Background: Penile cancer may cause significant morbidities to those who are treated with aggressive surgery. Conversely, there has been no improvement in penile cancer survival rates since 1990. While the causes for this stagnation may be multifactorial, one potential cause is undertreatment of high-risk disease. This study aimed to examine both the trend in the stage-dependent surgical treatment for penile cancer from 2000 to 2010 and the patterns of possible over and/or undertreatment during this period. Methods: The National Cancer Database (NCDB) Datalinks Portal was queried. Diagnosis by year, first course surgery by stage, in all hospitals from 2000-2010 was first obtained. Data was grouped into no surgery, penile sparing, and radical surgery. Data was also obtained for first course surgery by stage in community hospitals (C), comprehensive centers (CC), and teaching research hospitals (TR), individually. Groups were similar as above, with the exclusion of the no surgery group. Results: There were 1,405 patients with recorded first course surgical treatments in community hospitals, 3,930 in comprehensive hospitals, and 3,667 in teaching research hospitals from 2000 to 2010. Graphically, there has been no change in the trend in the pattern of surgical management of penile cancer from 2000 to 2010 in high or low stage penile cancers. Consistent overtreatment of stage I penile cancer with radical surgery was observed in all hospitals during this period. A variable, but high, percentage of penile-sparing surgery was observed for advanced stages among all hospital types. Conclusions: Corresponding to the stagnation in the survival rates of penile cancer, the surgical management trends ded not change between 2000 and 2010. Contrary to the 2013 National Comprehensive Cancer Network (NCCN) Guidelines, penile-sparing surgery continues to be performed in all types of treating hospitals for higher stage penile cancers, which may represent an undertreatment of potentially fatal penile cancers. Conversely, there was a persistent pattern of overtreatment of stage I penile cancer.