Penile carcinoma is an aggressive disease with significant treatment-associated psychosexual morbidity. For this reason, despite local control rates greater than 90% with radical surgical approaches, several organ-preserving treatments have been described during the past 30 years. Conservative surgery, Mohs micrographic surgery, radiotherapy, laser ablation and chemotherapy have been frequently used in order to interfere as little as possible with functional anatomy without compromising local cancer control. The aim of this article is to provide an overview of the current concepts of these organ-preserving procedures for penile cancer, and describe some of their indications, results and associated complications.