The Brazilian Society of Urology (SBU) carries out this month a campaign to combat penile cancer. In the last four years, more than 8 thousand cases were registered in the country, according to the Hospital Information System of the Unified Health System (SIH/SUS). 
Today (4), World Cancer Day, was chosen by the institution as Penis Cancer Day. The SBU starts a joint effort for postectomy surgery, or circumcision, in the North and Northeast states, aiming to serve about 150 men, patients of the public health network.
Phimosis surgery is a way to prevent the disease, as it facilitates the cleaning of the male genital organ, said the supervisor of the Penis Cancer Discipline at SBU, José de Ribamar Rodrigues Calixto. Although the Southeast has presented the highest number of cases in the last four years (3,162), the North and Northeast regions were chosen to start the task force because they have a higher prevalence of the disease. The Northeast, for example, leads the rankingwith 9.93 cases per 100 thousand inhabitants.
The first epidemiological study carried out by the SBU a few years ago identified that São Paulo ranked first in the prevalence of penile cancer, “most of the cases coming from the North and Northeast, seeking treatment in São Paulo”, highlighted the urologist.
The Federal University of Maranhão (UFMA) published an article in a specialized magazine, showing that the state has a record in the prevalence of this type of cancer in the world. The rate reached 6.2 cases per 100,000 inhabitants. “It’s very high”, said Calixto, adding that from Amazonas to Bahia, the North and Northeast states are also less served by specialized oncology centers.
Diagnosis
According to the professor, postectomy, or phimosis, does not prevent cancer, but provides earlier diagnosis of lesions that are starting on the glans of the penis. He stated that, in Brazil, diagnoses are made, “unfortunately”, in cases that are already very advanced. He regretted that the Brazilian reality is that of operating on penile cancer in phases T2 and T3, when the tumors are medium or large. Surgeries should be performed in phase T1, the first.
Therefore, the number of penis amputations in Brazil is high. According to the SBU, in the last 14 years there were 7,213 amputations of the male organ, which corresponds to an increase of 1,604% in the period and an average of 515 procedures per year.
As the sociocultural and economic condition is very low in the North and Northeast, most men are unaware that the disease exists. “They think it’s venereal, that it’s a disease of time, that natural remedies will solve it.” When they look for the urologist, they are already in a very advanced stage, with a diagnosis of large lesions. “We don’t want that. We want, at least, to diagnose in the early stage; do not amputate or, if amputated, remove just a small piece of the penis, resect that lesion, only remove the foreskin, where the lesion was born, and preserve the penile shaft”.
The highest incidence of penile cancer, above 60%, is detected, in general, among men aged 50 to 60 years, but urologists have had cases in the 28 to 30 age group. At UFMA, doctors even operated on a 19-year-old boy. “That’s very rare.” Between 15% and 18% of men affected by the disease are between 30 and 40 years old.
Calixto reported that phimosis, or excess skin that prevents the head of the penis, or glans, from being sterilized, associated with contamination with some type of HPV and lack of hygiene are some factors that can lead to the disease. Although there is still no proof of the histogenesis induced by HPV in penile cancer, the involvement of the virus in the genesis of the disease is already proven, said the expert.
Social health education
Calixto defended the need to develop socio-sanitary education in the country. “Wash, expose that penis.” In many cases, doctors start with phallic reconstitution, to restore self-esteem and sexual function. These are performance levels that the SBU already practices.
He recalled that penile cancer is the only one that can be prevented. “Before it comes, we anticipate. Make a prediction of it. If there is good hygiene, without risky sexual behavior, avoiding several partners so as not to contaminate yourself with viruses, use a condom and, if you have phimosis, remove this skin so that you can effectively wash the glans with soap and water, it is practically impossible for cancer to develop.” The urologist also recalled the importance of using condoms during anal intercourse with a partner, to prevent contamination of the penis with bacteria present in the feces.
He noted that the Jew is culturally circumcised and has no foreskin. The same is true of indigenous people. “The incidence in this community is practically zero”. Therefore, the SBU defends the postectomy in those who have phimosis. “It is a feasible, outpatient and protective surgery”.
The recommendation is that men effectively wash the glans three times a day, remove the foreskin and encourage vaccination against HPV, whose adherence in Brazil is still very low. It is necessary to work on the concept of protection, he warned. Good hygiene should be part of the education of children and parents, including brushing teeth, washing the penis with soap and water, performing good vaginal hygiene on the girl, not letting children sit on the floor in underwear to avoid contamination. with bacteria, he argued.
José de Ribamar Calixto also said that the expectation is that this year the development of a penile prosthesis by foreign researchers to restore the functional and emotional part of amputees will be publicized.
Throughout this month, the SBU will broadcast online with urologists in Urology Portal on Instagram, in addition to publishing posts and videos clarifying the main doubts about this type of cancer, postectomy, HPV vaccine and education about the disease.
Incidence
According to data obtained by the Brazilian Society of Urology in the Hospital Information System of the Ministry of Health, there was a drop in the number of records between 2020 and 2021, attributed to the covid-19 pandemic, which reduced the demand for medical treatment. Penile cancer cases totaled 2,140 in 2018; 2.19 thousand in 2019; 2.09 thousand in 2020; and 1,790 last year.
The highest number of cases in these four years was registered in the Southeast (3.16 thousand), followed by the Northeast (2.57 thousand), South (1.18 thousand), Midwest (658) and North (645). In the same period, the prevalence was higher in the Northeast (9.93); followed by the Midwest (9.42); South (8.82); Southeast (8.09); and North (8.05). The states with the highest number of penile tumors are São Paulo (1,480), Minas Gerais (1,050), Bahia (609) and Paraná (565).
In absolute numbers, the region with the highest incidence of amputations is the Southeast, with 2,870 cases in the period, followed by the Northeast (2,100), South (1,130), North (631) and Midwest. (472). The states with the highest number of amputation cases are São Paulo (1,220), Minas Gerais (1,060) and Paraná (582).
Alert
According to the SBU, men should be on alert for any change in the genitalia, which should be evaluated by the urologist. Among them are wound that does not heal, nodules, secretions coming out of the foreskin, red hardened area, bleeding from the glans that is not exposed, pruritus (itching). These changes can be pre-malignant. By consulting a specialist, the man can avoid the evolution to cancer, advised the supervisor of the institution.
According to Datasus/Information System of the National Immunization Program, from 2013 to 2020, the national average coverage for the second dose of the HPV vaccine in the population between 11 and 14 years old is 65.8% for females. and 35.6% for men. The states with the lowest vaccination coverage, with two doses for boys, are Acre (15.2%), Amapá (20.6%), Pará (22.6%) and Rio de Janeiro (23.1%). The vaccine in the SUS is available for girls between 9 and 14 years old and boys between 11 and 14 years old.
HPV has a worldwide prevalence estimated at 11.7%, and the age group with the highest incidence is below 25 years.
