Penile cancer is rare in the U.S., with only about 2,200 new cases diagnosed each year. But in many cases, men put off seeing a doctor until the disease has progressed, which can limit treatment options.
To learn about penile cancer symptoms and treatment options, we spoke with penile cancer specialist Curtis Pettaway, M.D.
What are the symptoms of penile cancer?
Most penile cancers start at the tip of the penis, called the glans. The cancer causes changes to the skin of the penis. Penile cancer symptoms may include:
a wart-like growth that might be painful
an open sore that won’t heal
a reddish rash
small crusty bumps
flat, bluish-brown growths
swelling at the end of the penis
If the patient hasn’t been circumcised, there may be persistent smelly discharge under the foreskin.
A rash or growth on the penis can be a sensitive topic. Do you see many patients who’ve put off getting a penile cancer diagnosis?
Delay is very common. It’s almost routine. I would bet that most penile cancer patients wait six months up to a year before they see a doctor. During this time the growth just gets larger. In some cases the delay makes it harder to preserve portions of the penis and to preserve normal urinary and sexual function.
Why is it important for men to see a doctor as soon as they have suspected penile cancer symptoms?
The longer you delay, the larger the tumor and the less likely you are to be able to undergo a penile preserving treatment or procedure.
Often, patients are told they’re going to lose the whole penis or a significant portion of the penis. But if we treat these tumors early, before they grow, we can often preserve a significant part of the penis, penile length and penile function. If we treat it before it spreads, there is a very high likelihood that they will be cured of the disease. The reason for early diagnosis is penile preservation, but also life preservation.
What are the goals of treatment, and how is penile cancer typically treated?
Our main goal is saving the patient’s life by controlling the primary tumor. The next goal is to maintain penile length and function. The third goal is cosmetic appearance.
We have a lot of different options for treating penile cancer. This includes cancer drugs like topical chemotherapy and immunotherapy. At the next level of invasiveness, we can offer radiation therapy or laser surgery. Then we offer local excisions, and partial and total glansectomy, which is the removal of tissue at the head of the penis, where most cancers form. The most serious penile cancer surgery is partial or total penectomy.
How do the limited number of penile cancer cases impact new treatment options?
Because penile cancer is so rare, conducting clinical trials is difficult. It’s very hard to get enough patients at any one place to conduct meaningful clinical trials of new therapies.
That said, there are resources we can leverage at MD Anderson. Penile cancer is caused by to the human papillomavirus (HPV) in about half the cases. We can use what we know about treating other HPV-related tumors, like head and neck cancers, cervical cancers and anal cancers. We’re often able to put our patients in clinical trials for those HPV-related cancers. These are called basket trials, where the biology of the tumor process might be similar, although the tumor is in a different location. MD Anderson’s HPV-Related Cancers Moon Shot® has been a tremendous resource for us with respect to learning more about penile cancer.
Are there any clinical trials that focus exclusively on penile cancer?
I’m a chair of InPACT, the International Penile Advanced Cancer Trial. This is a collaboration of cancer centers in the United States, the UK and Canada to get baseline information on the treatments for men whose penile cancer has spread to other parts of the body.
The goals of the trial are pretty simple. We have some hints that certain types of chemotherapy are active in advanced disease. We know that chemoradiation, a combined chemotherapy and radiation therapy treatment, can be effective in treating advance disease. But we’re trying to establish baseline evidence to show these treatments work in advanced penile cancer. We want to determine if combining these treatments with surgery is more effective than surgery alone. We also hope to find which combination of two treatments might be better -- chemotherapy and surgery, or chemoradiation and surgery.
This will be useful immediately, but will also help when we look at other treatment options like immunotherapies and targeted therapies. The trial will give us a baseline that can show if a new therapy is better than, worse than or the same as what we consider the standard penile cancer treatment option.
What advice do you have for newly diagnosed penile cancer patients?
Get a thorough understanding of penile cancer and all treatment options before treatment. Given the rarity of the disease, it’s best to seek out treatment at a comprehensive cancer center like MD Anderson that regularly sees penile cancer patients. This will help to insure that your penile cancer treatment team has experience with the disease. If you have questions or are unsure about the recommendations, get a second opinion. It’s important that you have confidence in the care you’re receiving from the beginning.