Treatment strategy depends on the size of the tumour, the extent it has invaded, whether it has spread (metastasised), and whether the risk of recurrence is low or high.
In general, for early penile cancer, men with a low risk of recurrence are candidates for organ preservation treatment; whereas those with a high risk of recurrence will require penile resection.
For advanced penile cancer, such as when the tumour is very large or if there is involvement of lymph nodes, treatment will likely include chemotherapy and other modes of therapy in combination with surgery.
Penile resection
Invasive disease requires partial or total amputation of the penis. Removal of lymph nodes in the groin is usually done in the same setting.
Chemotherapy before and/or after surgery is often recommended if lymph nodes in the groin or pelvis are involved.
Partial amputation
A partial amputation may be suitable for invasive tumours located at glans, where resection of the tumour will still allow sufficient penile length for passing urine while standing.
Total amputation
A total penile amputation would involve removal of the glans penis and most or all of the underlying corporal bodies. This procedure is done if the tumour cannot be safely removed while allowing sufficient penile length to stand and void. This is often necessary for very large tumours that extend down the shaft of the penis.
The urethra would need to be brought out onto the perineum as an opening, to facilitate voiding in a sitting position.