{"entity":{"id":"localised-penile-cancer","kind":"cancer","name":"Localised penile cancer (organ-confined, node-negative)","aka":["Early penile squamous cell carcinoma","Organ-confined penile cancer","Penile intraepithelial neoplasia and T1 to T2 penile cancer","cN0 penile cancer"],"tldr":"Localised penile cancer is squamous cell cancer confined to the penis with no spread to the groin lymph nodes, and the aim of treatment is to remove the tumour while keeping as much of the penis as possible. Precancer and small tumours are treated with creams, laser or glans-sparing surgery, and the groin nodes are checked by sentinel node biopsy or surveillance rather than removed wholesale.","summary":"Penile squamous cell carcinoma begins on the glans, the inner foreskin or the coronal sulcus, in roughly a third to a half of cases driven by HPV (basaloid and warty types, p16 positive) and otherwise by chronic inflammation, lichen sclerosus and phimosis (usual, verrucous and sarcomatoid types, often TP53 mutant). Penile intraepithelial neoplasia (PeIN) is its precursor. The 2023 EAU-ASCO guideline places organ preservation at the centre of care: PeIN and superficial tumours are treated with topical fluorouracil or imiquimod, laser ablation, circumcision or glans resurfacing; T1 and T2 tumours with glansectomy or partial penectomy with a margin of a few millimetres, which oncological series have shown to be safe; and brachytherapy is an alternative for small distal tumours. Total penectomy is kept for large or proximal tumours.\n\nWhat decides survival is the groin. Palpably normal nodes still hide metastases in about a fifth of patients with tumours of intermediate or high risk (T1 with grade 2 or higher, lymphovascular invasion, or any T2 or worse), so the guideline recommends dynamic sentinel node biopsy for those patients rather than surveillance, and surveillance only for low-risk tumours; if the sentinel node is positive the patient moves into node-positive management. Circumcision and HPV vaccination prevent much of the disease, and the rarity of penile cancer means that referral to a specialised centre, as required in the United Kingdom since 2002, improves organ preservation and survival.","asOf":"2026-09-18","wikipedia":"https://en.wikipedia.org/wiki/Penile_cancer","links":[{"label":"EAU-ASCO penile cancer guideline 2023","url":"https://doi.org/10.1016/j.eururo.2023.02.027"},{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Penile_cancer"}],"tags":["subtype-page","genitourinary"],"related":["node-positive-penile-cancer","penile","localised-anal-cancer"],"cancers":[],"sections":[],"technologies":["sentinel-node","brachytherapy","hpv-vaccine","precancer-ablation"],"targets":[],"drugs":["fluorouracil","gardasil-9"],"companies":[],"institutions":[],"pathways":[],"terms":["hpv-p16","hpv-status","mohs-surgery","lymphadenectomy"],"trials":["nct06465914"],"people":[],"bottlenecks":[],"keyPapers":["paper-who-2022-gu-moch-eur-urol-2022","paper-eau-asco-penile-cancer-guideline-eur-urol-2023"],"journals":[],"dependsOn":[],"notes":[],"group":"genitourinary","burden":"Most penile cancers in high-income countries are diagnosed while confined to the glans or foreskin; the disease is far commoner in parts of South America, Africa and Asia where circumcision is rare and HPV vaccination low.","subtypes":["Penile intraepithelial neoplasia (PeIN, precursor; topical therapy, laser or circumcision)","HPV-associated penile squamous cell carcinoma (basaloid, warty; p16 positive)","HPV-independent penile squamous cell carcinoma (usual type, verrucous, sarcomatoid)","Ta to T1 low-grade penile cancer (organ-sparing surgery, groin surveillance)","T1 high-grade to T2 penile cancer with clinically negative groins (organ-sparing surgery plus sentinel node biopsy)"],"biomarkers":["p16 immunohistochemistry and HPV DNA","Grade and lymphovascular invasion of the primary (decide sentinel node biopsy)","Depth and stage (Ta, T1, T2) of the primary","Surgical margin status","Dynamic sentinel node biopsy result"],"standardOfCare":[{"setting":"Penile intraepithelial neoplasia","approach":"Circumcision if the foreskin is involved; topical fluorouracil or imiquimod, laser ablation or glans resurfacing; close follow-up because recurrence is common.","refs":["fluorouracil","precancer-ablation"],"guideline":{"version":"EAU-ASCO Collaborative Guideline on Penile Cancer 2023","url":"https://doi.org/10.1016/j.eururo.2023.02.027"}},{"setting":"T1 to T2 tumours","approach":"Organ-sparing surgery (wide local excision, glansectomy, partial penectomy) with narrow margins; brachytherapy for small distal tumours; total penectomy only for large or proximal disease.","refs":["mohs-surgery","brachytherapy"],"guideline":{"version":"EAU-ASCO Collaborative Guideline on Penile Cancer 2023","url":"https://doi.org/10.1016/j.eururo.2023.02.027"}},{"setting":"Clinically negative groins","approach":"Surveillance for low-risk tumours (Ta, T1 grade 1 without lymphovascular invasion); dynamic sentinel node biopsy for intermediate- and high-risk tumours, with inguinal lymphadenectomy if positive.","refs":["sentinel-node","lymphadenectomy"],"guideline":{"version":"EAU-ASCO Collaborative Guideline on Penile Cancer 2023","url":"https://doi.org/10.1016/j.eururo.2023.02.027"}},{"setting":"Prevention","approach":"HPV vaccination (now offered to boys in many countries and being tested in Chinese men) and treatment of phimosis and lichen sclerosus.","refs":["hpv-vaccine","gardasil-9","nct06465914"],"guideline":{"version":"EAU-ASCO Collaborative Guideline on Penile Cancer 2023","url":"https://doi.org/10.1016/j.eururo.2023.02.027"}}],"stateOfArt":["Organ-sparing surgery with narrow margins is standard and preserves sexual and urinary function in most men.","Dynamic sentinel node biopsy finds hidden groin metastases without the morbidity of prophylactic node dissection.","Centralisation of care has improved outcomes in the United Kingdom and the Netherlands."],"history":[{"year":1994,"title":"Dynamic sentinel node biopsy for penile cancer introduced in Amsterdam","refs":["sentinel-node"]},{"year":2002,"title":"England centralises penile cancer surgery in supra-regional centres","refs":[]},{"year":2009,"title":"HPV vaccination shown to prevent external genital lesions in men","refs":["hpv-vaccine","gardasil-9"]},{"year":2022,"title":"WHO classification separates HPV-associated and HPV-independent penile squamous cell carcinoma","refs":["hpv-p16"]},{"year":2023,"title":"EAU-ASCO collaborative guideline sets organ preservation and sentinel node biopsy as standards","refs":["sentinel-node","mohs-surgery"]}],"pipeline":["hpv-vaccine","nct06465914"],"openProblems":["Local recurrence after organ-sparing surgery is common and needs long follow-up.","Sentinel node biopsy misses some metastases, and the false-negative rate depends on centre experience.","Whether HPV status should change treatment is unknown.","Most of the world's patients present late in places without specialist centres."],"parent":"penile"},"route":"/cancers/localised-penile-cancer/","neighbours":{"cancer":[{"id":"localised-anal-cancer","kind":"cancer","name":"Localised anal squamous cell carcinoma (stage I to III)","route":"/cancers/localised-anal-cancer/"},{"id":"node-positive-penile-cancer","kind":"cancer","name":"Node-positive and metastatic penile cancer","route":"/cancers/node-positive-penile-cancer/"},{"id":"penile","kind":"cancer","name":"Penile cancer","route":"/cancers/penile/"}],"technology":[{"id":"brachytherapy","kind":"technology","name":"Brachytherapy","route":"/technologies/brachytherapy/"},{"id":"hpv-vaccine","kind":"technology","name":"HPV & HBV vaccination","route":"/technologies/hpv-vaccine/"},{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","route":"/technologies/sentinel-node/"},{"id":"precancer-ablation","kind":"technology","name":"Thermal ablation and cryotherapy for cervical precancer","route":"/technologies/precancer-ablation/"}],"drug":[{"id":"fluorouracil","kind":"drug","name":"Fluorouracil (5-FU)","route":"/drugs/fluorouracil/"},{"id":"gardasil-9","kind":"drug","name":"Nonavalent HPV vaccine","route":"/drugs/gardasil-9/"}],"term":[{"id":"hpv-status","kind":"term","name":"HPV status (HPV-positive / HPV-negative)","route":"/terms/hpv-status/"},{"id":"hpv-p16","kind":"term","name":"HPV-positive (p16) head and neck cancer","route":"/terms/hpv-p16/"},{"id":"lymphadenectomy","kind":"term","name":"Lymphadenectomy (lymph node dissection)","route":"/terms/lymphadenectomy/"},{"id":"mohs-surgery","kind":"term","name":"Mohs surgery","route":"/terms/mohs-surgery/"}],"trial":[{"id":"nct06465914","kind":"trial","name":"A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese Males","route":"/trials/nct06465914/"}],"paper":[{"id":"paper-eau-asco-penile-cancer-guideline-eur-urol-2023","kind":"paper","name":"EAU-ASCO collaborative guideline on penile cancer, 2023 update","route":"/key-papers/paper-eau-asco-penile-cancer-guideline-eur-urol-2023/"},{"id":"paper-who-2022-gu-moch-eur-urol-2022","kind":"paper","name":"WHO classification of tumours of the urinary system and male genital organs, 2022: renal, penile and testicular tumours","route":"/key-papers/paper-who-2022-gu-moch-eur-urol-2022/"}]}}