Introduction:

Amongst the genitourinary malignancies, penile cancer ranks as one of the least common with an incidence of less than 1 per 100,000 men. Current NCCN guidelines recommend systemic therapy and partial or total penectomy for men with T2 stage or greater penile cancer which has a significant impact on both the sexual and urinary health of men. Previous research has shown that men from racial minority groups have higher age-adjusted incidence of penile cancer and worse mortality rates than Caucasian men. Therefore our objective was to determine if men from various racial minorities in the United States (US) are more likely to present with penile cancer of T2 stage or greater necessitating penectomy or systemic therapy.

Methods:

A retrospective review of the National Cancer Database (NCDB) Public Benchmark Reports was used to determine the contemporary burden of penile cancer amongst men from racial minority groups in the US. All males diagnosed with penile cancer from 2019-2021 were included in the study. Patients were stratified into two groups of men with T2-stage or greater and those with less than T2-stage penile cancer. Fischer’s exact test was used to compare the proportion of Caucasian men with T2-stage or greater penile cancer against men of other races. Alpha was set a priori at .05. All analyses were performed using the R Statistical Software version 4.2.1.

Results:

A total of 2986 men with penile cancer were identified from the database. Figure 1 demonstrates the number of men diagnosed with penile cancer from 2019-2021 stratified by race and stage. Caucasian men made up 72.4% of this cohort, African-American men 9.4%, Hispanic men 15.1%, Asian/Pacific Islanders 2.5%, and Native American men 0.5%. Hispanic men were significantly more likely to present with T2-stage or greater penile cancer compared to Caucasian men (p < .01). There was no significant difference between Caucasian men and African-American men, Asian/Pacific Islander, and Native American men.

Conclusion:

Hispanic men exhibit a higher likelihood of presenting with T2-stage or greater penile cancer compared to Caucasian men. Retrospective analyses spanning 1995-2003 revealed that African-American and Hispanic men were disproportionately diagnosed with advanced-stage penile cancer relative to their Caucasian counterparts. Seventeen years later, contemporary data reaffirm that Hispanic men continue to present with more advanced disease at a greater frequency than other racial groups. The persistence of this disparity is multifactorial and not entirely elucidated.

One significant contributing factor may be the historically lower rates of neonatal circumcision among Hispanic men, influenced by cultural traditions, economic barriers, and insufficient advocacy by healthcare providers. Given the established association between neonatal circumcision and reduced penile cancer risk, this factor warrants consideration. Nonetheless, neonatal circumcision represents merely one element within a complex array of determinants influencing the advanced-stage presentation of penile cancer in Hispanic men.

These findings should should be the catalyst in engaging stakeholders at all levels to ensure that seventeen years from now this trend becomes a relic of the past rather than a persisting issue.

Funding: N/A