Supportive care for penile cancer

Supportive care helps men meet the physical, practical, emotional and spiritual challenges of penile cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of men living with cancer and their loved ones, especially after treatment has ended.

Recovering from penile cancer and adjusting to life after treatment is different for each man, depending on the stage of the cancer, the type of treatments given and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A man who has been treated for penile cancer may have the following concerns.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Penile cancer and its treatments can affect a man’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• scars
• changes to the shape or size of the penis
• loss of all or part of the penis
• loss of the ability to urinate standing up
• a urethrostomy

These body changes can cause concern, anxiety and feelings of embarrassment. Men with penile cancer may feel uncomfortable around others because of changes to their body.

Talking about feelings may help some men cope with their changed body. If you are in a relationship, talk to your partner about your feelings and concerns. Support from other men who’ve had penile cancer and professional counsellors can help. Reconstruction with a penile implant or a penile prosthesis may also help you cope with changes to body image and self-esteem.

Many men have strong, supportive relationships and a satisfying sex life after penile cancer. If sexual problems occur because of penile cancer treatment, there are ways to manage them. How much penile cancer affects your sex life and sexuality depends on the stage of your cancer and what treatments you have. It also depends on how sexually active you are at the time of your diagnosis, including your relationship status, age and life stage. Doctors will always try to give you the treatment that keeps as much of your penis as possible. Having penile cancer doesn’t mean the end of your sex life.

If you are diagnosed with early stage penile cancer, your treatment may not have a big effect on your sex life. If you have a circumcision, Mohs surgery, wide local excision, laser surgery, cryosurgery, radiation therapy or topical drug therapy, it won’t usually affect your ability to have an erection and penetration during sex. Most men are able to carry on with their sex life as before.

If part of your penis is removed (called a partial penectomy), it is still possible to have an erection and there is often enough of the penis left for penetration during sex. But you may have difficulty having an erection (called erectile dysfunction) after treatment. When this happens, sensitivity and function usually return over time. Using drugs such as sildenafil (Viagra) may help. You may lose interest in sex or feel embarrassed about the reduced size of your penis but talking to your partner or talking to a counsellor about any concerns you have can help.

If all of your penis is removed (called a total penectomy), you will not be able to have an erection or penetration during sex. You may need to think differently or adapt how you express yourself sexually. It is still possible to experience pleasure and have a satisfying sex life. Some men may be able to have reconstructive surgery to allow penetration during sex. And men may find other ways to enjoy sex without penetration. Talk to your partner openly about how you can experience pleasure. Talking to a counsellor can also help you and your partner talk more openly about sex and explore other approaches to sexual satisfaction. This can be comforting to both of you and bring you closer as a couple.

Counsellors or health professionals who specialize in sexual problems can provide information and support. You can have sexual counselling alone, with a partner or in a group.

Find out more about sexual problems for men and how they can be managed.

Lymphedema is the swelling that occurs when lymph fluid builds up in the soft tissues. The lymph nodes work like small filters in the body. They filter extra body fluids, abnormal cells and cells that cause infections.

Lymphedema may occur in a man’s legs if he has lymph nodes removed from his groin or pelvis during penile cancer surgery. Lymphedema is more likely to occur if he also received radiation therapy to the pelvis.

Find out more about lymphedema.

Some types of treatments for penile cancer can cause changes to how you urinate. If you have your penis removed, you will have a perineal urethrostomy and will have to sit down to urinate. A perineal urethrostomy is an opening between the anus and scrotum for the urethra where urine can leave the body. You can still control urination because the muscle that keeps the bladder closed is further inside the body, above the penis. Your healthcare team will teach you how to care for the perineal urethrostomy.

Radiation therapy directed to the tip of the penis can narrow the opening of the urethra in some men. This can make it difficult to urinate normally, but it can be managed by stretching (dilating) the opening. Your healthcare team will show you how to stretch the opening.

Some treatments for penile cancer can cause fertility problems, which can affect a man’s ability to conceive children. For some penile cancers that have spread to the testicles, the testicles may be removed (called an orchiectomy). If both testicles are removed, the man no longer makes sperm so he can’t father children.

Chemotherapy and radiation therapy can lower the number of healthy sperm made by the testicles. This is usually temporary. Sperm production returns to normal after treatment is finished. Sometimes it can take up to 2 years after treatment for sperm counts and health to return to normal.

Most men diagnosed with penile cancer are over the age of 60. But penile cancer can occur at any age including in men under 40. Depending on your life stage, if you want to have children in the future, you may be offered sperm storing or banking before treatments.

Find out more about fertility problems and how they can be managed.

To make the decisions that are right for you, ask your healthcare team questions about supportive care.