Cancer of the penis is rare, but the global incidence and mortality rates are on an upward climb. Several factors may put individuals at risk of penile cancer, and are not necessarily unique from other cancer diagnoses—such as being over age 60 and tobacco use.

 

Certain geographic areas see more cases

 

The rate of penile cancer is less than 1 per 100,000 individuals per year in most developed countries, including the US, where around 2,100 new cases and 500 deaths from penile cancer were reported in 2024.

National Cancer Institute. Penile Cancer Treatment (PDQ) – Health Professional Version. February 2, 2024.

However, in some countries, the rate is much higher. 

 

According to a 2022 analysis of 43 countries, published in the journal JMIR Public Health and Surveillance, researchers reported that Uganda had the highest incidence of penile cancer, at 2.2 per 100,000 people, during the study period (2008 and 2012).

Fu L, Tian T, Yao K, et al. Global Pattern and Trends in Penile Cancer Incidence: Population-Based Study. JMIR Public Health Surveill. 2022;8(7):e34874.

 

"Penile cancer is a rare disease but also highly preventable,” explained Maurício Dener Cordeiro, MD, PhD, of the Brazilian Society of Urology, in an interview with BBC. Even so, by 2025, the global incidence of penile cancer is expected to rise by more than 77% by 2050.

Barrucho L. Penis cancer cases increasing: Brazil sees 6,500 amputations in a decade. BBC. June 21, 2024.

 

 

Risk factors

 

Individuals aged 60 years or older are at increased risk of penile cancer, an unchangeable risk factor.

National Cancer Institute.Penile Cancer Treatment (PDQ) – Patient Version. May 30, 2024.

However, a 2024 study, published in the International Journal of Impotence Research (IJIR), looked at the long-term outcomes of penile squamous cell carcinoma in individuals younger than 50 years vs those older than 50 years.

Pang KH, Fallara G, Hemat M, et al. Long-term outcomes of penile squamous cell carcinoma in men age ≤50 years old compared with men >50 years old from a single tertiary referral centre: a propensity score matched analysis. Int J Impot Res. Published online February 29, 2024.

 

The younger patients had better overall survival, but no difference was found in the disease-specific survival, recurrence-free survival and metastasis-free survivals between the age groups.

"Penile cancer in younger patients is fatal, public awareness and patient education are crucial for early detection and management,” the IJIR authors wrote.

 

A study published in Scientific Reports provides further context.

Vieira CB, Feitoza L, Pinho J, et al. Profile of patients with penile cancer in the region with the highest worldwide incidence. Sci Rep. 2020;10(1):2965. February 19, 2020.

Researchers interviewed 116 patients with penile cancer in Brazil and found, along with low socioeconomic status, a high prevalence of poor genital hygiene, at 73%, phimosis, at 66%, and HPV infection, at 62%.

 

"Mass vaccination against HPV is essential due to its high effectiveness in preventing related lesions," Dr. Cordeiro told BBC.

Barrucho L. Penis cancer cases increasing: Brazil sees 6,500 amputations in a decade. BBC. June 21, 2024.

He also recommended using condoms during sex and undergoing circumcision in cases of phimosis to help reduce penile cancer risk.

 

As Dr. Cordeiro explained, when an individual “does not expose the glans and fails to clean the foreskin properly, it produces a secretion that accumulates. This creates a highly favorable environment for bacterial infections. If this occurs repeatedly, it becomes a risk factor for the appearance of the tumor."

Barrucho L. Penis cancer cases increasing: Brazil sees 6,500 amputations in a decade. BBC. June 21, 2024.

 

 

Signs and symptoms

 

According to the American Cancer Society (ACS), the first sign of penile cancer usually involves a skin change on the glans of the penis or the foreskin, but sometimes on the shaft.

American Cancer Society. Signs and Symptoms of Penile Cancer. June 25, 2018.

The skin may become thicker, change color, develop a lump, or present with an ulcer that may bleed. A rash may appear under the foreskin, or the skin may develop crusty bumps, or bluish-brown flat growths. In some cases, bleeding under the foreskin or a smelly discharge will occur. These changes are not usually painful.

 

Another possible sign of penile cancer is phimosis or swelling of the lymph nodes in the groin. A doctor should check signs and symptoms that persist or worsen.

 

The sooner a diagnosis is made, the sooner you can start treatment and the better it is likely to work.

 

Diagnosis and treatment

 

If penile cancer is suspected, doctors will examine the penis for signs of disease or take a biopsy of any penile tissue that appears unusual.

National Cancer Institute.Penile Cancer Treatment (PDQ) – Patient Version. May 30, 2024.

If cancer is diagnosed, doctors may refer patients for tests, such as CT, PET, MRI, or ultrasound scans, or biopsies of the lymph nodes. Such tests can help determine the prognosis and treatment options, which depend on the cancer stage and the tumor’s location.

 

Surgery is used most often to treat individuals with penile cancer. Mohs microsurgery, in which the tumor is cut away in thin layers, is used in early stage disease. Individuals may also undergo laser surgery, cryosurgery, wide local excision, and circumcision. 

Other treatment options include radiation therapy, chemotherapy, and immunotherapy with topical imiquimod. Treatments being tested in clinical trials include radiosensitizers (drugs that make tumor cells more sensitive to radiation therapy) and sentinel lymph node biopsy followed by surgery.

“In the case of partial amputation, urine continues to exit through the penis,” explained Thiago Camelo Mourão, MD, PhD, urologist at AC Camargo Cancer Center in São Paulo, Brazil, to BBC.

Barrucho L. Penis cancer cases increasing: Brazil sees 6,500 amputations in a decade. BBC. June 21, 2024.

“However, in total amputation, the urethral orifice can be relocated to the perineum, between the scrotum and the anus, requiring the patient to urinate while sitting on the toilet.”