Localised penile cancer (organ-confined, node-negative)
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.
Overview
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.
What 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.
State of the art
- 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.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowBlood clot (lenalidomide, pomalidomide, thalidomide)
A swollen painful calf, or sudden breathlessness with chest pain; venous and arterial thromboembolism is a boxed warning and blood-thinning prophylaxis is recommended.
- Check before combiningFood and drink: Fluorouracil (5-FU)
Capecitabine: take within 30 minutes after a meal. DPD deficiency (DPYD variants) causes severe toxicity: pre-treatment genotyping is recommended in Europe.
- Check before combiningKidneys: Fluorouracil (5-FU)
Capecitabine: reduce to 75% for CrCl 30-50; contraindicated below 30.
See all on the product pages:Fluorouracil (5-FU)·Printable cards in the navigator
Anatomy and lymph node drainage
- Renal cortex (RCC)
- Renal pelvis and ureter (upper tract urothelial)
- Bladder lining (non-muscle-invasive)
- Bladder muscle wall (muscle-invasive)
- Adrenal cortex
- Adrenal medulla and sympathetic chain (neuroblastoma)
- Developing kidney (Wilms tumour)
- Nodes: renal hilar
- Nodes: para-aortic and paracaval
- Nodes: obturator and iliac (bladder)
Renal cell carcinoma comes from the kidney's filtering cortex, urothelial cancer from the lining of the collecting system and bladder, and the adrenal on top hosts cortical and medullary (neuroblastoma) tumours.
- Renal cortex (RCC)HPV-independent penile squamous cell carcinoma (usual type, verrucous, sarcomatoid)
- Renal pelvis and ureter (upper tract urothelial)
- Bladder lining (non-muscle-invasive)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)
- Bladder muscle wall (muscle-invasive)HPV-associated penile squamous cell carcinoma (basaloid, warty; p16 positive) · HPV-independent penile squamous cell carcinoma (usual type, verrucous, sarcomatoid)
- Adrenal cortex
- Adrenal medulla and sympathetic chain (neuroblastoma)
- Developing kidney (Wilms tumour)
- renal hilar
- para-aortic and paracaval
- obturator and iliac (bladder)
Same organ: Non-muscle-invasive bladder cancer, Muscle-invasive and advanced bladder cancer, Bladder & urothelial cancer, Clear cell renal cell carcinoma, Papillary renal cell carcinoma, Chromophobe renal cell carcinoma, Renal cell carcinoma, Wilms tumour (nephroblastoma), Neuroblastoma (paediatric), Low-risk neuroblastoma (INRG very low and low risk, including stage MS), Intermediate-risk neuroblastoma, High-risk neuroblastoma, Adrenocortical carcinoma, Pheochromocytoma and paraganglioma (PPGL), Urethral cancer, Penile cancer, Node-positive and metastatic penile cancer, Localised adrenocortical carcinoma (ENSAT stage I to III, resectable), Advanced and metastatic adrenocortical carcinoma (ENSAT stage IV or unresectable), Hereditary pheochromocytoma and paraganglioma (SDHx, VHL, RET, NF1, MAX and TMEM127), Metastatic pheochromocytoma and paraganglioma
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.
- HPV & HBV vaccinationStandard of care
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Circumcision if the foreskin is involved; topical fluorouracil or imiquimod, laser ablation or glans resurfacing; close follow-up because recurrence is common.
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.
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.
HPV vaccination (now offered to boys in many countries and being tested in Chinese men) and treatment of phimosis and lichen sclerosus.
Subtypes & biomarkers
top- 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)
- 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
How often this target appears
- 1994Dynamic sentinel node biopsy for penile cancer introduced in Amsterdam
- 2002England centralises penile cancer surgery in supra-regional centres
- 2009HPV vaccination shown to prevent external genital lesions in men
- 2022WHO classification separates HPV-associated and HPV-independent penile squamous cell carcinoma
- 2023EAU-ASCO collaborative guideline sets organ preservation and sentinel node biopsy as standards
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 10 changes by month →- 2026-09-18This recordLocalised penile cancer (organ-confined, node-negative)Facts on this page last checked
When this page itself was last checked or edited.
- 2023GuidelineLocalised penile cancer (organ-confined, node-negative)Guideline EAU-ASCO Collaborative Guideline on Penile Cancer 2023: Clinically negative groins
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.
- 2023GuidelineLocalised penile cancer (organ-confined, node-negative)Guideline EAU-ASCO Collaborative Guideline on Penile Cancer 2023: Penile intraepithelial neoplasia
Circumcision if the foreskin is involved; topical fluorouracil or imiquimod, laser ablation or glans resurfacing; close follow-up because recurrence is common.
- 2023GuidelineLocalised penile cancer (organ-confined, node-negative)Guideline EAU-ASCO Collaborative Guideline on Penile Cancer 2023: Prevention
HPV vaccination (now offered to boys in many countries and being tested in Chinese men) and treatment of phimosis and lichen sclerosus.
- 2023GuidelineLocalised penile cancer (organ-confined, node-negative)Guideline EAU-ASCO Collaborative Guideline on Penile Cancer 2023: T1 to T2 tumours
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.
- 2023MilestoneSentinel lymph node biopsyEAU-ASCO collaborative guideline sets organ preservation and sentinel node biopsy as standards
A milestone in how this cancer is treated.
What is in development for Localised penile cancer (organ-confined, node-negative), drawn from the whole corpus: 1 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Trials under way · 1
- A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese Males · phase 3 · Shanghai Bovax Biotechnology Co., Ltd.
Open problems and what is being done
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.
and how the field plans to fix it →What is being done about thisAdvanced and metastatic diseaseAvailable now- Sentinel lymph node biopsyStandard of care
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Also on OnCo: Atlas of advanced disease · Invasion and metastasis.
Whether HPV status should change treatment is unknown.
Most of the world's patients present late in places without specialist centres.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Milan · cancer center | Italy | none recorded | 0 | 1,246 | 21,746 | #11 | |
Wuhan · hospital | China | none recorded | 0 | 2,478 | 31,527 | - | |
Heidelberg · research institute | Germany | none recorded | 0 | 2,202 | 32,575 | - | |
New Delhi · government | India | none recorded | 0 | 2,028 | 15,043 | - | |
Bethesda, MD · government | United States | none recorded | 0 | 1,312 | 26,262 | - | |
Leiden · university | Netherlands | none recorded | 0 | 1,245 | 16,125 | - | |
L'Hospitalet de Llobregat · cancer center | Spain | 0 | 988 | 14,310 | - | ||
Oakland, CA · research institute | United States | none recorded | 0 | 908 | 10,296 | - | |
New Delhi · hospital | India | none recorded | 0 | 880 | 5,143 | - | |
Taipei · hospital | Taiwan | none recorded | 0 | 746 | 8,966 | - | |
Chennai · cancer center | India | none recorded | 0 | 691 | 13,919 | - | |
Geneva · government | Switzerland | none recorded | 0 | 599 | 45,298 | - | |
Bordeaux · cancer center | France | none recorded | 0 | 410 | 4,462 | - | |
Chandigarh · hospital | India | none recorded | 0 | 398 | 3,509 | - | |
Budapest · cancer center | Hungary | none recorded | 0 | 378 | 3,070 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Localised penile cancer but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Localised penile cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example p16 immunohistochemistry and HPV DNA, Grade and lymphovascular invasion of the primary, Depth and stageof the primary, Surgical margin status, Dynamic sentinel node biopsy result), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Penile intraepithelial neoplasia, HPV-associated penile squamous cell carcinoma, HPV-independent penile squamous cell carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Penile intraepithelial neoplasia
- For my situation (penile intraepithelial neoplasia), which of the standard options do you recommend and why?Why: Guideline options include: Circumcision if the foreskin is involved; topical fluorouracil or imiquimod, laser ablation or glans resurfacing; close follow-up because recurrence is common.
- Am I a candidate for Fluorouracil (5-FU), and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
T1 to T2 tumours
- For my situation (t1 to t2 tumours), which of the standard options do you recommend and why?Why: Guideline options include: 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.
Clinically negative groins
- For my situation (clinically negative groins), which of the standard options do you recommend and why?Why: Guideline options include: 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.
Prevention
- For my situation (prevention), which of the standard options do you recommend and why?Why: Guideline options include: HPV vaccination (now offered to boys in many countries and being tested in Chinese men) and treatment of phimosis and lichen sclerosus.
- Am I a candidate for Nonavalent HPV vaccine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese Males apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of HPV & HBV vaccination, A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese Males?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Local recurrence after organ-sparing surgery is common and needs long follow-up”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Sentinel node biopsy misses some metastases, and the false-negative rate depends on centre experience”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Localised penile cancer, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
5drugs
2companies
2terms
4trials
1key papers
2The standard-of-care entries on the penile cancer pages, from keeping as much of the penis as is safe to staging the groins with a sentinel node procedure, follow this guideline.
Kidney cancer subtype pages use these definitions; several rare entities are now diagnosed by molecular testing rather than appearance alone.
Latest papers
topQuery for this cancer: (TITLE:"Localised penile cancer" OR ABSTRACT:"Localised penile cancer" OR TITLE:"organ-confined, node-negative" OR ABSTRACT:"organ-confined, node-negative" OR TITLE:"Early penile squamous cell carcinoma" OR ABSTRACT:"Early penile squamous cell carcinoma" OR TITLE:"Organ-confined penile cancer" OR ABSTRACT:"Organ-confined penile cancer" OR TITLE:"Penile intraepithelial neoplasia and T1 to T2 penile cancer" OR ABSTRACT:"Penile intraepithelial neoplasia and T1 to T2 penile cancer" OR TITLE:"cN0 penile cancer" OR ABSTRACT:"cN0 penile cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Localised penile cancer (organ-confined, node-negative), not a curated reading list.
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