Malignancies of the Penis and Urethra

Abstract

Carcinoma of the penis is an uncommon malignancy in the United States. It accounts for less than 1% of all male cancers in America, but it accounts for 10-20% of male malignancies in countries with poor genital hygiene or where neonatal circumcision is rare (1,2). This circumstantial evidence reinforces a belief that neonatal circumcision is protective for the development of squamous cell carcinoma of the penis, and indeed, reports of this disorder in males who were circumcised during the neonatal period are rare. Over the past 20 yr, however, more reports have surfaced indicating that penile cancer is not fully prevented by neonatal circumcision, although its risk is reduced by a factor of between 3.0 and 3.2 (3,4). Other factors that contribute to an increased risk of carcinoma of the penis include smoking (risk increased by factor of 2.8), longstanding phimosis (3.5), chronic balanitis or penile rash or tear (3.9-9.4), a history of human papilloma virus (HPV) infection (5.9), and a history of multiple sexual partners (2.8) (3,5). Clearly, some risk factors overlap with the absence of neonatal circumcision. For example, phimosis and chronic balanitis are virtually never seen in circumcised males, and circumcision provides at least some protection against infection by sexually transmitted diseases, including HPV (6,7).