When Patrick noticed a rash on his penis while showering, he thought it was down to his new bodywash. But it was cancer. And it’s on the rise because of THIS intimate act

Patrick Meehan noticed a rash on his penis while in the shower and initially thought it might be a reaction to a new shower gel.

‘It wasn’t painful, but it didn’t look quite right,’ recalls Patrick, 36.

The angry marks on the glans had not diminished even after a week; so Patrick saw his GP in January 2021, who prescribed a daily steroid cream.

The redness quickly disappeared, but a pea-sized swelling remained under the foreskin, which gradually turned into an ulcer.

‘It looked like burning,’ says Patrick, who runs a home for young people in need and lives in Blackpool with his partner Ruth, 48, and his stepson.

But he says it wasn’t painful and life was ‘hectic’, so Patrick thought about it some more and continued using the steroid cream.

By October, nine months after she first noticed the rash, she presented to her local genitourinary medicine clinic after being referred by her doctor.

‘The doctor who examined me said it was probably a cyst,’ says Patrick, who was 32 at the time. A biopsy was taken and sent for analysis. About six weeks later, Patrick was called back to the hospital; where a consultant told him that the lump was actually penile cancer.

The diagnosis came as a huge shock to Patrick, who had barely heard of it before: “Just hearing the word ‘cancer’ completely caught me off guard because I didn’t even think it could happen like this,” he says.

Professor Asif Muneer, consultant urological surgeon at University College London Hospitals NHS Foundation Trust, says the number of men diagnosed with penile cancer is increasing, with a 20 per cent increase in the last decade.

It’s unclear exactly why the trend is upward, but ‘this may be due to increasing rates of human papillomavirus (HPV), a very common virus that lives on our skin and moist lining.’ [mucous membrane] “inside our bodies,” he says.

Arie Parnham, consultant urological surgeon at Christie NHS Foundation Trust in Manchester, says another cause of penile cancer may be HPV, a virus that an estimated 80 per cent of sexually active individuals will have at some point in their lives.

The virus is transmitted through skin-to-skin contact, usually during vaginal, anal and oral sex.

Around 770 new cases of penile cancer are diagnosed each year, claiming the lives of around 180 men in the UK each year

He explains: ‘Most people have HPV without even knowing it. In the vast majority of cases, the body clears the virus naturally and it does not cause any harm. Only a small number of HPV subtypes are linked to cancer, and even then problems develop very slowly.’

He adds that this subtype of viruses can stay in the body for a long time and affect the way some cells work.

Another factor may be lower rates of newborn circumcision. [where the foreskin is removed early in a baby boy’s life, often for cultural or religious reasons] ‘And penile cancer often develops under the foreskin,’ says Professor Muneer.

Around 770 new cases are diagnosed each year, claiming the lives of around 180 men in the UK each year. It is much more common in men over the age of 50.

The psychological impact on those affected can also be devastating.

A study of penis cancer patients by the charity Orchid Fighting Male Cancer found 22 per cent of men were suffering so badly they were ‘considering destroying their lives’.

Early symptoms may include minor changes in the skin of the penis, such as painless swelling, sores, ulcers, or wart-like growths. Professor Muneer says there may also be ‘large cauliflower-like growths hidden under the foreskin’.

‘Some men notice bleeding around the glans, discharge, a foul odor or that the foreskin becomes tight and difficult to retract,’ he adds.

He says patients may often assume these symptoms are due to other causes, such as thrush, a common fungal infection.

Despite worrying symptoms such as swelling in the penis, many patients are slow to seek treatment.

‘Men are often less willing to voice health problems, and in this case there is more embarrassment because their penis is involved,’ says Professor Muneer.

It’s unclear what causes penile cancer, but risk factors include smoking, a weakened immune system (for example, due to other cancer treatments), and in rare cases, lichen sclerosus (a chronic inflammatory skin disease that causes white, itchy patches).

Another theory is that men with tight foreskins, known as phimosis, may be more susceptible to penile cancer.

‘Inflammation may develop in the glans’ [the head] ‘A non-retractable foreskin causes swelling under the foreskin, pain, redness and in rare cases can turn cancerous,’ explains Professor Muneer.

In 2019, the HPV vaccination program was expanded to include boys aged 12-13 as well as girls, after it was proven that vaccinating girls alone did not adequately protect against conditions including HPV-related cancers such as penile cancer.

‘Any wound, swelling or change on the penis that does not heal within four weeks should always be checked by a doctor,’ says Mr Parnham.

If diagnosed early, treatment options can be very effective; but only 10 per cent of men over the age of 18 have ever heard of penile cancer, according to the Urology Foundation charity. The charity has launched an awareness campaign that includes guidance on self-examination for abnormalities such as swelling and bleeding.

Mr Parnham says the establishment of nine specialist treatment centers in England in 2002, such as The Christie in Manchester, has led to improved and centralized treatment and contributed to a 10 per cent increase in survival from penile cancer in the last 25 years.

Circumcision is an effective treatment for early-stage cancers and tumors under the foreskin. A small lump can also be removed surgically.

Patrick says: ‘Just hearing the word cancer caught me completely off guard; I didn’t even think it could be like that’

These treatments are normally curative but depend on the extent and stage of the cancer.

Penectomy (removing all or part of a man’s penis) was previously performed for large or advanced cancers, but is now rare.

An important advance is improved techniques for penis-sparing surgery.

‘We can now leave more normal tissue in place, safely preserving function and cosmetic results,’ explains Mr Parnham.

This means, for example, that a patient can continue to have frequent sexual intercourse.

Currently, the most common procedures are glansectomy, in which the glans is removed and the organ is shortened, or glans resurfacing, in which only the outer tissue of the glans is removed.

In both surgeries, the penis is reconstructed using a skin graft taken from the patient’s thigh.

Mr Parnham said both surgeries ‘look quite frightening for patients, but the results are quite good’.

Many patients who undergo these procedures ‘can have erection, penetrative sex and have children later,’ he says, although some may find sexual intercourse more difficult due to loss of length and psychological distress.

Mr Parnham adds that the survival rate for penile cancer is more than 90 per cent, but if the cancer spreads it would “fall off the edge”. ‘Early diagnosis makes a huge difference.’

Penile cancer tends to spread to the lymph nodes in the groin and pelvis, at which point the chance of survival may be less than 50 per cent, Mr Parnham says.

Dynamic central node biopsy is a relatively new technique used to detect whether penile cancer has spread to sentinel nodes in the groin; These are the first lymph nodes to which penile cancer typically spreads.

Previously, surgeons routinely removed all lymph nodes as a precaution. But in about 80 percent of cases, this turned out to be unnecessary, exposing patients to unnecessary risks, including lymphedema, where fluid builds up in body tissues and causes swelling in the legs.

Many ongoing clinical trials are also examining ways to improve penile cancer treatment.

The EPIC Trial at University Hospitals Bristol and Weston NHS Foundation Trust is testing a new approach for patients whose penile cancer has spread.

Standard chemotherapy has limited success, so researchers are combining it with cemiplimab, an immunotherapy drug that works by activating the body’s own immune system to attack cancer cells.

Half of the 48 participants received cemiplimab alone, while the remainder received it in combination with chemotherapy. Full results are expected next year, but early findings suggest that combining the two treatments may increase response rates compared to using both treatments separately.

Following diagnosis, Patrick was told that his glans would need to be resurfaced to remove his tumor.

‘I was horrified,’ he admits. ‘But it was either this or I was going to die. ‘It was a small lump but the cancer was aggressive and likely to spread and I was told it was much harder to treat.’

Patrick found the support of the Male Cancer Fighting charity Orchid invaluable in reassuring him ahead of his surgery in February 2022.

After the upper layer of tissue containing the lump was removed, a five-inch skin graft was taken from his left thigh and used to reconstruct the glans.

In the same surgery, which lasted four hours, some sentinel nodes were removed from his groin for analysis.

A week later, when Patrick’s bandages were removed, he saw his penis for the first time after surgery.

‘I was very emotional and in a lot of pain while the dressing was being removed,’ he recalls. ‘I couldn’t look at him at first. The assistant doctor held my hand as we looked together.

‘It was swollen, bloody and bruised – but I remember saying something like ‘oh, that’s totally fine, I can get used to it’.’

Patrick was allowed home the next day with a catheter tube to make urinating easier while the stitches on his penis healed.

‘I was limping at home for a week,’ says Patrick, who took painkillers to ease his discomfort.

Three weeks later, biopsy results showed no signs of cancer and no further treatment was needed; ‘It was a huge relief,’ Patrick says, although he banked some of his sperm as a precaution in case future treatment affected his fertility.

Two months later, in April, Patrick managed to climb a mountain and perform with his band again while on holiday in Ireland.

Although he lost some sensitivity in his penis after surgery, he was comfortable having sex and functioning normally after three months.

Today, he remains cancer-free and receives annual checkups at Christie’s.

He is also passionate about raising awareness about penile cancer among other men.

‘I feel confident talking about penile cancer when I stand on stage at concerts. I’m trying to help people learn this – and I know that even if you have it, it’s not a “game over” situation. When I heard I had penile cancer, I was afraid it might be the same for me. ‘I’m still enjoying my life here.’

(nameit.theurologyfoundation.org)