Diagnosis and tests for penile cancer
For many men, their first point of contact when seeking help will be their GP. Most GPs won't be an expert in penile cancer but if after an examination they are unable to make an accurate diagnosis, the GP should be able to refer a patient onto a local hospital for further tests. A GP will usually make a referral to a urologist who is a health professional who specialises in diseases affecting the urinary system and genitals. Urology specialists will have a wider range of diagnostic tests and instruments available to them than a GP and will therefore be able to give the patient a more accurate diagnosis.
Asking men about their symptoms
When first seeking help, and throughout the diagnostic phase, men will be asked questions about their general health and the symptoms that they are experiencing. These questions are intended to help the doctor find out more about the patient’s health and possible causes of their symptoms. Some of the questions may be quite sensitive or personal, but it's important that all questions are answered as clearly and honestly as possible in order to help the doctor make the right diagnosis.
The men we spoke to were asked about the following, by their doctors:
- The symptoms experienced
- The length of time they had experienced the symptoms
- How the symptoms had changed
- Sexual activity
- Sexually transmitted infections
Colins doctor asked him how long he had had the pimple on his penis for and if it had bled.
I did explain to him that I’d got a small growth or pimple on the side of my the gland on my penis. And which he actually examined. And he said, ‘Does it does it bleed?’ and I said, ‘Well it has on occasion’. And he asked me how long that I’d had it. It must have been a couple of years. Which up until then it never ever given me any problems, no problems at all. And to which he went onto the...computer and typed a letter out for me to go up and see the urologist and the… the local hospital. At which…I think it was a week or maybe 10 days later I went up and seen him. And he said that it was penile cancer. Which obviously I’d never heard of penile cancer but he did explain to me after that it was cancer of the penis basically. But they couldn’t really give me… confirm that, due to a biopsy being taken. Of which approximately a couple of weeks after I went back in, they give me a biopsy, took a biopsy off it. And it was confirmed that I’d got penile cancer.
Tim had tests for prostate cancer but he also asked his GP to look at a new growth on the end of...
I started to notice a growth right from the end of my penis. It looked like a sort of tiny wart. So when I went back to see the doctor, talking about the prostate cancer, but those tests had come back negative, but he wanted to do a, an inspection finger up your bum inspection, so I had to do that. And I must admit that was the, that was the start of the sort of nervousness if you like, the first time you have to [hesitation] drop your trousers to the doctor that’s [laughs]. You’re quite, quite embarrassed and you don’t really want to talk about it. And I think perhaps if I hadn’t been going to see him about the blood pressure, I probably would have waited a bit longer before I plucked up the courage. So while he was doing the, the checking the prostate, I just said to him, ‘Look, can I, I think I’ve got another problem, you know on my penis. Can you, can you have a look at that while I’ve, while I’ve got my trousers down?’ So that was, yeah ok, that was another embarrassing moment. I’d got, I’d coped with the finger in the bum, but looking at your penis, I don’t think any man had really seen it [chuckles] ever. So he looked at that and he obviously asked a lot of questions, you know, ‘Do you think it’s sexually transmitted? Have you been playing away or anything? Well, I knew I hadn’t so that was fine enough, but. So his reaction then was, ‘Ok this could be something, something nasty.’
Jims doctor recommended that he visit the local hospital. At the hospital he was tested for...
Wasn’t that terribly concerned but... and left it until January of 2010. At the beginning of January I thought I’d better go to the hospital and have it checked. And my doctor recommended me to the local hospital where they tested me for various sexual diseases and it was none of those. They couldn’t work out what it was and sent me to another local hospital to the urology department and a specialist had a look at me. This specialist suggested that it may be cancer and that he had to take a biopsy. I was asked in at the beginning of February, which was about 3 weeks later, for this biopsy and it came back malignant.
Mark went to A&E where a lady examined him. He was examined by five or six people during his visit.
And I jumped in the car and got myself ready for work, and I drove to the local hospital. And admitted myself into A&E. Explained to the lady at the back of the counter what the problem was, to the best that I knew. And I’d also grown a lump, had grown to the base of the penis as well. But that had only been a fairly recent thing. That had happened maybe two or three days before. And… I spoke to the lady, I’d no sooner made my way back to find a seat and they actually called me over. And by this time I just wanted to know, I wasn’t bothered about, undressing, I wasn’t bothered about anything, I just wanted somebody to have a look. The lady asked me to drop me trousers and me underpants. Quickly, or relatively quickly, inspected me. I was there maybe two minutes, no more. And I’m very upset and I’m very emotional and I want to know what’s going on but she didn’t have any definitive answers at all. She said just to try and keep myself calm. And I said I’ll have to try and go to the toilet. And I actually went in there for about 25 minutes, and managed, to maybe half empty, or three quarter empty, which gave me a bit of relief. But the pain was still awful. I went and sat down again, and I was called up. I forget the timescale but I was called up into the, like 7th or 8th floor of the local hospital. And I was sat down in this room, on my own. And assured that somebody would be coming to inspect me, have a look at me. And over the course of the next... five, I was there altogether about nine hours- over the course of the next four hours, I was inspected by five or six people.
About six weeks after seeing his doctor, Tim went to see a consultant. The consultant looked at...
And from that point, yes, while I was waiting to see the consultant, yes the symptoms were getting, were getting worse. Yeah, I was dribbling. I was leaking a bit more than, after weeing. It was starting getting a bit embarrassing. Then yeah, so we got to see the consultant in the end and again that was eh about six weeks after I’d seen the doctor. So it was a fairly quick appointment. And you start to think, ‘Ok, if I’m seeing the consultant this quickly, you know, perhaps it is something really serious, because you’re quite used to hearing tales of, you know, you see a consultant in eight months’ time or nine months’ time. So you got to see one in that time, you, they obviously think there’s something going on. So I got to see him, he was very nice, very pleasant. Had a look and he had a lot of prodding and poking around. I suppose, yeah, by that time I was starting to get used to people prodding me down there, so... He was very chatty, very helpful, and he said, ‘Right, I think there is something that we need to look at. It’s probably nothing, but you do realise we’re talking about penile cancer here.’ And he said, ‘Oh, oh there’s just a very slim chance.’ And I said, ‘OK, what sort of chance is it?’ And he said, ‘10%.’ And to me that suddenly started to sound much more than a slim chance. It started to be serious. And there was definite chance there.
Ok, so having seen the consultant, he’s referred me for a biopsy, and again said, ‘Look, I’m going to book you into hospital for a biopsy and if you don’t get the appointment within a month, ring me, and I will make sure it’s done.’ So, again that’s another, another danger sign, isn’t it, that something definite coming [chuckles]. Again, you, you book in for a minor operation and if it’s not urgent, six months is not unusual, is it to wait? If you’ve got to have it in a month, it’s urgent. The consultant wants to know. So then we went in, yeah, we got the appointment, about oh, again about a month or so after that. And so it’s about – so we’re talking about, just about a year ago now. I went in for the biopsy. And then, that operation was fairly ok. And that was when I first got used to, sort of, the nurses prodding me around, putting catheters in and out, and things like that yeah… So one of the funny stories was when you to have, I went to have the biopsy and came home for a couple of days with a catheter in and had to go back a few days later to have it taken out, and the nurse who took it out turned out to be one of my former pupils. I last saw her at the age of fourteen sitting in my maths class and there she was trying to… and she goes, ‘Hello, I know you [chuckles]. I’m going to take your catheter out. I always enjoyed your lessons though.’ And I was very relieved to hear that because the, because the yeah, because the consequences if she’d wanted to take revenge there, she’d got a great opportunity. But Ok, I mean that was probably the way I coped with it as well at that stage was to, was to you know see the funny side, look at it and face it head on, I think.
Frosty found it a bit strange having health professionals examine his penis, but he got used to...
Well it was a bit strange to start with because the first doctor I saw other than my doctor at the hospital was a male then his superior was a female and her superior was a female …The first one, I wouldn’t say I felt uncomfortable, I would just say I wasn’t comfortable. Second one I couldn’t really, you know, worry about it and by the time I’d got to see the top person in the hospital in [city] where I had the operation, it didn’t worry me in the least because you’re the only person when I say worried about it, or think, and to put it crudely they’ve seen hundreds and hundreds of men in all shapes and sizes well before your good self and …I made the joke when I was in hospital after I had the second op that I said even the cleaning ladies have seen all my bits, I don’t really care anymore now! [Laughs]. And you don’t you know it’s, you know, we’re all human, we’ve all got them, you know, it’s not something that you, you, I worry about. Funnily enough it did prior to that if you’d have asked me three or four months before I found out I had cancer I probably would have told you a completely different story, but you know, the actual fact of having it makes what anybody can do more important than people looking at you if you know what I mean.
Frank Z had no objection to health professionals seeing his groin; he feels men shouldnt fear this because the most important thing is to get well.
All through the time I’ve been going to the hospital I’ve had no objection to anybody seeing my groin or working on my groin area. In 99.9 it’s all been done by female nursing staff of different grades. My consultant, he kept initially having a look and giving his advice to his nursing staff what has got to be undertaken. But I had no problem with anything like that. And people shouldn’t fear anything like that because as I say the main thing you should consider is getting yourself well.
John did not mind nursing staff seeing his penis; he used humour to overcome any potential...
How did you feel about people observing your penis like that?
[Laughs] Oh I had I had quite a joke with the nurses and the staff. I you know to this day it... with nursing staff it doesn’t embarrass me at all, you know. But with obviously nobody else sees it but with nursing staff I mean you know that’s it, you know …So I was not embarrassed at all, you know. I have to strip down and that’s it, you know. And it was sometimes a lady medical assistant doing it. It was sometimes... well it was mainly they were the one that did the treatment of course. The district nurses we just had a great... honestly we had a great laugh because I had a dressing which had to be removed and it was it was wrapped round something which itself was very mobile and we had to work out how to you know... and we’d have a good laugh about it, you know so… no I was not embarrassed. I can’t explain why but I was not. I mean they were part of my process of … So there wasn’t any embarrassment. It’s all to do with how people react to you in the way in the way that you’re being treated I think.
Rodger had no worries about students looking at his body, he felt that the only way for them to...
How did you feel about letting students look at that area of your body?
I’ve no worries at all because at the end of the day... people have got to learn and the only way of learning is by seeing it in the field.. in the hospital it was the same, when they came...
...round on the next day after the operation... he had students with him and they all inspected me and muttered. It doesn’t worry me now, it’s not a thing that has ever worried me in a sense, alright I’m not an exhibitionist (chuckles), yer know, you’ve seen one you’ve seen them all I should imagine, that was the comment that the nurse said when she took the dressing off, she said, ‘You do realise I’ve got a job in a million’ so I said, ‘Why, why is that?’ she said, ‘It’s not every day you’ll be able to get hold of a man’s penis as part of the job!’ and I laughed and she laughed and when I came out the room where she was taking the dressing off everybody outside who was with me said, ‘What was going off in there? You were having a laugh and a joke!’ so I said ‘I’ll tell you later.’ But it was light-hearted... from everybody’s point of view really, on that side.
One of Johns consultants suggested that he undergo a circumcision: this revealed a red patch on...
And then for some reason they decided to do... my foreskin was tight and that was a thing I’d always known from a kid and it didn’t impair my love life or anything but, and I wasn’t the sort of person, you know you hear of these doctors on the radio saying “check yourself everyday”, I wasn’t the sort of person that used to look at my foreskin and see if it was alright but it was a fact that it was slightly difficult to pull it back. And, so one of the consultants, and the great thing about the National Health is you have all these people on it, all these different people, students, consultants, all these different people, so you’re getting people, all these people from different angles are thinking of ways to go forward, which I’ve always found brilliant actually and so you do, it’s a scatter approach so you do, you never know – there’s always hope in that I’ve found. And somebody came up with the idea that we should do – “maybe that’s the problem, let’s do a circumcision” and then they did a circumcision, a little bit, partial circumcision it’s called, so, and that revealed on the gland of my penis that the primary source was the cancer and you could see it. It was like a little patch of redness and it definitely didn’t look, it didn’t look good – you thought ‘oh that’s trouble.’ And then they thought ‘that’s it’.
- Incisional biopsy – Removal of a small piece of tissue from the affected area.
- Excisional biopsy – Removal of the whole of the affected area.
- Fine needle aspiration – Insertion of a fine needle into the penis through which a fluid sample is sucked up. This technique can be used to examine lumps that some men have in their groins.
Toms dermatologist told him that he had more than a rash but he couldnt diagnose it without...
Immediately I saw the dermatologist he immediately said, ‘I think there is something more than just a rash or inflammation. Ah, I can’t really diagnose it without, ah doing a small biopsy on it,’ and so he decided that he would do it himself, a few days later, so that was done and after that we had – my wife and I attended, ah his clinic and he informed us that there was in fact traces of cancer there and he would then immediately forward us to the urology department of the hospital where I was actually being seen in at that point in time and he personally conducted acro... us across the hospital and the urologist was involved and they decided more or less instantaneously that they would do an operation.
Jordon went in to have his biopsy at 7am as a day case; the operation was performed under a general anaesthetic. After the operation there was discomfort, but no pain.
Could you just talk me through the process of having the biopsy?
Right, it was a day as an outpatient. Went in there at 7 o’clock in the morning. Ah, nothing to eat the night before. Pre-med, went in, it was a general anaesthetic obviously. And so it was, it was a proper operation. When I woke up I had a catheter in the end of my penis which was very uncomfortable. But I was out of hospital by the end of the day, at 8 o’clock at night. And… there was just a little stitch in there, so it was not a problem. And once the catheter came out, I could sort of urinate ok, so it didn’t seem like a problem at all. They took a tiny little bit of the lump and a bit off next to it from the good skin as well, so that they could compare it. Then… went on holiday with a daughter in Spain for a couple of weeks. And then, had the appointment to go back and then, they sort of dropped the bombshell so.
Was there any pain associated with the biopsy?
No, no it was really good, really very, very good indeed. They gave me painkillers obviously, but just a bit of general discomfort but certainly not pain. It was more of a worry because as I say I’d not been in hospital before and the big worry of course are they going to find anything that’s much worse than it looks. So, voilà anything can be worse than cancer of the penis, worse than it looks, I don’t know, so that’s a bit of a contradictory in terms.
Steve had a pinch taken out of his penis without anaesthetic; he found it quite painful, but was...
Well he took… a pinch out the end of my penis where the sore was and it was quite painful. And me being me, I’ve... I thought it was funny at the same time. So … the nurses and the doctor thought it was funny that I could sit there laugh about it [chuckles]. It did become… I thought it was comical. That I‘m sitting there, they’re taking a nip out the end of my dick [chuckles] to do a test on. They were good people, they done the job, sorted it out.
Did you have any anaesthetic at that point?
No, no ‘cause, because I had to have it done… he wanted it done straight away. There was no chance for any anaesthetic or anything like that. They just said they was going to do it…so they could results quick.
Frank was told that he must have a biopsy to confirm it was cancer. The biopsy was quite painful...
The next thing he said was that, “You must have a biopsy.” And that was arranged and again within a very short space of time I went back into hospital and had a biopsy in order to confirm that there was an infection and very probably that it was a cancer. The biopsy was quite painful actually and it meant that I had to stop in hospital overnight. It was almost a mini operation. I came out and within two days the results came through and yes, I had been confirmed as having penile cancer.
Simon didnt expect so much of his penis to be taken away when he had a biopsy performed.
And he said, ‘We’ll do they oper... I’ll do’ what, I forget what they call it, when they cut a bit off …n ah, they’ll do a biopsy you see. So I hung about till half past seven at night in this hospital and expecting this biopsy. Next minute I was whisked in and I had my, half my penis removed totally, and by a local anaesthetic.
After receiving a diagnosis of penile cancer, Tim was given an appointment for an MRI scan.
Having had the diagnosis from the consultant, the next stage was waiting for the – was another appointment back at the hospital, booking in for an MRI scan, going through pre-medical things, and that’s the point at which I felt I was really in the medical system, that I was under their care so the disease was under their care. So that wasn’t really my problem. I had to go through it. I’d just turn up to the appointments, and a lot of interesting appointments – the MRI scan and such. And also that’s the point I learnt then that penile cancer was quite rare. And the nurses and the doctors were also quite interested. And I found that actually having something rare felt, I always felt I was getting sort of special attention. They were all, they were all interested in what they were doing. They were all – it wasn’t the routine appointment for them. So, yeh I started to feel quite special actually in that way [chuckles]. So ok, so we had the MRI scan. We had to go back for the results of those.
On the day of his operation, Tim had a radioactive trace on his lymph nodes to find which nodes...
The actual operation day, the operation was timed for the afternoon. But they wanted me in the hospital early in the morning because they were going to do a radioactive trace on my lymph nodes. So rather than, rather than take all the lymph nodes out, they were going to just find the ones that were going to be affected on those. So I had to be in the hospital ready to go at 8 o’clock in the morning, which was – which meant a very early start. And again at that stage it was quite fun because I had to go around and find the department of nuclear medicine and told all my friends that’s where I was going, where I was going to be, and that sounds really impressive. So that went, that went through, I had to have that scan early in the morning, and then it was off to the opera – off to the, off to check in for the actual operation.
After his lymph nodes were removed John had small samples taken to see if there was any evidence...
Then they said, ‘Well since the lymph nodes have gone now we’ve now got to check whether they’ve spread to your main system’. Now that was something that hadn’t been mentioned initially. But they then said, ‘If it’s at the main system then we have all kinds of possible problems because once it’s got there, it can go anywhere in your body’. So, you know, then I just accept that. I thought if it’s going to happen it... it will happen. Again my faith sort of said, ‘Well I’ll be looked after’. And… it was done at... well they had a special I think they used micro-surgery and they removed samples and there was no evidence in my in my system whatsoever. So therefore as far as they were concerned it was clear. But then I had to be referred to the another specialist who looked after radiotherapy. Because paralleling this they found that my PSA [chuckles] was higher than… so they suspected that I had prostate cancer. That suspicion has been verified with another [chuckles] another biopsy. But you know I smile but these all went on very quickly the whole thing was done.
After his operation, Jim returned to his doctor at frequent intervals to have ultrasound scans...
After the operation I’ve been seen by the doctor at frequent intervals. Basically every three, four months. And also have had been receiving ultrasound scans to confirm that everything is okay. The doctor has been checking the various the two lymph glands in the groin area. And the ultrasound scans have confirmed that everything has been fine. I do have some lumps on my right lymph gland but they have been determined to be fatty lumps as opposed to anything to do with cancer. And up until now the everything has been clear. So this is approximately 18 months after the operation.
Peter was followed up for 18 months after treatment, when a scan showed a recurrence in the lymph...
After the initial procedure … life got back to more or less what it normally is. Keep going for the scans and every scan you got and it was clear, it was like ‘oh, I’ve scored a goal, I’m past that part there.’
And eventually I got to 18 months and my consultant said, “You’re doing very good” he says, “Usually if we don’t get any more reoccurrences at the eighteen month period.” So the next scan after that imagine my surprise when he turned round and said, “It’s come back.” Well I was shattered. And I turned round and I telled the wife and I says, “I don’t know what’s going to happen this time.” I says, “It’s come back and I don’t know where it’s come back.” And while the doc… the consultant did say it was at the lymph nodes in my groin and he told me the left hand side was full of cancer, but the right hand side was clear. But he would do a procedure where he removed the lymph nodes on either side because eventually it would travel to the other side.
Last reviewed July 2017.
Last updated January 2015.