Penile Cancer: Amputations Rise in Brazil – Symptoms & Prevention
A preventable disease, penile cancer, is projected to result in 2,900 amputations and 2,300 deaths in Brazil between 2021 and 2025, according to data from the Ministry of Health (MS) analysed by the Brazilian Society of Urology (SBU).
A Concerning Trend
The SBU identifies a lack of information and existing societal stigmas as primary obstacles to prevention. Preventative measures include proper hygiene, vaccination against the Human Papillomavirus (HPV), and surgical correction of phimosis, known as postectomy.
Early Detection is Key
According to Roni de Carvalho Fernandes, president of the SBU, initial signs are often localized and may not cause pain. These can include sores or ulcers on the penis that do not heal, changes in skin colour – becoming reddish, whitish, or darker – particularly on the prepuce or glans, skin thickening, nodules, and secretions with a strong odor under the prepuce. Bleeding can also occur.
In advanced stages, patients may experience pain and enlarged lymph nodes in the groin.
What Causes Penile Cancer?
The disease stems from a chronic infection of the prepuce, initially presenting as a non-healing wound that develops into a severe ulcer or lesion. Poor hygiene, allowing fungi and bacteria to proliferate, is a common contributing factor. Daily hygiene, including retracting the prepuce to expose the glans and washing with soap and water, is recommended.
Phimosis, a condition hindering glans exposure, increases risk, and surgical removal of the prepuce (postectomy) can facilitate hygiene.
HPV infection, a sexually transmitted virus also linked to cervical cancer in women, can also lead to penile cancer. Protection includes using condoms and vaccination – available through the SUS for individuals aged 9-14 and immunocompromised individuals up to age 45.
Diagnosis and Treatment Options
Early-stage penile cancer has a high cure rate and can be treated less aggressively. When the tumor is confined to superficial skin layers, only the affected area may need removal, avoiding amputation.
Amputation is reserved for extreme cases, potentially partial or total, requiring uretra repositioning to the perineum, resulting in seated urination. This can present daily challenges and impact self-esteem.
Diagnosis relies on a physical exam by a urologist, a review of the patient’s medical history – including hygiene practices, phimosis, smoking habits, and HPV infection – and a biopsy to confirm tumor presence.
Regional Disparities
São Paulo recorded the highest number of amputations with 542 procedures, followed by Minas Gerais (476) and Rio de Janeiro (442). While the Southeast region accounts for the largest absolute numbers, the SBU emphasizes the need for increased attention to the North and Northeast regions.
These regions face greater challenges due to socioeconomic vulnerability, limited access to specialized healthcare, inadequate hygiene practices, a high prevalence of untreated phimosis, increased HPV exposure, and a lack of health information, leading to delayed care-seeking.
Frequently Asked Questions
What are the initial symptoms of penile cancer?
Initial symptoms include sores or ulcers that don’t heal, changes in skin colour, skin thickening, nodules, secretions with a strong odor, and bleeding.
How is penile cancer prevented?
Prevention involves proper hygiene, HPV vaccination, and surgical correction of phimosis (postectomy).
What happens if amputation is necessary?
Amputation may be partial or total, and the urethra is repositioned to the perineum, requiring the patient to urinate while seated.
Considering the preventable nature of this disease and the potential for life-altering outcomes, what steps can be taken to improve awareness and access to preventative care for men in affected regions?