Jamaican men urged to watch for penile cancer signs and get HPV protection

Consultant urologist Dr Elon Thompson is cautioning Jamaican men that penile cancer, although uncommon, can bring life-changing damage when it is found late. The disease is often connected to the human papillomavirus, or HPV, and some local patients have lost their penis to surgery, along with the chance to have children if they had not already done so.

Thompson told The Sunday Gleaner that penile cancer is seen far less often than prostate cancer in men and cervical cancer in women, but Jamaica has recorded cases severe enough to require full removal of the organ.

“Penile cancer is one of those cancers that initially was thought to be affecting persons at the lower socio-economic status, who are a lot of times, smokers as well. And definitely there is an involvement with HPV. So, we would a lot of times describe it as the homologue for cervical cancer. Even though it’s not as common in men as cervical cancer is in women, but it certainly can be one of those very bad cancers in men,” he said.

While earlier thinking placed the illness mainly among poorer men, Thompson said it is now known to affect men at every level of society. He said the harm can be both physical and emotional, especially where the cancer is not picked up until it has advanced.

The doctor said he has managed patients who had to undergo amputation, including one who was only 40 years old. For men who have not yet fathered children, he said, the operation can remove not only sexual function but also their future ability to become a parent.

Thompson is urging men to pay closer attention to their bodies and check for changes to the penis. “The most important thing with penile cancer, I guess, is to really look at the penis and see if there is something abnormal there,” he said. He identified the foreskin and the head of the penis as areas that men should examine.

“A lot of times we find some big lesions on the penis and you wonder, like, ‘You didn’t see this before?’, and you’re very concerned that persons could allow it to get to this size. And you wonder, ‘How many persons are taking note of what is happening to their bodies?’” Thompson said.

He also cautioned that oral sex involving a cancerous lesion could raise the chance of HPV transmission, which may put partners at risk of throat cancer.

Thompson, who also serves in the Upper House, said that in his work as a surgeon he has removed the penises of men diagnosed with penile cancer. He said the mental distress can be profound, and depending on how far the illness has progressed, some men die not long after diagnosis.

“It is a very serious consideration, and it is one of those psychologically traumatic [and] impactful conditions that I don’t know if we even understand fully how much trauma that can cause. ... It’s one of those cancers that really can be ... really fatal if you leave it. And I have seen cases where persons have decided not to follow through with treatment or have not treated their primary lesion on the penis, and, you know, within months [or a few] years, they are gone,” he said.

Thompson said early discovery is essential, but prevention must also be pushed through HPV vaccination. He noted that the vaccine was first offered only to girls because of the strong concern about cervical cancer, which affects women more frequently than penile cancer affects men.

“Initially when the [HPV] vaccine was only being given to girls, it was seen as an ethical consideration. Why are we giving it only to girls? Yes, it was because the alert was sounded with regard to cervical cancer, and [it] being more common in terms of affecting women more commonly than, per se, penile cancer in men. But, to basically create that balance, it was also included in advice for boys. So, [it is now recommended for] both girls and boys, preferably prior to first sexual encounter,” he said.

He said vaccination is generally advised between ages nine and 12, with the expectation that children should receive it by age 15. However, he said acceptance of the vaccine is still below the level needed.

Because cancer treatment places a heavy financial burden on both patients and the State, Thompson wants stronger public education and advocacy from parents, schools, churches and community organisations.

“Putting on the policy hat now, ... I would absolutely want to re-engage the public with regards to vaccination [against] HPV,” he told The Sunday Gleaner.

Thompson also raised concern about prostate cancer, describing it as one of the major causes of death for Jamaican men. He said the disease is found through screening, but too many cases are still being identified only after they have moved into a late stage.

“It is detected through screening. A lot of the time, though, what we are finding is that we detect it at an advanced stage. And the reason why we detect it at an advanced stage is because we are not screening enough persons to pick it up early,” he said.

He explained that advanced prostate cancer may travel to other parts of the body, including the bones. In some patients, difficulty walking becomes the first sign that leads doctors to the diagnosis.

Screening is done with a prostate-specific antigen, or PSA, blood test and is often paired with a physical prostate examination.

“PSA is a blood test that is used for screening in prostate cancer. It is used along with the prostate examination, which has been a common topic of discussion for men in our country. The narrative, however, is if it is that you are uncomfortable for any reason with doing the prostate examination, then at least you must do the PSA. The recommendation, however, is still a PSA blood test and a prostate examination,” Thompson said.

He said PSA readings usually fall between zero and four, and follow-up checks may be needed to see how the result changes over time.

Thompson added that men of African descent, including most Jamaicans, face a higher risk of prostate cancer. The risk is greater for men with relatives who have had the disease or whose mothers had breast cancer.

He is encouraging men, particularly those approaching 40 or already older than 40, to make screening a priority, saying that finding the disease early can greatly improve the outcome.