HIV Insight: Cancer of the Penis Associated with HIV: A Report of Three Cases Presenting at the CHU Cocody, Ivory Coast

We describe three cases of advanced penile cancer associated with HIV infection.

Advanced penile cancer associated with VIH infection were discovered in three patients aged respectively 47, 56 and 40. The prognosis was extremely poor. Two patients died without receiving any treatment and one patient was lost to follow-up after refusing all treatment proposed.

There appears to be a link between HIV infection and penile cancer with concomitant HIV infection worsening the prognosis of the disease.

Cancer of the penis is extremely rare. In Europe and the USA, the incidence of this form of cancer is estimated as 1.0 per 100,000 men [1]. The incidence varies between different countries worldwide with a higher incidence in Hispanic individuals, in Brazil and in Uganda [2]. Circumcision in the perinatal period or before puberty has a preventative role, but not circumcision carried out in adulthood. Early circumcision decreases the risk 3–5-fold [3], probably by improving local hygiene. Cancer of the penis is usually a disease of older men and its incidence increases with age. The peak in frequency occurs between 60 and 70 years of age [1], [2], [4]. In 95 % of cases penile tumours are squamous cell carcinomas [5]. Penile cancer may present as a flat or ulcerated exophytic papillary lesion, with the latter having a worse prognosis. The most common locations are the glans (48 % of cases) and the foreskin (25 % of cases). Penile cancer patients with advanced disease have a poor prognosis. Grades 2 and 3 disease, T3 stage and positive lymph nodes are adverse prognostic factors for cancer-specific survival in penile squamous cell carcinoma [6], [7]. In a study of eight patients with metastatic penile cancer, the longest and shortest survival times (from diagnosis of the primary cancer to death) were 16 years and 9 months, respectively [8]. Other, rarer histological forms of penile cancer such as melanoma and sarcoma may also occur [9].

There is a higher risk of penile cancer in patients with AIDS although it is not possible to conclude formally about a causal link with immunosuppression [10]. An increasing number of cases of penile cancer associated with HIV are being reported in the literature [1], [10], [11]. The aim of this report is to describe three cases of penile cancer associated with HIV that presented at the Urology Department of the CHU Cocody and to review the literature...

Below: Cancer of the penis (patient 1), view 3