Hundreds of British men are forced to undergo life-changing surgeries every year because doctors miss the warning signs of penile cancer, experts say.
The disease, which affects about 700 men every year, can be cured if caught early, with little impact on sex life.
But studies show that half of all penile cancers are diagnosed at a late stage — when it’s impossible to save the organ. And a fifth of patients die from the disease.
The cancer is often mistaken for a sexually transmitted disease by GPs and sex nurses, as the first symptoms are usually small lesions or red spots.
‘It’s very common for doctors to misdiagnose penile cancer,’ says Arie Parnham, consultant urological surgeon at The Christie NHS Foundation Trust in Manchester, and the UK’s foremost expert on the disease.
‘This is a relatively rare cancer, so most GPs will only see it two or three times in their career. Plus, there are plenty of relatively harmless diseases that lead to red spots on the penis that aren’t cancer, so doctors really need to know what to look for.”
One man diagnosed late with penile cancer is Gavin Brooks, 44, of Crewe, who started showing symptoms in July 2021. The Army officer noticed that the skin around his foreskin was beginning to swell. (He is pictured with his son, Jorje)
Parnham and other urologists are calling on GPs to be better informed about the disease, to reduce the number of late diagnoses. ‘This disease kills men every year, but we never talk about it,’ said Marc Lucky, consultant urologist and surgeon at Aintree University Hospital NHS Foundation Trust in Liverpool.
‘The NHS needs to do more to ensure these patients are diagnosed and treated early.’
Doctors believe there are two main causes of penile cancer. The human papillomavirus (HPV), a sexually transmitted infection that causes a range of other cancers, including cervical cancer, is believed to be the cause of about half of cases.
It is estimated that eight in ten people will be infected with HPV at some point. Normally, the virus lives harmlessly on the skin and mucous membranes of the body – in the mouth and around the genitals – and causes few problems. Eventually, the immune system clears it up. But in rare cases, it can cause changes in cells that become cancerous.
After the introduction of the HPV vaccine in 2008 for teenage girls and in 2019 for boys, experts believe that penile cancer cases will eventually decline as fewer men will be susceptible to the virus.
However, the other half of cases are thought to be caused by damage to the skin. Conditions such as phimosis and lichen sclerosus, which lead to inflammation around the foreskin, can lead to the formation of cancer cells. For this reason, circumcised men are noticeably less likely to develop penile cancer.
Signs of the cancer usually first appear on the top of the penis, as red spots or white raised spots. When caught at this stage, surgery can be performed to remove the cancerous tissue, leaving the organ mostly intact. The longer the disease is left untreated, the more invasive the operation becomes.
One of the most common surgeries to address the cancer is to remove the head of the penis. This is then replaced with a skin graft taken from the thigh.
The disease, which affects about 700 men every year, can be cured if caught early, with little impact on sex life. But studies show that half of all penile cancers are diagnosed at a late stage — when it’s impossible to save the organ. And a fifth of patients die from the disease. (File photo)
“It sounds strange, but it has surprisingly good results,” says Parnham. “If you were in a public shower, no one would notice the difference at a glance.”
This procedure is defined as a ‘penis-preserving’ surgery – meaning the organ is still functional.
But figures show that in many cases the disease is picked up too late. Analysis conducted by Mr Parnham in 2009 found that 47 percent of men with penile cancer were diagnosed late for penile-preserving surgery.
This means that these men had cancer that had spread through the organ, meaning the entire penis had to be removed.
Early diagnosis is also crucial because if the cancer spreads in the groin, it becomes fatal.
‘The average survival rate when the cancer is in the penis is about 90 percent, but if it reaches the pelvis [the bone structure around the groin] that drops to less than 30 percent,” says Parnham.
Experts say some patients delay seeing a doctor because they feel uncomfortable talking about their genitals.
“If you had an untrustworthy mole on your shoulder, you’d ask your friends in the pub what they thought, but if it’s your penis, you’re more likely to keep it to yourself,” says Mr. Lucky. “You wouldn’t believe how many men don’t come forward until their wives say so.”
One man diagnosed late with penile cancer is Gavin Brooks, 44, of Crewe, who started showing symptoms in July 2021. The Army officer noticed that the skin around his foreskin was beginning to swell. “It was like there was a rubber band around it. After a month the swelling had gotten worse. It got really painful and would cut easily.’
Gavin, a single father of two, eventually went to see his GP but was initially told nothing was wrong. ‘He told me it was probably thrush’ [a common yeast infection] and would go away.’
But after a second opinion at a sexual health clinic, he was referred to a urologist who diagnosed cancer. But this didn’t come until December, five months after his symptoms started.
He says the diagnosis came as a shock. “I had never heard of penile cancer,” he says.
Gavin has since had two surgeries and is now on chemotherapy after the cancer had spread to his groin. He says he has to sit down to go to the toilet now because of the magnitude of the operation.
Gavin has set up an Instagram page to raise awareness of the disease and says he hopes more men will come forward sooner if they notice symptoms of penile cancer.
What’s the difference between…sarcoma and carcinoma?
Sarcoma and carcinoma are both types of cancer. A carcinoma develops in cells that line the organs — such as the kidneys, liver, skin, breasts, or prostate — and cavities such as in the chest and abdomen.
Examples include basal cell carcinoma, a common skin cancer, and most breast cancers. About 85 percent of cancers are carcinomas.
Sarcomas are less common. This type of cancer begins in the connective or supportive tissue such as bone, cartilage, fat, muscle, or blood vessels.
Less than one in 100 cancers diagnosed each year are sarcomas. Soft tissue sarcomas usually affect the abdomen, arms or legs.