It was in 2018 when João, a Brazilian pensioner, discovered a wart on his penis. “I wanted to know what it was, so I consulted several doctors.” But they all said it was just excess skin and prescribed me medication,” says the now-63-year-old, who prefers not to see his real name in the newspaper, to the British BBC.
The medications were useless, and the wart continued to grow. João and his wife’s marriage and sexual life deteriorated. He desperately wanted to solve the problem. He went from specialist to specialist for over five years, receiving new medications and ordering new biopsies. But nothing helped. It wasn’t until 2023 that a doctor made the correct diagnosis: penile cancer.
Penile cancer is very rare, which is why many doctors don’t recognize it. However, its frequency and mortality rate are increasing worldwide. Brazil, where João lives, has one of the highest incidence rates, according to recent studies, with 2.1 affected men per 100,000. In Maranhão, Brazil’s poorest state, the incidence is even among the world’s highest, at 6.1 per 100,000 men. Between 2012 and 2022, according to the Brazilian Ministry of Health, 21,000 cases were reported in a population of about 215 million. Over 4,000 affected individuals died from the carcinoma, and more than 6,500 required (partial) amputation, averaging two per day.
Risk of Partial Amputation
The first symptoms are usually a hardening or lesion on the penis that doesn’t heal, possibly accompanied by a strong-smelling discharge. Bleeding and color changes are also common. Early detection of the carcinoma increases the chances of healing, typically resulting in successful surgical removal of the lesion, radiation therapy, and chemotherapy. However, if left untreated, the disease can progress further, eventually necessitating partial or even complete amputation of the penis and possibly other genital parts, such as the testicles.
João also had to have a part amputated. “I was terrified of the operation, but there was no alternative. He reports that after the operation, he felt as if someone had beheaded him. It was a very difficult time. “I could never have imagined something like this; it’s terrible to lose part of your penis.”
A study from 2022 confirms the rising numbers. It examined the geographical differences in the incidence and mortality of penile cancer in 185 countries in 2020, as well as long-term incidence trends in 43 countries from 1973 to 2012. The highest incidence rates were found in Swaziland (7.0 per 100,000), Uganda (4.6 per 100,000), and Botswana (4.4 per 100,000). Low rates were recorded in North Africa, such as in Nigeria and Libya (less than 0.01 per 100,000).
The incidence trends are increasing in 15 out of 40 populations studied, mainly in Europe, for example in Israel, Croatia, Cyprus, and Lithuania. In Germany, the incidence increased by about 50 percent from 1961 to 2012. In the USA, Canada, India, and the Philippines, however, the numbers decreased slightly. According to forecasts, cases will continue to increase, with the incidence expected to be 77 percent higher than it is currently by 2050.
Dangerous HPV Infection
But why are the numbers rising? In all likelihood, one of the main causes is certain types of the Human Papillomavirus (HPV), namely types 16 and 18. The viruses are transmitted during sexual contact and are much better known for causing cervical cancer in women. They can also cause carcinomas in the throat area.
Other risk factors for penile cancer, according to the German Cancer Society, include a narrowing of the foreskin, known as phimosis, which can lead to chronic inflammation, and poor genital hygiene. The society points out that the carcinoma is really extremely rare, with about 800 men per year facing the diagnosis in Germany. For Austria, one can assume that the number of affected individuals is about one-tenth of that, corresponding to the smaller population, at around 80 men per year. Almost all affected individuals are 60 years of age or older.
Preventive measures include using condoms during sexual intercourse and circumcision. Studies show that in societies where most men are circumcised, the incidence is significantly lower. And of course, HPV vaccination makes an important contribution. The strains 16 and 18, which are primarily associated with carcinoma, are included in the vaccine. In Austria, the vaccination is also available for free for everyone up to the age of 30.
Organ-Preserving Surgery
If a carcinoma develops despite preventive measures, early detection is essential to preserve the organ and cure the cancer. Men should immediately see a doctor if they notice skin changes, hardening, or swelling. The German Cancer Society also recommends an annual checkup with a urologist by the age of 45 at the latest. Usually, creams or chemotherapeutic solutions can effectively treat a precursor or superficial early stage.
When possible, surgeons remove deeper tumors while preserving the organ. If a piece still needs to be removed, there are now surgical methods where the organ is largely reconstructed with skin from the thigh or even the oral mucosa, although the penis will usually be somewhat shorter afterward. Reconstruction can even involve a corpora cavernosa prosthesis and skin transplantation in the case of a full amputation.
João is no longer in pain. While awaiting the final results, he remains confident in his current cure. However, “I have to live with a partially amputated penis for the rest of my life.” And that, despite everything, is still a major burden for him.