer. 9

Treatment overview

When diagnosed early (stage 0, stage I, and stage II), penile cancer is highly curable. Curability decreases sharply for stage III and stage IV. Because of the rarity of this cancer in the United States, clinical trials specifically for penile cancer are infrequent. Patients with stage III and stage IV cancer can be candidates for phase I and phase II clinical trials testing new drugs, biologicals, or surgical techniques to improve local control and distant metastases.

The selection of treatment depends on the size, location, invasiveness, and stage of the tumor. 10 11

References:

  1. American Cancer Society.: Cancer Facts and Figures 2010. Atlanta, Ga: American Cancer Society, 2010. Also available online [PUBMED Abstract]
  2. Del Mistro A, Chieco Bianchi L: HPV-related neoplasias in HIV-infected individuals. Eur J Cancer 37 (10): 1227-35, 2001. [PUBMED Abstract]
  3. Griffiths TR, Mellon JK: Human papillomavirus and urological tumours: I. Basic science and role in penile cancer. BJU Int 84 (5): 579-86, 1999. [PUBMED Abstract]
  4. Poblet E, Alfaro L, Fernander-Segoviano P, et al.: Human papillomavirus-associated penile squamous cell carcinoma in HIV-positive patients. Am J Surg Pathol 23 (9): 1119-23, 1999. [PUBMED Abstract]
  5. Frisch M, van den Brule AJ, Jiwa NM, et al.: HPV-16-positive anal and penile carcinomas in a young man--anogenital 'field effect' in the immunosuppressed male? Scand J Infect Dis 28 (6): 629-32, 1996. [PUBMED Abstract]
  6. Castellsagué X, Bosch FX, Muíoz N, et al.: Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 346 (15): 1105-12, 2002. [PUBMED Abstract]
  7. Schoen EJ, Oehrli M, Colby C, et al.: The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 105 (3): E36, 2000. [PUBMED Abstract]
  8. Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society. CMAJ 154 (6): 769-80, 1996. [PUBMED Abstract]
  9. Christakis DA, Harvey E, Zerr DM, et al.: A trade-off analysis of routine newborn circumcision. Pediatrics 105 (1 Pt 3): 246-9, 2000. [PUBMED Abstract]
  10. Razdan S, Gomella LG: Cancer of the urethra and penis. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1260-7. [PUBMED Abstract]
  11. Chao KS, Perez CA: Penis and male urethra. In: Perez CA, Brady LW, eds.: Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1998, pp 1717-1732. [PUBMED Abstract]


Cellular Classification of Penile Cancer

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Virtually all penile carcinomas are of squamous cell origin and include the following subtypes:

  • Verrucous carcinoma. 1
  • Warty carcinoma (verruciform). 2
  • Basaloid carcinoma. 3

Although they are less common subtypes, warty carcinoma and basaloid carcinoma appear to be more highly associated with human papillomaviruses (HPV), particularly HPV 16, than typical squamous cell carcinoma or verrucous carcinoma of the penis. 3 4 5

In addition, neuroendocrine carcinomas can also be seen. 6

References:

  1. Schwartz RA: Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol 32 (1): 1-21; quiz 22-4, 1995. [PUBMED Abstract]
  2. Bezerra AL, Lopes A, Landman G, et al.: Clinicopathologic features and human papillomavirus dna prevalence of warty and squamous cell carcinoma of the penis. Am J Surg Pathol 25 (5): 673-8, 2001. [PUBMED Abstract]
  3. Cubilla AL, Reuter VE, Gregoire L, et al.: Basaloid squamous cell carcinoma: a distinctive human papilloma virus-related penile neoplasm: a report of 20 cases. Am J Surg Pathol 22 (6): 755-61, 1998. [PUBMED Abstract]
  4. Gregoire L, Cubilla AL, Reuter VE, et al.: Preferential association of human papillomavirus with high-grade histologic variants of penile-invasive squamous cell carcinoma. J Natl Cancer Inst 87 (22): 1705-9, 1995. [PUBMED Abstract]
  5. Rubin MA, Kleter B, Zhou M, et al.: Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol 159 (4): 1211-8, 2001. [PUBMED Abstract]
  6. Vadmal MS, Steckel J, Teichberg S, et al.: Primary neuroendocrine carcinoma of the penile urethra. J Urol 157 (3): 956-7, 1997. [PUBMED Abstract]


Stage Information for Penile Cancer

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Note: The American Joint Committee on Cancer has recently published a new edition of the AJCC Cancer Staging Manual, which includes revisions to the staging for this disease. The PDQ® Adult Treatment Editorial Board, which is responsible for maintaining this summary, is currently reviewing the new staging to determine the changes that need to be made in the summary. In addition to updating this Stage Information section, additional changes may need to be made to other parts of this summary to ensure that it is up-to-date. The changes will be made as soon as possible.

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification. 1


TNM Definitions

    Primary tumor (T)

  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
    • Ta: Noninvasive verrucous carcinoma

  • T1: Tumor invades subepithelial connective tissue
  • T2: Tumor invades corpus spongiosum or cavernosum
  • T3: Tumor invades urethra or prostate
  • T4: Tumor invades other adjacent structures

Regional lymph nodes (N)

  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis in a single superficial, inguinal lymph node
  • N2: Metastasis in multiple or bilateral superficial inguinal lymph nodes
  • N3: Metastasis in deep inguinal or pelvic lymph node(s), unilateral or bilateral

    Distant metastasis (M)

  • MX: Distant metastasis cannot be assessed
  • M0: No distant metastasis
  • M1: Distant metastasis


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