Carcinoma of the penis

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Swathi Venkatesan, M.B.B.S.[2]

Carcinoma of the penis is a malignant growth found on the skin or in the tissues of the penis. Carcinoma of the penis may be classified according to cell types into several subtypes: squamous cell carcinoma, adenocarcinoma, melanoma, basal cell carcinoma, lymphoma, and sarcoma. The incidence of carcinoma of the penis is approximately 1 per 100,000 men in the United States. On gross pathology, scaly patches or nodules, erythematous, and ulceration are characteristic findings of carcinoma of the penis. Common risk factors in the development of carcinoma of the penis are human papillomavirus, phimosis, poor genital hygiene, not being circumcised, weakened immune system, smoking, and treatment for psoriasis. And it is caused by an infection with human papillomavirus. The most common symptoms of carcinoma of the penis include non-healing lesion, change in the colour of the penis, redness or irritation of the penis, lump or thickening of the skin on the penis, phimosis, foul-smelling discharge or bleeding from the penis or from underneath the foreskin, itching or burning under the foreskin, swelling of the penis, lump in the groin, and dysuria. Biopsy is helpful in the diagnosis of carcinoma of the penis. The predominant therapy for carcinoma of the penis is surgical resection. Adjunctive chemotherapy, radiation therapy, and biological therapy may be required. Prognosis is generally good, and the 5-year survival rate of patients with carcinoma of the penis is approximately 67%.

Carcinoma of the penis may be classified according to cell types into several subtypes including, squamous cell carcinoma, adenocarcinoma, melanoma, basal cell carcinoma, lymphoma, sarcoma.

Most types of penile cancer traditionally begin as small lesions, most commonly on the glans or prepuce. About 95% of penile cancers develop from flat, scale-like cells called squamous cells. squamous cell carcinoma (SCC) can develop anywhere on the penis, but most develop on the foreskin (in uncircumcised men) or the glans. This type of cancer is typically slow growing. When found early, it is often curable. On gross pathology, the glans and the foreskin are the most common locations to find scaly patches, nodules, palpable painless lump, erythematous, ulceration, concurrent phimosis may conceal the lesion, surface of the lesion may be exophytic, flat, or ulcerated, chronic penile rash or subtle burning sensation and swollen inguinal lymph nodes as characteristic findings of carcinoma of penis. On microscopic histopathological analysis, keratinization and intercellular bridges are characteristic findings of carcinoma of the penis. Penile cancer arises from precursor lesions, which generally progress from low-grade to high-grade lesions.

The incidence of carcinoma of the penis is approximately 1 per 100,000 males in the United States. The majority of cases are reported in less developed areas. The incidence of penile cancer increases with age; the diagnostic median age usually is 40 – 70 years, median age 58 years. Penile cancer is rare if circumcision is done at birth, and is more common in cases of late circumcision (after age 10). Carcinoma of the penis is more prevalent in populations with lower education and higher poverty. More commonly seen in Hispanic and African American men; familial cases have occasionally been reported.

Common risk factors in the development of carcinoma of the penis include human papillomavirus, phimosis, poor genital hygiene, uncircumcised males, weakened immune system, smoking, and psoralen ultraviolet A (PUVA) therapy treatment for psoriasis.

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for carcinoma of the penis.

Carcinoma of the penis is caused by an infection with human papillomavirus.

Carcinoma of the penis must be differentiated from condyloma acuminata, penile intraepithelial neoplasia (PeIN), balanitis xerotica obliterans, Buschke-Lowenstein tumour, Bowenoid papulosis, leukoplakia.

Prognosis of carcinoma of the penis is generally good, and the 5-year survival rate is approximately 67%. The prognosis varies with the stage of tumor; stages 0–II have the most favorable prognosis.

Carcinoma of the penis may be classified into several subtypes based on TNM system and UICC staging system.

The most common symptoms of carcinoma of the penis include any non-healing lesion, change in the colour of the penis, redness, irritation of the penis, lump, thickening of the skin on the penis, phimosis, foul-smelling discharge, bleeding from the penis or from underneath the foreskin.

Common physical examination findings of carcinoma of the penis include weight loss, pallor, inguinal lymphadenopathy, non-healing ulcer on the penis, mass on the penis, phimosis, skin induration on the penis, change in the colour of the penis, erythema of the penis, foul-smelling discharge, bleeding from the penis or from underneath the foreskin, as well as swelling of the penis.

Some patients with carcinoma of the penis may have elevated concentration of serum calcium, which is usually suggestive of bone metastases.

There are no X-ray findings associated with carcinoma of the penis. X-ray may be performed to detect metastases of penile cancer to lungs and bones.

CT scan may be performed to detect metastases of carcinoma of the penis to surrounding lymph nodes, liver, lungs, and other organs.

MRI may be performed to detect metastases of carcinoma of the penis to brain, spinal cord, and nearby organs and tissues.

Ultrasound may be helpful in the diagnosis of the extent of carcinoma of the penis.

There are no other imaging findings associated with carcinoma of the penis.

There are no other diagnostic study findings associated with carcinoma of the penis.

Biopsy is helpful in the diagnosis of carcinoma of the penis.

The predominant therapy for carcinoma of the penis is surgical resection. Adjunctive chemotherapy, radiation therapy, and biological therapy may be required.

Surgery is the mainstay of treatment for carcinoma of the penis.

Effective measures for the primary prevention of carcinoma of the penis include circumcision, good personal hygiene, and safer sexual practices. Gardasil vaccine is recommended for men to prevent HPV infection.

There are no secondary preventive measures available for carcinoma of the penis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Swathi Venkatesan, M.B.B.S.[2] Sogand Goudarzi, MD [3]

History of Circumcision

• The earliest reference to the circumcision procedure dates back to around 2400 B.C, in Egypt ^[1]
• In the late 1800s, doctors turned to circumcision to “cure” an array of ailments, from childhood fevers to brass poisoning to paralysis
• Lewis Sayre, a professor of orthopedic surgery at Bellevue Hospital Medical College,was called to the bedside of a 5-year-old boy whose knees were flexed and paralyzed, preventing him from walking
• During his examination, Sayre discovered that the boy’s foreskin had contracted, causing the child great pain
• Speculating that the foreskin problem could be the source of the boy’s “physical prostration and nervous exhaustion,” Sayre conducted a circumcision the next day
• In less than two weeks, Sayre reported, the boy was walking again
• South Koreans started to circumcise children during the American trusteeship following World War II ^[2]
• The American cultural practice of circumcision became nearly universal in South Korea after the Korean War of 1950-52

History of HPV relation to Carcinoma of Penis

• In 1965, the first published HPV study characterized its DNA ^[3]
• Prior to 1965, papillomavirus studies focused on rabbit papillomavirus and its association to cancer
• During the 1970’s, more than one type of HPV was recognized
• In 1982, several studies associating HPV type 6 with genital warts, but neither cervical nor penile cancer, were published
• The theory that penile and cervical cancer may have a common etiology was proposed as early as 35 years ago
• Initial studies supported a causal relationship between male sexual behaviors and the incidence of cervical carcinoma before the role of HPV was even recognized

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Swathi Venkatesan, M.B.B.S.[2]

Carcinoma of the penis may be classified according to cell types into several subtypes: squamous cell carcinoma, adenocarcinoma, melanoma, basal cell carcinoma, lymphoma, and sarcoma.

Squamous cell carcinoma^[1][2][3]

• The most common type of penile cancer is squamous cell carcinoma (SCC).

• There are several subtypes of SCC:^[4]

• Warty carcinoma (verruciform) and verrucous carcinoma

• Looks like a genital wart and may have a cauliflower-like appearance
• Usually slow growing, but they gradually enlarge and can spread deeply into surrounding tissue
• Rarely spread to lymph nodes or other parts of the body
• Often associated with human papillomavirus (HPV) infection

• Basaloid carcinoma

• Uncommon type of squamous cell penile cancer^[5]
• Fast growing

• Sarcomatoid carcinoma

• Fast growing

• There are several rare types of penile cancer:

Adenocarcinoma“Penile Cancer: Introduction | Cancer.Net”.

• Develops from sweat glands (glandular cells) in the skin of the penis
• Occurs much less often than SCC
• Also called Paget’s disease of the penis

Melanoma

• Develops from skin cells called melanocytes
• Usually develops on sun-exposed areas of skin, but sometimes develops on the penis

Basal cell carcinoma

• A type of non-melanoma skin cancer
• Slow growing and rarely spreads to other areas of the body

Lymphoma

• A type of cancer that starts in immune cells of the lymphatic system

Sarcoma

• A type of cancer that starts in connective tissues (tissue that surrounds and supports various organs in the body)
• Starts in the connective and supporting tissues of the body
• Tends to be fast growing
• May include AIDS-related Kaposi sarcoma (KS)

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Swathi Venkatesan, M.B.B.S.[2]

On gross pathology, the glans and the foreskin are the most common locations to find scaly patches, nodules, palpable painless lump, erythematous, ulceration, concurrent phimosis may conceal the lesion, surface of the lesion may be exophytic, flat, or ulcerated, chronic penile rash or subtle burning sensation and swollen inguinal lymph nodes as characteristic findings of carcinoma of penis. On microscopic histopathological analysis, keratinization and intercellular bridges are characteristic findings of carcinoma of the penis.

• Penile cancers traditionally begin as small lesions, most commonly on the glans or prepuce ^[1]
• About 95% of penile cancers develop from flat, scale-like cells called squamous cells. squamous cell carcinoma (SCC) can develop anywhere on the penis, but most develop on the foreskin (in uncircumcised men) or the glans. This type of cancer is typically slow growing. When found early, it is often curable
• Penile cancer arises from precursor lesions, which generally progress from low-grade to high-grade lesions

Grossly noted growth patterns include:

1. Superficial spreading: tumors are limited to lamina propria or superficial corpus spongiosum.
   1. Usually extend horizontally through multiple anatomical compartments
2. Vertical growth: tumors invade deep anatomical levels, surface is non-verruciform and frequently ulcerated
3. Verruciform: tumors are exophytic and papillomatous with a cauliflower-like aspect.
   1. May be limited to surface (verrucous) or invade deep anatomical levels (cuniculatum)
4. Mixed patterns: observed in 10 – 15% of all cases

On microscopic histopathological analysis, characteristic findings of carcinoma of the penis include:

• keratinization
• intercellular bridges
• Most histologic subtypes resemble those in vulva, anus or buccal mucosa
• 48 – 65% are squamous cell carcinoma
• Verruciform tumors are verrucous, warty, papillary or cuniculatum carcinomas
• Basaloid and sarcomatoid carcinomas usually have a vertical growth pattern

• Penile malignant lesions and tumors, can be divided into HPV-related and non–HPV-related groups^[2]
• For HPV related penile cancers this sequence is as follows:^[3]

• Squamous hyperplasia
• Low-grade penile intraepithelial neoplasia (PIN)
• High-grade PIN (carcinoma in situ—Bowen’s disease, erythroplasia of Queyrat and bowenoid papulosis (BP))
• Invasive carcinoma of the penis

• Non-HPV related penile squamous cell cancers include:

• SCC usual type/Not Otherwise Specified (NOS)
• Pseudohyperplastic carcinoma
• Pseudoglandular carcinoma
• Verrucous carcinoma
• Carcinoma cuniculatum
• Papillary carcinoma NOS
• Adenosquamous carcinoma
• Sarcomatoid carcinoma

• Tumors with basal and/or warty morphology display HPV more frequently

Grading:

• Grade 1: well differentiated cells, almost undistinguishable from normal squamous cells except for the presence of minimal basal / parabasal cell atypia
• Grade 2: all tumors not fitting into criteria for grade 1 or 3
• Grade 3: any anaplastic cells

HPV-related Penile Carcinoma

• Basaloid SCC
  • Occurs most frequently the glans or the foreskin ^{[4] [5]}
  • Flat ulcerated masses, which are deeply invasive and sometimes necrotic
  • Metastasis is seen in about 50% of cases; lymph nodes most common
  • Closely packed small basophilic cells; mitosis is frequent with central keratinization
  • “Starry sky” like features; displays close features to neuroendocrine tumors
  • p16 positive
  • Hyalinization of the stroma is frequent
  • Local recurrence is high; mortality is high, depends on the extension at time of treatment

• Papillary basaloid carcinoma
  • Rare and affect the glans
  • Hyperparakeratosis and kondylomatous features are frequent ^[6]
  • p16 positive
  • Resemble urothelial carcinomas

• Warty carcinoma
  • Look like condylomas
  • Account for 5–10% of the penile carcinomas
  • Macronodular cauliflower-like appearance
  • Papillae have a dark fibrovascular core that the tumor surrounds with a whitish aspect
  • Pleomorphic koilocytes, hyper and parakeratosis, nuclear pleomorphism, and cellular clarification
  • Individual cell necrosis
  • Carcinomas invading corpus cavernosum and dartos, usually do not display intravascular or perineural invasion
  • Nodal metastasis is seen in <20%
  • The mortality rate is low

• Warty–basaloid carcinoma
  • Shows both warty and basaloid features
  • Present as voluminous masses growing from the glans and foreskin
  • Histologically, these tumors are mixed with a papillomatous warty-like surface and a solid basaloid invasive component
  • p16 is strongly expressed
  • Invasion into deeper structures is frequent, vascular and perineural invasions are frequent
  • More aggressive than their warty counterpart
  • Around 50% will develop lymph node metastasis; 30% will die of disease

• Clear-cell carcinoma
  • Aggressive
  • Occurs as a large mass of the glans and foreskin
  • Tumor develops in sheets
  • Necrosis is frequent
  • Staining of the clear cells is positive for p16
  • Vascular and perineural invasion is frequent
  • Tumor-related mortality is around 20%

• Lymphoepithelioma-like carcinoma
  • Poorly differentiated
  • Tumor growth starts most of the time at the glans and extends to the foreskin
  • More or less circumscribed; sheets with lymphocytic or plasmacytic cells mixed with tumor cells are common
  • p63 and p16 positive
  • Prognosis is adverse; only few cases have been described

Non-HPV related Penile Carcinoma

• SCC usual type/not otherwise specified
  • Exophytic gross appearance
  • Endophytic ulcerated cases
  • A tendency to invade deeply into the penile tissue deeply
  • Two-thirds of patients present inguinal metastasis, and the mortality is about 30%
  • The number of positive lymph nodes is an important prognosticator

• Pseudohyperplastic carcinoma
  • Tumor is an extremely differentiated SCC
  • Mostly associated with lichen sclerosis, and occurs on the foreskin of older patients
  • An association with other histological types is frequent
  • Gross aspects are flat or slightly elevated; multifocality is common
  • Sharp borders, cells are very well differentiated, and peritumoral stroma is absent or minimal
  • No vascular or perineural invasion or metastasis

• Pseudoglandular carcinoma
  • This variant is aggressive with acantholysis and pseudoglandular spaces
  • Patients are younger, around 50 yr of age
  • Distal, irregular, firm, whitish, ulcerated mass
  • Histologically, honeycomb aspects present
  • Filled with necrotic debris.
  • Poorly differentiated and high-grade tumors
  • Lymph node metastases occur in more than two-thirds and the mortality rate is high

• Verrucous carcinoma
  • Accounts for 2-3% of all penile carcinomas
  • Extremely well differentiated with papillomatous aspects;
  • Tumor base is broad and the tumor has borders pushing into the stroma
  • Has a slow evolution and is seen in older patients
  • Frequently associated with lichen sclerosus
  • Grossly, the aspect is exophytic, papillomatous is white to gray, and the interface between tumor and stroma is sharply delineated
  • Shows hyperkeratosis, acanthosis, and papillomatous aspects
  • Tumor does not directly invade the lamina propria, but pushes the borders into deeper tissue, known as invasion
  • Prognosis is good
  • Slowly growing tumor recur in a third of cases, mostly because of underestimation in histology as a benign neoplasm or because of insufficient surgery

• Carcinoma cuniculatum
  • A variant of the verrucous carcinoma and a low-grade carcinoma
  • Men between the age of 70 and 80 yr
  • Most frequently the lesions grow from the glans into the deeper layers to the erectile corpora
  • Tumor is whitish and grey, and deep invaginations are common
  • Histologically well differentiated; no koilocytes are seen
  • No vascular or perineural invasion
  • The invasion is with broad pushing borders; no metastasis can be found

• Papillary carcinoma NOS
  • carcinoma is papillomatous and verruciform
  • No koilocytes
  • Tumor accounts for about 5–8% of penile carcinomas and is usually associated with lichen sclerosus
  • Tumor has a cauliflower-like, whitish aspect that is badly limited
  • Histologically, we see well-differentiated hyperkeratotic lesions
  • Tumors can recur, but mortality and metastasis are rare

• Adenosquamous carcinoma
  • SCCs with mucinous features
  • Also called mucoepidermoid carcinomas
  • Recurrence and lymph node metastasis is seen in up to 50%, but mortality remains low
  • Rare

• Sarcomatoid SCC
  • The most aggressive neoplasm of penis
  • Focal squamous differentiation is seen
  • Spindle cell component should be present in at least 30%
  • Masses are slowly growing and frequently ulcerated
  • Recurrence and regional or systemic metastases are possible
  • Necrosis and hemorrhage are frequent.
  • Atypia, mitosis, pleomorphism, and sarcomatoid aspects
  • In 80%, local recurrence exists with inguinal metastases
  • Mortality is high (up to 75%), and most patients die within a year

• Mixed SCC
  • Contain at least two variants of SCCs
  • Patients are older, mostly in their 7th decade
  • Located on the glans
  • Present as a white, exophytic, grayish mass replacing the distal penis, invading deeply the erectile tissue
  • Most frequent is the combination of warty and basaloid carcinomas
  • Possible to have HPV– and non–HPV-related features in the same tumors
  • Mortality is rare (<5%)
  • Less aggressive

• On microscopic histopathological analysis, keratinization and intercellular bridges are characteristic findings of carcinoma of the penis.^[7]

• Grading is a way of classifying penile cancer cells based on their appearance and behaviour when viewed under a microscope.^[8]

• The grade of penile cancer is based on the degree of differentiation of cells and their rate of growth.

Grade	Definition
GX	Grade of differentiation cannot be assessed
G1	Well differentiated or low grade
G2	Moderately well differentiated or moderate grade
G3	Poorly differentiated or high grade
G4	Undifferentiated or high grade

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753, Swathi Venkatesan, M.B.B.S.[2]

Carcinoma of the penis is most commonly caused by an infection with human papillomavirus, lack of circumcision, phimosis, smegma, smoking and other tobacco use, UV light treatment of psoriasis as well as immunocompromised states such as AIDS.

Human papillomavirus^{[1] [2]}

• Infection with the human papillomavirus (HPV) is associated with penile cancer. Most sexually active men will be exposed to HPV at some time in their life.
• The types of HPV are often grouped into low and high risk according to their association with cancer.

• Low-risk HPV types such as 6 and 11 rarely cause cancer, but they can cause warts on or around the genitals. Men with penile cancer often report having a history of genital warts.
• High-risk HPV types are more likely to lead to cancer. In particular, HPV types 16 and 18 are linked to penile cancer. The exact role that these viruses play in the development of penile cancer is not clear.

Lack of Circumcision

• Circumcision removes all (or part) of the foreskin
• This procedure is most often done in infants, but it can be done later in life as well
• Men who are circumcised can’t develop the condition called phimosis, and they don’t accumulate material known as smegma

Phimosis

• In men who are not circumcised, the foreskin can sometimes become tight and difficult to retract
• Penile cancer is more common in men with phimosis
• Due to build-up of smegma or from inflammation that results from phimosis

Smegma

• Secretions can build up underneath an intact foreskin
• If the area under the foreskin isn’t cleaned well, these secretions build up enough to become a thick, odorous substance known as smegma
• Smegma is more common in men with phimosis
• Can occur in anyone with a foreskin if the foreskin isn’t retracted regularly to clean the head of the penis
• It can irritate and inflame the penis eventually leading to penile carcinoma

Smoking and other tobacco use

• Tobacco users who have HPV infections have an even higher risk of developing

UV light treatment for psoriasis

• Treated with drugs called psoralens and then an ultraviolet A (UVA) light source. This is called PUVA therapy
• To help lower this risk, men being treated with PUVA now have their genitals covered during treatment

Immunocompromised states Poor genital hygiene

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Swathi Venkatesan, M.B.B.S.[2]

Carcinoma of the penis must be differentiated from condyloma acuminata, penile intraepithelial neoplasia (PeIN), balanitis xerotica obliterans, buschke-Lowenstein tumour, bowenoid papulosis, and leukoplakia.

Carcinoma of the penis must be differentiated from:^[1][2]

• Noncancerous conditions

• Condyloma acuminata
  • A common sexually transmitted disease caused by a virus belonging to the human papilloma virus (HPV) group
  • Lesions normally grow as a papilloma and are usually found on the glans, prepuce, or shaft of the penis
  • Lesions are benign, caused by low-risk HPV 6/11
  • Mixed infections with high-risk HPV types are relatively common
  • Progression to malignancy is rare.

• Precancerous conditions ^[3]

• Penile intraepithelial neoplasia (PeIN)
  • most common precancerous condition of the penis
  • General term used to describe precancerous conditions of the penis that may develop into invasive squamous cell carcinoma (SCC) if they are not treated
  • Refers to abnormal cell changes, called carcinoma in situ, that occur on the skin surface of the penis
  • PeIN on the glans (head) or foreskin of the penis is also called erythroplasia of Queyrat
  • PeIN on the shaft of the penis is also called Bowen’s disease
• Balanitis xerotica obliterans (BXO) also known as lichen sclerosis
  • A precancerous skin condition localized to the glans and the prepuce
  • Presents as white atrophic patches
  • The secondary development of phimosis inhibits washing and prevents early diagnostics of possible malignancy development on the glans or inside of the prepuce
  • A radical circumcision should therefore be performed for this disease
• Buschke-Lowenstein tumour
  • A slow–growing, locally destructive verrucous plaque
  • Cauliflower-like mass
  • A regional variant of verrucous carcinoma, also known as giant condyloma acuminate
  • Can involve the penis, vulva, scrotum, bladder, and perianal or anorectal regions
  • Rare
• Bowen’s Disease
  • Undifferentiated PeIN
  • Manifests as a solitary, pigmented, scaly or scab-covered area
  • Affects the penis shaft, scrotum, perineum, and the suprapubic area
• Bowenoid papulosis
  • Multiple, slightly elevated, red to violet or brownish papules, on the penis shaft and scrotum
  • Very rare, is preferably seen young men
  • May regress without treatment
  • Caused by high-risk HPV, most commonly HPV 16
  • Histologically cannot be separated from undifferentiated PeIN
• Leukoplakia
  • Rare
  • Appear as a white hypertrophic or atrophic patch and usually occur secondary to chronic irritation
  • Develops in the meatus
  • Biopsy is necessary to exclude cancer and intraepithelial neoplasia (PeIN)
• Erythroplasia of Queyrat
  • Grows on the glans and the prepuce
  • Presents as a well-defined, red patch
  • Undifferentiated PeIN

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The incidence of carcinoma of the penis is approximately 1 per 100,000 males in the United States. The majority of cases are reported in less developed areas. The incidence of carcinoma of the penis increases with age; the median age at diagnosis is 60 years.

• Penile cancer is a malignancy that is rare in the Western Hemisphere ^{[1] [2]}
• The incidence of carcinoma of the penis is approximately 1 per 100,000 males in the United States
• Penile cancer accounts for 0.4–0.6% of malignant diagnoses in the USA and Europe, and is responsible for 0.1% of cancer deaths
• The incidence is significantly higher in developing countries where penile cancer constitutes a significant public health hazard
• Two pathways have been proposed for penile cancer development—one related to HPV infection and the other related to phimosis and/or chronic inflammation

The incidence of carcinoma of the penis increases with age; the median age at diagnosis is 60 years.^[3][4]

Carcinoma of the penis usually affects individuals of the white, African American, and Hispanic race. Asian males are less likely to develop carcinoma of the penis.^[3]

The majority of carcinoma of the penis cases are reported in less developed areas, such as Africa, Asia, and South America.^[5]

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Swathi Venkatesan, M.B.B.S.[2]

Common risk factors in the development of carcinoma of the penis are human papillomavirus, phimosis, poor genital hygiene, uncircumcised males, weakened immune system, smoking, and PUVA treatment for psoriasis.

Common risk factors in the development of carcinoma of the penis include:^[1]

• Human papillomavirus
• Multiple sex partners
• Phimosis
• Poor genital hygiene
• Uncircumcised males
• Weakened immune system
• Smoking
• PUVA treatment for psoriasis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Swathi Venkatesan, M.B.B.S.[2]

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for carcinoma of the penis.

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for carcinoma of the penis.^[1]

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Joel Gelman, M.D. [2], Director of the Center for Reconstructive Urology and Associate Clinical Professor in the Department of Urology at the University of California,Irvine

Prognosis of carcinoma of the penis is generally good, and the 5-year survival rate is approximately 67%. The prognosis varies with the stage of tumor; stages 0–II have the most favorable prognosis.

Prognosis is generally good, and the 5-year survival rate of patients with penile cancer is approximately 67%.^[1]

Stage	Definition	5-year survival rate
Stages 0–II	Within the penis	80-100%
Stage III and some stage IV	Spread to nearby tissues or lymph nodes	40-80%
Some stage IV	Spread to distant sites in the body	11%

The prognosis varies with the stage of tumor; stages 0–II have the most favorable prognosis.^[2]

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