Circumcision, Buried Penis and Obesity in a Contemporary Cohort of Patients with Penile Cancer

Introduction: We reviewed patient demographics and body morphology in a contemporary cohort of patients presenting to a tertiary care center for treatment of penile cancer.

Methods: The University of Iowa Oncology Registry was retrospectively reviewed for cases of penile cancer managed between 2006 and 2016. The database was queried for cancer specific details, followed by a chart review for body morphology data and comorbidity status.

Results: We treated 54 patients for penile cancer in the study period with a mean ± SD age of 64.3 ± 12.9 years and body mass index of 36.2 ± 10 kg/m². Of these men 31.5% (17) had a clinically buried penis and 50% (27) reported prepubertal circumcision. Patients with a buried penis had a higher body mass index (46.53 ± 10.6 vs 31.48 ± 5.63 kg/m², p <0.0001) and underwent fewer inguinal lymph node dissections (20% vs 58%, p = 0.05) than patients without a buried penis, but had similar rates of higher stage (2-4) presentation. Stage correlated with penile cancer death. Those with cancer specific mortality had a significantly higher body mass index (41.2 ± 12.4 kg/m²) vs those without penile cancer death (34.6 ± 9.1 kg/m²).

Conclusions: Penile cancer remains relatively rare but contemporary cohorts suggest that circumcision may no longer be protective, especially in the setting of a clinically buried penis that may mimic an intact prepuce. How a buried penis and higher body mass index affect presentation, clinical management, surgical outcomes and disease course deserves further study.