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Stage 4

The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor plan the best treatment for you.

Stage 4 is part of the number staging system and means one of the following:

  • The cancer has grown into a body part near the penis such as the prostate gland. It may or may not have spread to any lymph nodes. It hasn't spread to tissues or organs in other parts of the body.
  • There is cancer in lymph nodes in one or both sides of the pelvis. Or the cancer in a nearby lymph node has grown into surrounding tissues. It hasn’t spread to tissues or organs in other parts of the body.
  • The cancer might have spread into lymph nodes and it has spread to tissues and organs in other parts of the body, such as the liver, lungs or bones.

In the TNM staging system stage 4 penile cancer is the same as:

  • T4, Any N, M0
  • Any T, N3, M0
  • Any T, Any N, M1


The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions that you have

Treatment for stage 4 penile cancer depends on the area of the body that the cancer has spread to.

Cancer in nearby tissues

For cancers that have spread into nearby tissues, such as the prostate, bladder, scrotum, or abdominal wall, you usually have surgery. You might need to have the whole penis and other affected areas removed. Your surgeon will talk you through the operation and explain what this involves. They make a new opening in the abdomen or the perineum (area between the scrotum and anus) so you can pass urine this way.

Some people have chemotherapy, sometimes with radiotherapy, before surgery to shrink the tumour and make it easier to remove. Your surgeon removes the lymph nodes in your groin (inguinal nodes) on both sides. Afterwards, you might also have radiotherapy to that area, unless you had it before surgery.

Cancer beyond nearby lymph nodes or in pelvic lymph nodes

You usually have surgery if the cancer has spread into the nearby lymph nodes and surrounding tissues or to lymph nodes in the pelvis. The surgeon removes the whole penis and the lymph nodes in the groin on both sides. They remove the lymph nodes inside the pelvis if they are enlarged or feel hard.

You might have radiotherapy to the lymph node areas to try to kill any cancer cells that might be left behind. Some people also have chemotherapy.

Cancer in distant organs or tissues

Surgery or radiotherapy can't completely get rid of a cancer that has spread to distant organs and tissues. Treatment aims to keep the cancer under control and prevent or relieve symptoms. You might have surgery to remove as much of the cancer in the penis as possible. Or you might have radiotherapy to shrink the cancer. 

You might have surgery or radiotherapy (sometimes with chemotherapy) to treat lymph nodes close to the penis. Radiotherapy may also help to treat areas of cancer in other parts of the body, such as the bones, brain or spinal cord. Chemotherapy can help to treat cancer that has spread to the lungs or liver. 

Other stages

Last reviewed: 
04 Jan 2021
Next review due: 
04 Jan 2024
  • American Joint Committee on Cancer (AJCC) Manual (8th edition)

    S Edge and others (editors)

    Springer, 2017

  • Guidelines on Penile Cancer
    OW Hakenberg and others
    European Association of Urology (EAU), 2016

  • Cancer Principles and Practice of Oncology (11th Edition)

    VT DeVita, TS Lawrence and SA Rosenberg

    Wolters Kluwer, 2019