A large international survey reveals that one in 4 men refuses total or partial amputation of the penis, even though this intervention is the only one able to double their chances of being cured of penile cancer. Total amputation in particular is a very difficult surgical procedure for men to accept.
Cancer of the penis is one of the rarest cancers. Each year, about one in 100,000 men contract this disease in the West. However, in recent years it affects more and more men, especially older men.
Researchers from five countries (Italy, Spain, United States, Brazil and Hungary) carried out a large investigation about this disease. Presented as part of 33rd Congress of the European Association of Urology, in Copenhagen, this study reveals that a quarter of men with penile cancer do not receive the ad hoc treatment which consists of a partial or total amputation of the penis.
Choose disease over cure
It is often the patient himself who refuses to benefit from treatment: “Removing part or all of the penis is often the most effective cure for cancer, but for many men the cure seems worse than the disease,” says the American Cancer Society.
“To no longer have a masculine attribute and to be cured”, or “to keep his penis but to remain sick”. Difficult choice for these men according to this study. And this decision can have serious consequences: twice as many patients survived the disease when they had a partial or total amputation of the penis, according to the study.
To conduct this investigation, the researchers retrospectively reviewed the charts of 425 patients who had been treated between 2010 and 2016.
# WATER18 press coverage: Quarter of men with penis cancer are not getting recommended surgery, warns international study https://t.co/NF0jWf6ZfD
– European Association of Urology (EAU) (@Uroweb) March 16, 2018
Cancer that is too rare
Sometimes, however, the decision not to operate comes from the doctor. Not by mistake, but because healthcare professionals do not know enough about how to treat this rare cancer. In a way, patients with such cancer are at a loss for luck. Because they are faced with doctors and surgeons who, sometimes, have never treated this disease.
It would therefore be preferable for the patient to go to specialized centers. Obviously, there aren’t any on every street corner. But, according to the study, some countries cope better with this situation. In the United Kingdom, for example, penile cancer treatment is centralized in 10 specialized establishments. This therefore increases the chances of survival.
Reconstruction of the penis
In the event of partial amputation, reconstruction, and various associated techniques, make it possible to obtain a satisfactory result, at least functionally (urination) and for external appearances.
But, it is clear that the total or almost total amputation of the penis directly affects urination and sexuality. It goes all the more badly since the reconstructions constitute a real surgical challenge and are only carried out in a few very specialized centers. In the absence of reconstruction, the man will have to pee while sitting. Penile reconstruction from the remaining cavernous bodies is always attempted first in partial amputation, otherwise everything has to be reinvented and the process is long and painful.
The transplant has been attempted but remains very poorly supported, despite heavy anti-rejection and immunosuppressive treatment.
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