Penile cancer: early signs and risk factors
Look out for a sore or ulcer, a lump, a wart-like growth, a red or velvety patch, thickened skin, or bleeding or a bad-smelling discharge from under the foreskin. A lump in the groin can also be a sign. Most sores on the penis are infections, but one that has not healed in three or four weeks needs a check.
Known risk factors are:
- Phimosis, a tight foreskin that cannot be pulled back, which traps secretions underneath. See phimosis (tight foreskin).
- Poor hygiene under the foreskin, often linked to phimosis.
- HPV (human papilloma virus), passed on through sexual contact.
- Tobacco, whether smoked or chewed.
- Long-standing white, scarred skin on the penis (lichen sclerosus), and older age.
Many men delay because of embarrassment. A urologist sees these problems routinely, and the consultation is private.
Biopsy and staging tests
A biopsy, a small piece of the abnormal area taken under local anaesthetic, confirms whether it is cancer and its grade. Most penile cancers are squamous cell carcinoma, a cancer of the skin cells.
The groins are examined carefully. If a lymph node can be felt, an ultrasound and a fine-needle test of the node follow. An MRI or ultrasound of the penis sometimes helps show how deep the tumour goes. A CT or PET-CT scan is used when the groin nodes are involved, to check the pelvis and other organs.
Which surgery is suitable: organ-sparing, partial or total penectomy
The aim is to remove all the cancer with a clear margin of healthy tissue while keeping as much length and function as possible. Current practice accepts smaller margins than in the past, so organ-sparing surgery is possible more often.
| Situation | Usual surgery | What it means for you |
|---|---|---|
| Pre-cancer or very superficial cancer | Creams, laser treatment, or removing the surface skin of the head of the penis | The penis is kept |
| Cancer only on the foreskin | Circumcision | The penis is kept |
| Small tumour on the head of the penis | Wide local excision or removal of the head (glansectomy), often with a skin graft | Length is kept; sensation changes |
| Larger tumour on the head or lower shaft | Partial penectomy | Shorter penis; most men still pass urine standing |
| Large tumour near the base | Total penectomy with a new urine opening behind the scrotum (perineal urethrostomy) | Urine is passed sitting down |
If phimosis is the main problem and there is no cancer, phimosis treatment or circumcision is the right step.
How penile cancer surgery is done
Surgery is done under spinal or general anaesthesia at ManglamPlus Medicity, using standard surgical instruments. In a partial penectomy, the part of the penis containing the tumour is removed with a margin, the urethra is shaped into a new opening at the tip, and the skin is closed over it. A catheter is left for a few days. In organ-sparing surgery, the removed skin of the head may be replaced with a thin skin graft, usually from the thigh. In a total penectomy, the urethra is brought out to a new opening between the scrotum and the back passage.
The operation on the penis usually takes one to two hours. The tissue is sent to the pathologist, whose report on grade, depth and margins guides the next step.
Groin lymph node assessment and dissection
Penile cancer first spreads to the lymph nodes in the groin, so the groins are assessed in every case:
- Low-risk tumour, no nodes felt: regular examination and groin ultrasound.
- Higher-risk tumour, no nodes felt: the groins are staged surgically, either by a limited (modified) groin node dissection or, in some specialised centres, by a sentinel node biopsy that finds the first draining node with a tracer.
- Nodes felt: a needle test first, then a full groin node dissection, and sometimes removal of pelvic nodes. For large nodes, chemotherapy from medical oncologists may come first.
Groin surgery may be done at the same time as the penile operation or a few weeks later. Drains are left in the groins, often for one to two weeks.
Hospital stay and recovery after penile cancer surgery
| Time | What to expect |
|---|---|
| Day of surgery | Catheter, dressing, pain relief |
| Days 1-3 | Walking; home after 1-3 days for penile surgery alone; longer after groin surgery |
| Week 1-2 | Catheter and stitches or graft dressing checked; groin drains removed when dry |
| Weeks 3-6 | Light work; sexual activity usually after about 4-6 weeks if healed |
Keep the area clean and dry. After groin surgery, raise your legs when sitting and wear compression stockings if advised. Call the clinic for fever, spreading redness, wound breakdown, a weak or spraying urine stream, or swelling in a leg.
Risks and complications
Penile surgery: bleeding, infection, partial loss of a skin graft, and later narrowing of the new urine opening, which may cause a spraying stream and can be widened with a small procedure.
Groin node surgery has more problems: slow wound healing or wound breakdown, infection, a collection of lymph fluid (seroma), and swelling of the leg (lymphoedema). Careful technique, drains, antibiotics, early walking and compression stockings help reduce these.
Sex, passing urine and emotional health after surgery
These are natural worries, and you can ask about them openly, with your partner present if you wish.
- After organ-sparing surgery, most men keep erections and can have intercourse, although sensation at the tip changes.
- After partial penectomy, many men can still have erections, intercourse, orgasm and ejaculation, depending on the length that remains.
- After total penectomy, intercourse in the usual way is not possible, but some men still reach orgasm through touch of the remaining tissue. Reconstruction of a penis is possible in a few specialised centres for selected men.
Feeling low or anxious is common. Counselling and support are part of recovery. If erection problems affect you, see erectile dysfunction treatment.
Follow-up and prevention
Follow-up visits are usually every three months for the first two years, then less often, with examination of the penis and groins and ultrasound where needed. Check the area yourself too and report any new lump or sore.
The risk can be lowered by keeping the area under the foreskin clean, treating phimosis early, avoiding tobacco, and HPV vaccination where advised. See also our article on tight foreskin in men and boys and the overview of urology cancer surgery.
Cost of penile cancer surgery in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- The type of surgery: organ-sparing, partial or total penectomy
- Whether groin lymph node surgery is needed, and on one or both sides
- Biopsy, ultrasound, MRI, CT or PET-CT before surgery
- The room category at ManglamPlus Medicity and the number of nights, which is longer after groin surgery
- The pathology report, and any chemotherapy or radiotherapy, which is billed separately
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Penile cancer surgery with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Is every sore on the penis cancer?
No. Most are infections or skin conditions. A sore, lump or patch that has not healed in three or four weeks should be seen by a urologist, and a biopsy may be advised.
Can penile cancer be treated without removing the penis?
Often, yes, when it is found early. Small tumours can be treated with organ-sparing surgery that keeps the penis. This is one reason not to delay a check.
Will I be able to pass urine standing?
After organ-sparing surgery or partial penectomy, most men can. After total penectomy, urine is passed sitting down through a new opening.
Will I be able to have sex after surgery?
After organ-sparing surgery, usually yes. After partial penectomy, many men can, depending on the remaining length. These questions are discussed honestly before surgery.
Why are the groin lymph nodes checked?
The groin nodes are the first place penile cancer spreads to. Finding and treating spread there early is an important part of treatment.
Does circumcision prevent penile cancer?
Circumcision in childhood is linked with a lower risk, mainly because it prevents phimosis and makes hygiene easier. In adults, treating phimosis and keeping the area clean both help.
Will I need chemotherapy or radiotherapy?
Most men with early cancer do not. It may be advised by oncologists when the groin or pelvic nodes are involved.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.