Penile-Preserving Surgery for Penile Cancer
Penile cancer does not automatically mean removal of the penis. For selected superficial and localised tumours, surgery may remove the cancer while preserving as much healthy penile tissue and function as is safely possible.
The appropriate operation depends on the location, depth and pathology of the tumour — not simply the fact that penile cancer is present.
What does penile-preserving surgery mean?
Penile-preserving surgery is not one specific operation. It describes a group of techniques that aim to remove or appropriately treat penile cancer while retaining uninvolved penile tissue whenever this can be done safely.
Depending on the tumour, this may range from circumcision or local excision through to glans resurfacing or removal of the glans with reconstruction.
The amount of tissue that can be preserved depends mainly on:
- where the cancer is located
- how deeply it has invaded
- tumour pathology and grade
- whether adequate surgical clearance can be achieved
- previous treatment
- the patient's ability to attend appropriate surveillance
The aim is to use the least extensive treatment that remains oncologically appropriate for the individual tumour.
Who may be suitable for penile-preserving treatment?
Organ-preserving surgery is most relevant when disease is superficial or localised and adequate cancer treatment can be achieved without unnecessary removal of healthy penile tissue.
Disease confined to the foreskin or glans
Tumours restricted to the prepuce or glans are more likely to have an organ-preserving surgical option than disease that has invaded deeply into the penile shaft.
Superficial or selected localised invasive disease
PeIN and selected Ta, T1 and T2 tumours may have a preservation pathway depending on their exact anatomy and pathology.
Adequate cancer clearance is achievable
A preserving operation should only be used when the tumour can still be adequately treated without leaving clinically significant disease behind.
Follow-up is practical
Retaining penile tissue means local recurrence remains possible. Long-term penile surveillance is therefore an important part of the treatment strategy.
Which operations can preserve the penis?
The operation generally becomes more extensive as disease extends from the surface into deeper penile structures.
Circumcision
Cancer or PeIN confined to the foreskin can sometimes be completely treated by circumcision.
The removed foreskin is sent for pathological assessment, which confirms diagnosis, depth and margin status.
Disease extending onto the glans may require additional treatment.
Wide Local Excision
Selected small tumours may be removed together with an appropriate margin while retaining surrounding penile tissue.
The resulting defect may be closed directly, reconstructed with local tissue or covered with a graft depending on its size and position.
Glans Resurfacing
The abnormal epithelial surface of the glans is removed while the deeper glans is preserved.
A skin graft is commonly used to reconstruct the surface.
This can be considered for extensive or recurrent PeIN and selected superficially invasive disease.
Explore glans resurfacing →Glansectomy & Reconstruction
Part or all of the glans is removed while preserving the penile shaft when oncologically appropriate.
Reconstruction can create a new distal penile surface or neoglans, commonly using a skin graft.
Explore glansectomy & reconstruction →
How is penile preservation assessed?
The treatment decision begins with accurate diagnosis and local staging.
Assessment may include:
- examination of the penile lesion
- review or performance of biopsy
- pathology review
- assessment of tumour location and size
- examination of both groins
- MRI or ultrasound in selected circumstances
- review of previous treatment or previous cancer surgery
Disease confined to the glans may still allow organ-preserving surgery, whereas clear invasion of the corpora cavernosa generally requires a more extensive penile operation.
The deeper the tumour, the more tissue may need to be removed
This is a simplified framework rather than a substitute for individual cancer staging.
Preserve the glans
Selected superficial abnormalities may allow treatment of the affected surface while keeping the deeper glans intact.
- circumcision
- local excision
- glans resurfacing
Preserve the shaft
Selected deeper glans cancers may require removal of part or all of the glans while allowing the penile shaft to remain.
- partial glansectomy
- total glansectomy
- neoglans reconstruction
More extensive resection
If cancer invades the deeper erectile bodies, preservation may no longer provide adequate cancer treatment.
- partial penectomy
- reconstruction where appropriate
- total penectomy for selected extensive tumours
When might glans resurfacing be used?
Glans resurfacing removes the abnormal surface of the glans while preserving the deeper glans tissue.
It may be considered for:
- extensive PeIN
- recurrent or persistent PeIN
- multifocal superficial glans disease
- selected superficially invasive lesions
An important advantage of surgical resurfacing is that the removed surface can be examined fully by pathology.
Glansectomy
When invasive cancer extends deeper into the glans, resurfacing may no longer remove enough tissue.
In selected cases, part or all of the glans can be removed while preserving the penile shaft.
A reconstructed distal penile surface or neoglans may then be created.
Partial or total glansectomy
Partial glansectomy may be possible when a tumour is sufficiently localised.
Total glansectomy removes the glans while preserving the underlying shaft where cancer anatomy permits.
Reconstruction commonly involves:
- preparation of the distal shaft
- reconstruction of the urethral opening
- skin-graft coverage
- formation of a neoglans contour
When might partial or total penectomy be necessary?
Penile preservation is not appropriate for every tumour. A more extensive operation may provide safer cancer treatment when disease extends beyond the structures that can reasonably be preserved.
Corporal invasion
Clear invasion of the corpora cavernosa generally moves the treatment pathway toward partial penectomy rather than glansectomy alone.
Extensive shaft disease
Tumours extending well beyond the glans may require removal of involved shaft tissue to obtain appropriate cancer clearance.
Large or difficult recurrence
Small local recurrences can sometimes be treated with another preserving operation, while more extensive recurrence may require amputative surgery.
What can penile-preserving surgery mean for function?
Different operations have different consequences. When more than one oncologically appropriate option exists, urinary, sexual and reconstructive outcomes can form part of the decision.
Urination
Preserving the distal penis may allow the urethral opening to remain at or near the end of the penis.
Urinary spraying or narrowing of the opening can occur after some reconstructive procedures.
Erections & penetration
Preserving more of the penile shaft can retain erectile tissue and useful length where the cancer allows.
Sexual function still depends on baseline erections, the operation performed and the amount of tissue removed.
Sensation & body image
Glans surgery can change sensation and appearance even when penile length is largely preserved.
Reconstructive planning aims for useful function rather than recreating anatomy that is identical to before surgery.
Reconstructive options after penile cancer surgery
Reconstruction can sometimes be incorporated into the cancer operation rather than treated as an entirely separate issue.
Depending on the tissue removed, reconstruction may involve:
- skin grafting
- local tissue reconstruction
- neoglans formation
- urethral reconstruction or repositioning
- more complex genital reconstruction in selected cases
Penile preservation does not determine the groin lymph-node plan
Surgery on the penis treats the primary tumour.
The groin lymph nodes require a separate assessment because invasive penile cancer can spread to the inguinal nodes even when the penile tumour itself is small.
The lymph-node pathway depends on:
- tumour stage
- tumour grade
- other pathological risk factors
- whether groin nodes are clinically enlarged
Why is follow-up particularly important?
Penile-preserving treatment deliberately retains uninvolved penile tissue. This can have functional benefits, but recurrence can occur in the retained penis.
Penile examination
The treated area and remaining penile skin can be reviewed for recurrence, healing problems or new abnormalities.
Groin surveillance
Lymph-node follow-up is tailored to tumour stage and any previous groin staging or treatment.
Functional recovery
Urination, erections, sexual activity, wound healing and reconstructive concerns can also be reviewed.
From diagnosis to preservation and follow-up
Confirm the diagnosis
Examination, biopsy and pathology establish whether the abnormality is PeIN or invasive penile cancer.
Define local extent
Tumour location, depth and involvement of surrounding structures are assessed clinically and with imaging where appropriate.
Determine whether preservation is oncologically suitable
Circumcision, local excision, resurfacing, glansectomy and more extensive surgery are compared according to the tumour.
Plan reconstruction and function
When relevant, grafting, neoglans reconstruction, urinary function and sexual implications are discussed before surgery.
Review final pathology
The definitive specimen confirms stage, grade, margins and other features that can affect further treatment and lymph-node management.
Surveillance
Follow-up monitors the remaining penis, groins, urinary function, sexual recovery and reconstructive outcomes.
Dr Jack Crozier
Dr Jack Crozier is a Brisbane urologist with advanced fellowship experience in uro-oncology, andrology and reconstructive urology.
His practice includes penile cancer, penile-preserving surgery and reconstructive management following penile and genital cancer surgery.
Seeking another opinion before major penile cancer surgery?
When treatment options have substantially different effects on penile preservation, urination, sexual function or reconstruction, a further specialist opinion can be reasonable.
Patients travelling to Brisbane can provide available records before major travel arrangements are made where appropriate.
Useful information can include:
- biopsy and pathology reports
- previous operation reports
- MRI, CT, PET or ultrasound images and reports
- clinical photographs where available
- oncology correspondence
- specialist letters
Explore detailed treatment information
Penile Cancer
Understand diagnosis, primary tumour treatment, groin lymph-node staging and follow-up.
Glans Resurfacing
Detailed information about resurfacing for PeIN and selected superficial penile cancers.
Glansectomy & Neoglans Reconstruction
Learn about partial and total glansectomy for selected invasive glans tumours.
Penile & Genital Reconstruction
Explore reconstructive care following penile, genital and urinary surgery.
Does Penile Cancer Mean the Penis Has to Be Removed?
A patient-focused overview of preservation versus more extensive penile cancer surgery.
Penile & Testicular Cancer
Return to the broader specialist cancer treatment hub.
Penile-preserving surgery FAQs
Does penile cancer always mean part of the penis has to be removed?
No. Selected superficial and localised penile cancers can sometimes be treated with circumcision, local excision, glans resurfacing, glansectomy or another organ-preserving approach. More extensive disease may require partial or total penectomy.
What is penile-preserving surgery?
Penile-preserving surgery describes operations designed to adequately treat the cancer while retaining as much uninvolved penile tissue as is safely possible.
Which penile cancers can be treated with preservation?
Preservation is most relevant to PeIN and selected localised tumours confined to the foreskin or glans. The exact option depends on tumour depth, location, pathology and ability to achieve adequate cancer clearance.
Can cancer confined to the foreskin be treated with circumcision?
Selected disease confined to the foreskin may be treated by circumcision. Pathology of the removed foreskin determines whether any further treatment is required.
What is wide local excision?
Wide local excision removes a selected small tumour with an appropriate margin while preserving surrounding penile tissue. The resulting defect may require direct closure, local reconstruction or grafting.
When is glans resurfacing used?
Glans resurfacing is primarily used for extensive, recurrent or persistent PeIN and may also be considered for selected superficially invasive lesions. The abnormal surface is removed while the deeper glans is preserved.
When is glansectomy used instead?
Glansectomy may be considered when cancer invades more deeply into the glans but remains sufficiently confined for the penile shaft to be preserved.
Can the penis be reconstructed after glansectomy?
Yes. In selected patients, the distal penile shaft can be reconstructed to create a neoglans, commonly using a split-thickness skin graft.
When is partial penectomy required?
Partial penectomy is generally considered when adequate cancer clearance requires removal of part of the penile shaft, including when the tumour invades the corpora cavernosa or extends beyond what can safely be treated with glansectomy.
Can I still get erections after penile-preserving surgery?
Erectile tissue is preserved to varying degrees depending on the operation. Erections may therefore remain possible, but erectile and sexual function depend on baseline health, tumour treatment, penile length, sensation and individual recovery.
Can I still urinate standing after penile-preserving surgery?
Many organ-preserving procedures retain a distal urethral opening and may allow standing urination. Stream direction, spraying or narrowing can occur after some operations.
Does preserving the penis increase the risk of recurrence?
Local recurrence can occur after penile-preserving treatment because penile tissue remains. This is why careful surveillance is an important part of an organ-preserving strategy.
Can a recurrence still be treated with another preserving operation?
Selected small local recurrences that do not involve the deeper erectile bodies may sometimes be treated with further organ-preserving surgery. Larger or deeper recurrences may require more extensive treatment.
Does penile-preserving surgery mean I can avoid lymph-node surgery?
No. Treatment of the penile tumour and management of the groin lymph nodes are separate decisions. Lymph-node staging depends on tumour stage, grade and other pathological risk factors.
Why is follow-up important after penile-preserving surgery?
Because penile tissue remains, ongoing examination is needed to detect local recurrence or new abnormalities early. Groin follow-up is also tailored to the individual cancer stage and lymph-node pathway.
Can I seek another opinion before partial or total penectomy?
A further specialist opinion can be reasonable when available treatment options have substantially different implications for cancer control, penile preservation, urinary function, sexual function or reconstruction.
Can I be assessed if I live interstate or overseas?
Potentially. Existing pathology, imaging, operative reports and specialist correspondence can be useful for preliminary review. An in-person examination or further staging may still be required before a definitive treatment plan can be confirmed.
Have you been told you may need penile cancer surgery?
Specialist assessment can help clarify the tumour pathology, depth, lymph-node risk and whether circumcision, local excision, glans resurfacing, glansectomy, partial penectomy or another treatment pathway is appropriate.
Medical information disclaimer: This page provides general educational information and does not replace individual medical advice, diagnosis or informed consent. Penile-preserving surgery is appropriate only for selected patients and tumours. Treatment depends on examination, pathology, tumour location and depth, stage, grade, surgical margins, lymph-node findings, previous treatment, general health and the ability to attend appropriate surveillance. Cancer control remains the first priority. Penile-preserving surgery may affect penile appearance, sensation, urinary function, erections and sexual function and can be associated with local recurrence, wound or graft complications, urethral narrowing and the need for further treatment. Individual outcomes cannot be guaranteed.