Profile of patients with penile cancer in the region with the highest worldwide incidence

Abstract

To determine the epidemiological, histopathological, and clinical characteristics of patients diagnosed with penile cancer in the Brazilian state of Maranhão, the region with the highest incidence worldwide. One hundred and sixteen penile cancer patients were interviewed from July 2016 to October 2018. The majority of patients lived in a rural area (57%), worked in farming (58%), had a low level of schooling or no schooling (90%), and were married or in a stable relationship (74%). The mean age was 60.4 ± 16.51 years (range, 23-93 years). Phimosis (66%), poor/moderate genital hygiene (73%), history of sexually transmitted infections (55%), and zoophilia (60%) were found in the majority of patients. Most patients had their first sexual encounter at 16.2 ± 2.8 years (range, 10-25 years), and 75% had >6 sexual partners. The most common initial symptom was pruritus (37%), and most patients waited to seek treatment (average time to treatment, 18.9 months; range, 2-84 months). Human papillomavirus (HPV)-related histologies were observed in 62% of patients. Most patients had histological grades II or III (87%), stage ≥T2 disease (84%), and lymphadenopathy at admission (42%). Penectomy was performed in 96% of patients. The population with penile cancer in the region of highest incidence in the world is marked by low socioeconomic status, high prevalence of HPV infection, and phimosis. The delay in seeking treatment is related to a very high rate of advanced cancer and aggressive surgical treatment. The high prevalence of young patients was also a striking feature.Penile cancer is uncommon in developed countries, and its incidence varies according to the demographic region and the circumcision status 1,2 . In the US and Europe, the age-standardized incidence rate (ASR) for 100,000 inhabitants is between 0.1 and 1.0 3 . However, in less developed countries, including some countries in South America, Asia, and Africa, the incidence is alarmingly high 1 . In uncircumcised males, the cumulative lifetime risk for cancer of the penis is higher compared to the general population, corresponding to 1 in 600 men in the US 2 . Brazil has a high incidence, and the state of Maranhão, located in the northeastern region of the country, has the highest incidence of penile cancer in the world (ASR of 6.1 cases per 100,000 inhabitants) 4 .The etiology of penile carcinoma remains unknown, and its mechanisms of development have not been completely elucidated. Phimosis, balanitis, smegma, precarious genital hygiene, smoking, history of sexually transmitted infections (STIs), and human papilloma virus (HPV) infection (present in approximately 50% of cases) are the main risk factors, and circumcision is an important protective factor 5-8 . Its incidence is higher in regions History of STIs 55 (40/73) Sexual history Age of first sexual encounter [mean (range)] 16.2 years (10-25 years) Zoophilia 60 (43/72) No. female partners Less than 6 25 (19/75) Between 6 and 10 17 (13/75) More than 10 58 (43/75) Duration of symptom [mean (range)] 18.9 months ...

Genomic profiling reveals the pivotal role of hrHPV driving copy number and gene expression alterations, including mRNA downregulation of TP53 and RB1 in penile cancer

“…The main risk factors are lack of proper hygiene, phimosis, and uncircumcision 1,2 . Brazil still continues to present one of the highest rates of PeCa 3 and recently a high incidence of advanced tumors among young individuals was reported in Maranhão State, localized in the Northeast of the country 4,5 …”

“…1,2 Brazil still continues to present one of the highest rates of PeCa 3 and recently a high incidence of advanced tumors among young individuals was reported in Maranhão State, localized in the Northeast of the country. 4,5 Despite the recent increase of studies on PeCa, there are significant gaps in the knowledge of the molecular basis of penile tumorigenesis, mainly due to the low number of cases in developed countries, especially the ones associated with human papillomavirus (HPV) infection. A few numbers of studies have performed PeCa genomic profiling by array comparative genomic hybridization (aCGH), describing copy number alterations (CNAs), and their potential prognostic values in association with HPV infection.…”

A cohort study among 402 patients with penile cancer in Maranhão, Northeast Brazil with the highest worldwide incidence

“…The state of Maranhão—Northeastern Brazil–has the highest reported incidence of cancer of the penis (6.1 cases/100,000 ASR) and this fact is due to the high prevalence of risk factors in this region [ 4 ]. Maranhão is a poor state with highest prevalence of HPV infection in the country and has high rates of phimosis among the male population [ 5 , 6 ]. Penile cancer is a poorly studied topic compared to other more prevalent neoplasms, and few studies have been published on the population of the state of Maranhão.…”

“…Few advances have been made in the management of penile neoplasia in recent years, and this study also aims to provide theoretical ground for further research of the diagnosis and treatment of this condition. Part of the data obtained in this study was used in three previously published studies [ 4 , 5 , 7 ], addressing the epidemiological and histopathological profile of penile cancer in Maranhão, as well as immunohistochemical analyzes related to the presence of HPV and of the p16INK4a protein in this sample.…”

Distinct Patterns of Myeloid Cell Infiltration in Patients With hrHPV-Positive and hrHPV-Negative Penile Squamous Cell Carcinoma: The Importance of Assessing Myeloid Cell Densities Within the Spatial Context of the Tumor

“…Penile squamous cell carcinoma (PSCC) is a rare malignancy in developed countries (1,2). However, the incidence of this mutilating disease is steadily rising in Asian, African and Latin American countries, accounting for up to 10% of malignancies in men (2)(3)(4). The prognosis for patients with early stage PSCC is good but worsens with the presence and extent of lymph node metastases (5).…”