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Living with cancer·Standard of care

Localised penile cancer: the decisions you may face

Cancer page →Second-opinion finder →

4 treatment settings, 2 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Other settings

Penile intraepithelial neoplasia

2 options

Circumcision if the foreskin is involved; topical fluorouracil or imiquimod, laser ablation or glans resurfacing; close follow-up because recurrence is common.

Guideline
EAU-ASCO Collaborative Guideline on Penile Cancer 2023
The options, in plain words
Fluorouracil (5-FU)ApprovedFluoropyrimidine antimetabolite

The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.

Thermal ablation and cryotherapy for cervical precancerStandard of care

Destroying precancerous cervical cells with a heated or frozen probe in under a minute, the tool that makes screen-and-treat possible where there are no surgeons.

  • Cheap, fast, no anaesthesia or electricity mains
  • Enables single-visit screen-and-treat
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Fluorouracil (5-FU)all recorded rates →
  • Capecitabine: take within 30 minutes after a meal. DPD deficiency (DPYD variants) causes severe toxicity: pre-treatment genotyping is recommended in Europe.
  • Capecitabine: reduce to 75% for CrCl 30-50; contraindicated below 30.
Thermal ablation and cryotherapy for cervical precancer
  • No histology
  • Not suitable for large or endocervical lesions
Questions to ask about this decision
  1. Between Fluorouracil (5-FU) and Thermal ablation and cryotherapy for cervical precancer, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (EAU-ASCO Collaborative Guideline on Penile Cancer 2023), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. 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.
  6. 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.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

T1 to T2 tumours

One path named

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.

Guideline
EAU-ASCO Collaborative Guideline on Penile Cancer 2023
The path, in plain words
BrachytherapyStandard of care

Brachytherapy places a radioactive source directly inside or next to the tumour.

  • Highest conformality
  • Short treatment
Also referenced:Mohs surgery
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Brachytherapy
  • Invasive
  • Declining expertise in some regions
Questions to ask about this decision
  1. Is Brachytherapy the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (EAU-ASCO Collaborative Guideline on Penile Cancer 2023), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. 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.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Clinically negative groins

One path named

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.

Guideline
EAU-ASCO Collaborative Guideline on Penile Cancer 2023
The path, in plain words
Sentinel lymph node biopsyStandard of care

Removing just the first lymph node a tumour drains to, instead of all of them, to check for spread.

  • Avoids lymphoedema from full dissection
Also referenced:Lymphadenectomy (lymph node dissection)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Sentinel lymph node biopsy
  • False negatives in ~5-10%
Questions to ask about this decision
  1. Is Sentinel lymph node biopsy the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (EAU-ASCO Collaborative Guideline on Penile Cancer 2023), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. 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.

Add these to your appointment list, or take the full question set for this cancer.

2 options

HPV vaccination (now offered to boys in many countries and being tested in Chinese men) and treatment of phimosis and lichen sclerosus.

Guideline
EAU-ASCO Collaborative Guideline on Penile Cancer 2023
The options, in plain words
HPV & HBV vaccinationStandard of care

Vaccines that prevent the viral infections behind cervical, throat, anal, and liver cancers. The most effective anti-cancer intervention ever created.

  • Prevents cancer outright
  • Cheap at scale
Nonavalent HPV vaccineApprovedProphylactic vaccine (virus-like particles)

A vaccine against nine HPV types that prevents about 90% of cervical cancers, and now works with a single dose.

The evidence behind it
The main trade-offs on record
HPV & HBV vaccination
  • Coverage gaps, vaccine hesitancy
Questions to ask about this decision
  1. Between HPV & HBV vaccination and Nonavalent HPV vaccine, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese Males, and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  5. Does your recommendation follow the current guideline (EAU-ASCO Collaborative Guideline on Penile Cancer 2023), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  6. 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.
  7. 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.
  8. 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.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.