Carcinoma of the Penis

Carcinoma of the penis is more frequently seen in the treatment centers of Puerto Rico than of the continental United States. The incidence may be linked to racial, cultural, and socio-economic factors. Circumcision at birth has been associated with almost complete absence of this form of cancer; done later in life that procedure may diminish the incidence of the disease, but will not eliminate it. Carcinomas arise from the mucosal lining of the preputial sac, which is covered by modified skin. In contrast to carcinomas in other skin areas, these lesions are almost invariably of the epidermoid type and produce metastases in a significant percentage of cases. Since the penis is a very accessible organ, one is impressed by the fact that the five-year survival for penile cancer can be as low as 16 per cent (Furlong and Uhle, 12). The opinion prevailing in American centers is that the treatment of choice of the primary tumor is surgical ; a number of European centers, however, favor radiation therapy, reserving surgery for radiation failures. The results of amputation are considered superior to those achieved with more conservative procedures, such as limited operations or irradiation. A good number of these patients, however, are young—40 per cent under fifty years in Dean's series (8)—and loss of the penis causes considerable psychic trauma ; suicide may be the final outcome. The objectives of this report are to present the true incidence of cancer of the penis in Puerto Rico and to review the experience with this disease at the Dr. I. González Martínez Oncologic Hospital in San Juan. Specifically, we shall analyze the relation to survival of : macroscopic and microscopic features, the presence of metastases, and the various treatments employed. Material All cases with an unquestionable diagnosis of carcinoma of the penis seen from 1939 to 1960 are included in this study. During that time 277 patients were registered as having carcinoma of the penis. Nineteen cases without histologic proof, in which the clinical course did not show evidence of cancer, were eliminated. Three patients had no biopsy but eventually died of carcinoma of the penis and these cases are included with 255 histologically proved for a total series of 258. Follow-up was achieved by periodic examination or social service information in all but 18 instances. Patients without follow-up at the end of five years were counted as dead for the purpose of determining survival. For determination of survival we have included only those patients seen five or more years ago—216 cases. A partial report on these cases was presented in 1951 by Colón (6). Incidence of Carcinoma of The Penis Ackerman and del Regato (1) report that in some areas of Europe the incidence of carcinoma of the penis is as high as 5 per cent of all cancer in men.