Treatments for localised penile cancer (including surgery; Glansectomy)
The following treatments are used to treat pre-cancerous conditions of the penis as well as some early, localised penile cancers.
Topical Agents (local treatments)
This is a type of chemotherapy cream which is applied to the affected area of the penis for around 4 – 6 weeks. Chemotherapy works by destroying cancer cells. Chemotherapy will also affect some healthy cells on the penis and therefore the area treated may become inflamed, encrusted and sore. If this happens men may be advised to use a steroid cream to help reduce some of these symptoms. Soreness can sometimes last for a few months; however, it is important to continue treatment if possible for the full duration of the recommended period.
Men will need to make sure that they wash their hands thoroughly if they do not use gloves to apply the cream.
This type of chemotherapy will not cause hair loss.
This is a type of immunotherapy treatment. Unlike chemotherapy, immunotherapy stimulates the body’s immune system to fight and regress cancerous cells. It can be used as a treatment on its own or if chemotherapy cream has not worked fully.
Treatment is usually applied for 4 – 6 weeks.
For both of the above treatments it may be necessary to use a barrier cream to protect areas around the treatment site and treatment may not be suitable for patients with a weakened immune system.
This is the removal of the foreskin and may be appropriate if only the foreskin appears to have been affected by a precancerous condition or cancer itself. Sometimes it will be the only treatment that a man may need.
For more detailed information on circumcision from the British Association of Urological Surgeons (BAUS) please click here.
Wide local excision
Possible cancerous tissue will be removed from the affected area of the penis and a few millimetres of healthy tissue will be removed from around the site to reduce the possibility of any potentially cancerous cells from being left behind.
In general the following guidelines may be useful to follow after any minor penile surgery:
- There will be a surgical dressing on the penis. This can usually be removed about 24 hours after the procedure. Stitches (sutures) will be dissolvable but can take up to 2 weeks or more to fully dissolve.
- Men can shower, normally after 24 hours, but it is important not to rub soap on the wound area. The wound area should be dried by gently patting it with a clean towel/gauze pad. Men can have a bath after 1 week.
- The penis may be bruised and swollen after the operation. Prescribed painkillers should be taken on a regular basis, (not just when men get pain) for the first 48 hours or until they feel comfortable.
- Although these are minor procedures, it is important to take things easy for the first week. Most men should be able to return to work within a few days.
- Men may begin normal sexual activity again six weeks after their operation, as long as they feel comfortable.
- Men should be given a follow up appointment within a few weeks of their operation for the results. At this time any further treatment which may be reccommended will be discussed.
This technique uses liquid nitrogen at a temperature of between -20° C and -50° C to freeze and kill cancerous cells. The skin on the penis will later blister and peel and the procedure can leave a small scar.
Laser therapy is the use of a very powerful beam of light to kill cancer cells. Laser surgery can be used along with a minor surgical procedure to destroy cancerous cells. This can cause some minor pain and bleeding but is usually well tolerated. It may take 2 – 3 months after treatment for the penis to recover fully.
This is a newer treatment that is still being fully assessed. Light sensitive chemicals are applied to the penis and left for a few hours. A special type of light is then shone at the treated area which can cause the cancer cells to die.
Glansectomy / Split Skin Graft
The following type of surgery for penile cancer will affect the appearance of the penis and it is important for men and their partners to:
- Ask their surgeon or health professional to give them as much information as possible with regard to the possible change in appearance of their penis following surgery. This will help prepare them for any change in body image.
- Men should ask their specialist nurse to discuss the treatment that they are having and what to expect immediately after, and in the long term following treatment. If possible they should try and involve their partner and family as they will be affected by the changes too.
- If men are having difficulty in preparing for their treatment either emotionally or psychologically they can ask their specialist team about counselling; talking to a healthcare professional to express their fears or concerns.
Glans resurfacing and split skin graft
This involves removing the surface tissue of the glans while taking biopsies from deeper within the penile tissue to check for cancer. A small section of skin will usually be removed from a man’s thigh to act as a skin graft and will be used to replace the area of the penile tissue that has been removed. This is termed a split skin graft as only the surface cell layers of the skin will be used. In general post-operative care will be similar to Glansectomy (below).
This is performed for cancer that is confined to the penis and is a surgical technique to remove the area from the glans of the penis that contains cancer.The amount of tissue removed will depend on the extent of the cancer that is present, however to ensure there will be less chance of having cancer left behind, about 2mm of surrounding tissue will also be removed (this is called a surgical margin). To make the penis look as normal as possible after the procedure skin may be taken from the thigh and grafted over the area where the tissue was removed (see Fig. 1). Alternatively the foreskin may be used instead (Fig. 2).
To protect the urethra from becoming damaged during the procedure a catheter (urine drainage tube) will be inserted into the bladder. This will need to stay in place for 5 – 7 days.
For information on Catheter care please click here
- Painkillers will be given on a regular basis for any pain men may experience. It is important that men take painkillers regularly and not just when they have pain.
- Men will need to remain in bed for up to 48 hours after the operation (this is called bed rest) to allow the skin graft to join onto the remaining tissue of the penis.
- The penis will have surgical dressings over it which will usually be left in place for up to 5 days. Doctors and nurses will check these dressings and the site of the operation regularly for any abnormalities such as possible bleeding or infection. Baths or showers should be avoided during this time and men may be advised to have a salt bath after 14 days. They should pat the operation site dry with a clean towel or gauze and avoid any material that may leave fibres on the site. Alternatively a hairdryer on a cold setting can be used to gently dry the area.
- If a graft has been taken from the thigh a waterproof dressing will be applied which will need to remain in place for 2-weeks.As the site of the skin graft heals it may cause an unusual odour which can cause alarm but this is us a result of the natural haling process.
- Stitches will be dissolvable but may take 4 – 6 weeks to fully disperse.
- Men will need a minimum 4 weeks off work.
A follow up appointment will usually be made within a few weeks to check that the operation sites are healing satisfactorily and to discuss the results of surgery.
Men should be aware that the colour of the skin graft may be a different colour to the penile skin when fully healed.
Tips for surgery
- Always ask the healthcare team exactly what the surgery will involve and what to expect after the operation.
- Plan ahead with regard to time off work and allowing for the healing process.
- Try and maximise health prior to the operation by eating healthily and taking steady exercise.
- Try and get into the habit of moving feet when at rest and not crossing legs. This will help prevent possible blood clots forming in the legs which can occur when mobility is reduced.
To read personal stories of men who have been affected and treated for penile cancer please click here
Last reviewed 04/01/2018 Next review 04/07/2018.
References available on request.