Document Type

Article

Department

Urology

Abstract

Introduction

Penile carcinoma (PC) is a rare tumor, accounting for 0.4-0.6% of all male malignancies. There are remarkable racial and geographic differences in the prevalence of penile cancer. In United States, 1% of all male cancers are penile malignancies, with annual incidence of 1-2 new cases per 100,000 men. In certain areas of South America, Asia and Africa the frequency is as high as 10-20% of all male cancers. Many areas in Asia however, have very low figures; in Taiwan for example it comprised only 0.25% of all male cancers1. Penile carcinoma is most frequent in uncircumcised males than in those circumcised in infancy, for example: Non-Jewish versus Jewish population in the West1,2 and non-Muslim versus Muslim population in India3,4. Circumcision at birth however, does not always protect an individual from developing penile cancer5. Similarly circumcision beyond infancy is also not protective against the development of penile cancer6. PC has also been noted in the scared penile shaft skin following mutilating circumcision7. A strong etiologic association of PC has been found between Human Papilloma Virus (HPV), phimosis, paraphimosis, and balanitis5,8. Data from Asian countries indicates that the risk of PC increases progressively beyond 30 years of age with the peak incidence in the 6-7th decades of life9. Some of the key factors complicating effective management of PC are the frequent delay in establishing the diagnosis, controversy about lymph node dissection and patients wish for penile conservation. The time from the initiation of signs and symptoms till the time the patient presents to a physician is usually prolonged, resulting in rather advanced stage of the primary lesion6 at presentation. This tends to adversely affect the treatment outcome of the disease. In countries with very low incidence of PC, such as Pakistan, an average urologist rarely encounters such cases. Combined with the existing controversies about optimum treatment strategies, it is extremely difficult to develop management guidelines based on local experience. It therefore remains important to report such uncommon cancer cases to enlarge the existing local data. This paper describes 2 cases of PC managed at a university hospital during the last three years. Parameters assessed were clinical presentation, physical examination findings, radiological work up and details of treatment offered. Patients were followed up for long term complications related to cancer treatment and surgical morbidity. Based on personal experience and from review of contemporary literature on the subject protocol for evaluation and treatment in the form of an algorithm is also proposed.

Publication

Journal of the Pakistan Medical Association

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