Men need to discuss penile cancer — a bigger killer than testicular

Times

7 days ago

If you asked 100 people to name a cancer, most would probably come up with one of the more common, high-profile types such as breast, bowel, lung, prostate. Indeed, I would wager that cancer of the penis wouldn't even feature — yet it's on my mind this week following indications from a UK trial that immunotherapy can improve survival rates.
The six-year EPIC study, led by the urologist Professor Amit Bahl at University Hospitals Bristol, is ongoing. However, if these initial findings are confirmed, it could offer help to prolong the lives of a significant minority of men with advanced disease, many of whom have left it too late to benefit fully from other treatments. Late presentation is all too common in penile cancer, because men are either unaware of the threat posed by early symptoms or too embarrassed to seek help. Here's what every man should know.
Penile cancer is a rare condition typically not seen until middle age or beyond, but it can develop much sooner. And while it is uncommon compared with other cancers, 1 in 400 men in the UK will develop it at some point in their lives, and it kills more than twice as many people as testicular cancer. Early diagnosis not only improves the chances of a cure, it means treatment can be less invasive and less disfiguring. Or, to put it another way, early presentation may not only save your life, but your penis too. So what signs should you be looking out for?
• Why is the cancer rate surging among the under-50s?
Cancer can develop anywhere on the penis but typically it starts under the foreskin or on the head (glans). Early signs include areas of discolouration — often red or bluish-brown — and a persistent rash or sore that lasts longer than a month. It can also cause bleeding, an abnormal discharge, and an obvious lump, either on the penis itself or, in more advanced cases, in a lymph node in the groin. In some cases it can also tether the foreskin, making it hard to retract.
Fortunately, there are many other possible causes for these symptoms. Colour changes and rashes can develop as a result of infections such as thrush (candida) or inflammatory conditions including lichen sclerosus, balanitis and psoriasis. Bleeding can be a result of trauma, including a torn frenulum (the bit underneath that connects part of the foreskin to the glans) after intercourse. Difficulty retracting the foreskin is often caused by more innocent tightening (phimosis), and lumps in the shaft can sometimes form from scarring caused by Peyronie's disease, a relatively common condition that can lead to bends in the penis when it is erect.
So when you see your GP or specialist, there is a good chance the result won't be as bad as you feared — but that doesn't mean it's OK to put off that appointment. Caught early, penile cancer is relatively easy to treat, with more than 90 per cent of men still alive five years after diagnosis. However, the outlook for men with the most advanced cancer, where it has spread to other parts of the body, is bleak: no men in this group are expected to survive for five years.
• Read more from Dr Mark Porter
The other major advantage of early diagnosis is that often it means treatment is less invasive: the earliest suspicious lesions can be 'burnt' off using lasers or chemotherapy and immunotherapy creams. However the more established and advanced the tumour, the more aggressive the treatment required — ranging from circumcision of the foreskin and/or local excision with skin grafting to amputating the head of the penis (glansectomy), or even total removal (penectomy).
If the penis has to be removed — and this includes the 'root' inside a man — then a new outlet for the bladder is fashioned between the anus and scrotum, which means he will have to sit down to pee. Luckily this should preserve continence because the sphincter and muscles that control urine flow remain intact.
Chemotherapy, radiotherapy and immunotherapy are all treatment options, sometimes given before surgery to shrink tumours and afterwards to reduce the risk of spread or to control cancers that already have spread.
Any man can be affected but some are more at risk than others, including smokers, those infected with the human papillomavirus (HPV, see below), men with a weakened immune system because of an underlying disease such as HIV, and those who have not been circumcised. Circumcision as a child or teenager offers protection against the disease as it reduces exposure to secretions (smegma) produced by the foreskin.
• Read more expert advice on healthy living, fitness and wellbeing
Conversely, an inability to retract the foreskin (phimosis) increases the risk. While often normal in young children (those under three), it affects as many as 1 in 30 men at some point — because it either persists from childhood or develops later in life owing to scarring following infection or trauma. Treatment often involves circumcision.
For more information about penile cancer visit cancerresearchuk.org
• There are more than 150 strains of the human papillomavirus (HPV) and nearly all of us will be exposed to at least one type at some stage, often through sexual contact. • Most infections don't cause significant issues and are cleared by the body, but some can cause problems ranging from tissue overgrowth, as seen in warts and verrucas, to changes that can start the cell on a pathway to cancer.• Strains 16 and 18 are responsible for the majority of penile and cervical cancer cases.• The cervical cancer vaccine, which protects against types 16 and 18, should also reduce the risk of penile cancer because it is now administered to boys and some men. However, more research is needed to determine exactly how much protection it provides.• For more information on the vaccine visit nhs.uk