By Contributing Writer - June 12, 2020
“If you have a problem, get seen by a specialist, because it is only going to get worse if you don’t,” said James Wright. Wise words from a man who has experienced firsthand a diagnosis of penile cancer, followed by tissue-sparing surgery.
“I think people sometimes feel these things can’t happen to them, that they can’t develop cancer in places like the penis,” said Dr. Philippe Spiess, assistant chief of Surgical Services and senior member, Department of Genitourinary Oncology at Moffitt Cancer Center. “But the reality is such cancers occur, and it is essential for the patient to have the condition identified and evaluated as quickly as possible by the right specialist.”
Penile cancer usually forms on or along the penile glans or shaft and is often curable when found early. If left untreated, however, the cancer can spread rapidly to regional nodes or beyond and become potentially life threatening.
"Although an infrequent cancer in North America, for the men it affects, the physical and emotional effects can be devastating."- Dr. Philippe Spiess, genitourinary oncologist and assistant chief of surgical services
The most common age of penile cancer diagnosis is between 60 and 80 years. “But I’ve seen 30- and 40-year-olds present with this disease, and unfortunately several have died of this horrible cancer. The unfortunate thing is that it is aggressive, and patients suffer when they present with advanced disease,” said Spiess, who sees about five to 10 cases of penile cancer per month. He recommends vaccination against the human papillomavirus in sexually active men and women because HPV is thought to be one of the strongest risk factors for developing penile cancer, with an estimated 60%-80% of penile cancers being HPV related. In 2018 the U.S. Food and Drug Administration approved the expanded use of the GARDASIL 9 vaccine to include men and women ages 27 to 45. (Previously, the vaccine was approved for individuals ages 9 to 26.) The vaccine, which protects against nine types of HPV, prevents cancers and diseases, including genital warts, penile cancer, anal cancer and the spread of HPV to sexual partners.
Delayed or Missed Diagnosis
“Although an infrequent cancer in North America, for the men it affects, the physical and emotional effects can be devastating,” said Spiess. The National Cancer Institute reports about 2,000 cases per year. “Because penile cancer is so rare, there is much variety in how patients are cared for, depending on where they go for diagnosis and treatment. Sadly, some men are not recognized as having this disease and are left untreated or treated with antibiotics for a suspected infection, often delaying the diagnosis for many months. Then by the time some of these patients come and see us, they have advanced tumors, and we wish they would have come much earlier because the prognosis would have been much better.”
Wright, 55, says his initial diagnosis was delayed due to embarrassment. “About three years ago I noticed a lump that had come on, and it was embarrassing so I didn’t do anything about it.” He was living in Atlanta at the time. After moving to Florida about three years ago, Wright found a physician and during a routine checkup asked, “Oh, by the way, can you look at this while I’m here?” His physician immediately insisted he get the lump removed and referred him to another doctor.
Wright quickly made an appointment, and the referred doctor removed the lump. Because the pathology report revealed Wright had a low-grade cancer and there was still tumor at the edges of where it had been resected, it was necessary for him to have more tissue removed. Then all was fine for about a year, until the cancer came back, “even bigger than before.”
At that point Wright visited Moffitt, had a biopsy and also visited a cancer center in another state. Two different surgeons advised to have what sounded to him like radical surgery. “He [one of the physicians] was talking about cutting the whole thing off!”
Wright ultimately decided to come to Moffitt to be near his home and not have to fly back and forth. He made an appointment at Moffitt, “and then somehow or another — thank God! — Dr. Spiess got ahold of me. I liked what he told me, and I also liked the plastic surgeon” [Gerard Mosiello, MD].
"If you have a problem, get seen by a specialist, because it is only going to get worse if you don’t."- James Wright, cancer survivor
The surgery took place in July 2019 and went well. “When I went to have the surgery, I had packed a bag and was expecting to stay a few days. Much to my surprise, they sent me home the same day!” He recuperated at home for 10 days, and then was able to resume his active life as the owner of an insurance brokerage company. “It can be pretty travel intensive because I do business all over the place.” Wright and his wife also like to travel to see family. He has a son in New York City, and most of his family is in Atlanta. His wife is from Russia, so they often travel to Europe to visit with her family; their most recent trip was to Seville, Spain.
“I couldn’t say enough good things about the hospital, about Dr. Spiess, about Dr. Mosiello — about everybody there, really! I had a good experience,” said Wright.
“I’ve had a few patients come to me and say they were told they could not have any form of tissue-sparing surgery or treatment. And I examined them and found these tumors are in fact amenable to this as they have favorable characteristics and are situated in a favorable location for organ preservation to be performed. Helping such patients is a matter of working with colleagues in reconstructive surgery or being a little more innovative in one’s surgical approaches. And if you do that, it’s been shown in very small studies, and I see in my patient population, it is possible for the patient to be able to maintain sexual function and ultimately a high quality of life,” said Spiess.
Spiess cautioned against obtaining information from undependable sources and recommends — in addition to seeing a qualified specialist — searching out expert and trustworthy educational resources such as those offered within the National Cancer Institute and the National Comprehensive Cancer Network©.
Speak Up; Ask Questions
Spiess stresses the importance of being comfortable with one’s own body and to keep asking questions. “If something looks unusual, there’s never anything to be ashamed of, or wrong with having it assessed by a physician and just taking a look. And if you don’t necessarily get the answers that you feel comfortable with, getting a second opinion or giving physicians the opportunity to perform an exam and give their thoughts would be greatly beneficial,” said Spiess. “I can’t tell you how many cases I’ve seen, from pilots for major commercial airlines to lawyers and other highly educated professionals, who have had significant penile tumors and lesions and they were dismissed, either by themselves or by physicians. So my advice is that it’s always wise to go get assessed and checked out.”
“These doctors don’t take anything personally. You might be embarrassed, but they are not. To them it’s their job, what they do, and they are there to help you,” said Wright.