The Tribune

By DR GREGGORY PINTO

Penile cancer is relatively rare in developed countries, but in some penile cancer could represent as high as 20 percent of all male cancers. In the United States, according to the American Cancer Society, penile cancer affects one in 100,000 men. Prostate cancer has an incidence of one in seven American men in their lifetime.

Penile cancer is often unfortunately diagnosed at an advanced stage with poor survival outcomes. Many men are unaware that penile cancer exists and they often ignore signs and symptoms due to embarrassment and fear.

Penile cancer most commonly takes the form of squamous cell carcinoma but rarer types such as verrucous carcinoma, melanoma, carcinoma in situ, basal cell carcinoma, adenocarcinoma and sarcoma of the penis are possible.

1. What are the risk factors for penile cancer?

Circumcision significantly reduces the risk for penile cancer, and the rate of penile cancer in circumcised men is exceedingly low.

Human papilloma virus (HPV) exposure is a very strong risk factor in developing penile cancer, with 30 to 50 percent of penile cancer patients being positive for HPV.

The inner surface of the male penile foreskin has receptors that greatly enhance the transmission of all sexually transmitted diseases including HPV and human immunodeficiency virus (HIV).

A recent systematic review of 81 scientific published studies determined that circumcision was an important tool in reducing a woman’s risk for developing cervical cancer, HPV, bacterial vaginosis and the sexually transmitted disease Trichomonas vaginalis. The evidence for circumcisions being effective in reducing syphilis and chlamydia is mixed but promising, but there is no evidence that it reduces gonorrhea transmission.

HPV vaccines are readily available to males and females and they lower the risk of acquiring certain types of HPV.

2. Age is a risk factor

The majority of men who developed penile cancer are over the age of 60 years old and are uncircumcised. Young men rarely develop penile cancer.

3. Signs and symptoms of penile cancer

Penile cancer may present as painless penile warts or lesions. The lesions may appear as red flat lesions of the head of the penis or anywhere along the shaft or penile foreskin. Infected lesions or non-healing ulcers associated with sexually transmitted diseases may be painful. Advanced penile cancer could lead to groin masses and metastatic spread throughout the body and often urinary obstruction due to invasion of the urethra.

Signs and symptoms of penile cancer may also include a foul smelling penile discharge, thickening of the penile skin, bleeding from beneath the foreskin, penile skin changes and blue-brown penile growths.

4. Phimosis is a risk factor

Phimosis is the inability to fully retract the penile foreskin. Men with phimosis usually present with a tight band of foreskin around the glans/head of the penis.

Other risk factors include chronic poor penile hygiene, multiple sexual partners, ultraviolet treatment for the skin condition psoriasis and tobacco use.

5. Treatment options

Sadly, many penile cancers are advanced at the time of presentation, and require a partial amputation of complete penectomy amputation of the penis.

Confirmation of penile cancer is first made by having a surgical biopsy. Very early diagnosed penile cancer may be treated by laser therapy, cryotherapy involving freezing off the penile cancer, use of topical chemotherapy agents or Moh’s surgery, which is removal of the affected area of penile skin.

A total penectomy requires the creation of a perineal urethrostomy, an opening in the urethra to pee in the perineum, which is the area located between the anus and the scrotal sac. A neo-phallus may be created in an extensive surgical procedure, creating a new penis often from the muscles of the forearm.

More advanced cases of penile cancer often require removal of lymph nodes, radiation and chemotherapy.

Early detection leads to superior cure rates. Stage 1 and 2 penile cancer has an 85 percent penile cancer specific survival rate at five years.

The five-year survival rate for advanced stage 4 penile cancer is only 11 percent.

Any changes in the appearance or feel of the penis, should warrant urgent urologist attention.

A man is never too old for a circumcision, which is a relatively quick outpatient procedure with minimal to no recovery time required and there are multiple potential health benefits to having a circumcision.

Pre-pubertal boys and girls and up to younger adult men and women are encouraged to receive the HPV vaccine which can significantly lower cervical cancer rates in women and penile cancer rates in men and reduce anal cancer rates in both men and women.

Seek confidential, comprehensive and compassionate urological care.

• Dr Greggory Pinto is a Bahamian urologist and laparoscopic surgeon who has trained in South Africa, Germany and France. He is a member of the European Association of urologists. He can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, Collins Avenue and Sixth Terrace. Call (242 )326-1929; e-mail welcome@urologycarebahamas.com, or visit the website www.urologycarebahamas.com.