When a man sees a sore or a spot on his penis, he often thinks the worst. Cancer of the penis is a rare disease in the United States, but since early diagnosis is so important, men should know how to tell whether a spot is worrisome.
Who gets penile cancer?
Only about 1,500 cases are diagnosed in the United States each year, so the disease accounts for less than 1% of all malignancies in American men. But it's much more common in Asia, Africa, and South America, where it constitutes 10%–20% of all male malignancies. There are three explanations for this wide disparity.
Circumcision. Penile cancer is almost unheard of in Jewish males, who are traditionally circumcised on the eighth day of life. It is only slightly more common in Muslims, who often delay circumcision until sometime between the ages of 3 and 13. But circumcision in adulthood is not protective. All in all, circumcision reduces the risk of penile cancer by over 70%, with infant circumcision the most beneficial.
Hygiene. By removing the foreskin, circumcision prevents phimosis, a condition in which the foreskin adheres tightly to the glans, or tip of the penis. If the foreskin cannot be retracted, inflammation and infection can develop and a layer of debris called smegma can build up. Doctors believe that over time, this chronic irritation can lead to cancer. But good hygiene will prevent chronic irritation. In fact, soap and water are nearly as protective as circumcision.
Sexually transmitted infection. In this case, the culprit appears to be the human papilloma virus (HPV), or at least two strains of the critter (HPV-16 and HPV-18). In recent studies, evidence of HPV has been detected in 30%–80% of penile cancers
The disease typically develops between ages 50 and 70. The vast majority of these cancers occur on the tip of the penis. Over 95% are squamous cell cancers, which arise from the skin. At first, it may look like a small area of redness or thickening or sometimes like a small wart. In time, it may burrow into the skin to produce an ulcer that does not heal, or it may pile up to form a warty mass. In advanced cases, a bloody or foul-smelling discharge becomes evident.
A biopsy is the only way to diagnose cancer of the penis. If you see a spot near the tip of your penis, it's safe to wait 2–4 weeks to see if the abnormality clears on its own. If not, see a urologist or dermatologist, who may also watch it for a while before performing a biopsy. If the biopsy shows cancer, the next step is to find out if the disease has spread.
Cancer therapy is rarely pretty, but the traditional treatment for cancer of the penis is particularly distressing: radical penectomy, or amputation. This drastic operation is still necessary for some advanced or recurrent cases, but early disease can often be cured with far less aggressive procedures.
Small, superficial cancers confined to the foreskin can be cured with circumcision. Those on the penis itself can be treated with Mohs micrographic surgery, a technique in which tissues are removed in layers. Laser therapy and radiotherapy have been successful for early to moderate cases. For more advanced or relapsed cases, partial penectomy is preferred to amputation. Chemotherapy is also showing promise.
Penile cancer is hard to treat but easy to prevent. Infant circumcision and good hygiene have a proven ability to prevent cancer. But if prevention fails, early diagnosis is the next best.
December 2005 Update