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

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

The angry marks, on the penis head, hadn’t calmed down a week later – so Patrick saw his GP, in January 2021, who prescribed a daily steroid cream.

The rash soon cleared, but left a pea-sized lump under his foreskin which gradually became ulcerated.

‘It looked like a burn,’ says Patrick, who runs a home for teenagers who have been in care, and lives in Blackpool with his partner Ruth, 48, and stepson.

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

It wasn’t until October, nine months after he first noticed the rash, that he attended his local genitourinary medicine clinic after being referred by his GP.

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

The diagnosis came as a huge shock to Patrick, who’d barely heard of it before: ‘Just hearing the word “cancer” totally blindsided me as I didn’t think it could even possibly be that,’ he says.

The number of men diagnosed with penile cancer has been increasing – there’s been a 20 per cent increase in the past decade, says Professor Asif Muneer, a consultant urological surgeon at University College London Hospitals NHS Foundation Trust.

Exactly why the trend is upwards is unclear, but ‘it could be due to rising rates of the human papillomavirus (HPV) – a very common virus that lives on our skin and the moist lining [mucous membrane] inside our bodies,’ he says.

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

The virus is transmitted by skin to skin contact, often during vaginal, anal and oral sex.

He explains: ‘Most people have HPV without even knowing they do. In the vast majority of cases, the body clears the virus naturally and it causes no harm at all. Only a small number of HPV subtypes are linked to cancer, and even then, problems develop very slowly if at all.’ 

These subtype viruses can remain in the body for a long time, affecting how some cells work, he adds.

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

Around 770 new cases are diagnosed annually, and it claims the lives of about 180 men in the UK each year. It is much more common in men over 50.

The psychological impact on those affected can also be devastating.

A survey of penile cancer patients by Orchid Fighting Male Cancer charity found that 22 per cent of men suffered so badly that they ‘contemplated harming their life’.

Early signs can include small changes on the skin of the penis such as a painless lump, sore, ulcer or wart-like growth. There might also be ‘large cauliflower-like growths hidden under the foreskin’, says Professor Muneer.

‘Some men notice bleeding around the head of the penis, discharge, a bad smell – or that the foreskin becomes tight and difficult to pull back,’ he adds.

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

Yet even despite worrying signs such as lumps on the penis, many patients are slow in seeking treatment.

‘Men are generally less keen to come forward with health issues, and in this case there’s more embarrassment as it involves their penis,’ says Professor Muneer.

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

Another theory is that men who have a tight foreskin – known as phimosis – could be more susceptible to penile cancer.

‘Inflammation can develop on the glans [the head] under a non-retractable foreskin, which causes swelling, soreness, redness – and in rare cases can transform into cancer,’ explains Professor Muneer.

In 2019, the HPV vaccination programme was extended to include boys aged between 12-13 as well as girls, following evidence that vaccinating girls only didn’t adequately protect against conditions including HPV-related cancers, such as penile cancer.

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

Treatment options can be very effective if it is diagnosed early – yet only 10 per cent of men over 18 have heard of penile cancer, according to The Urology Foundation charity. The charity has launched an awareness campaign with a self-examination guide for any abnormalities such as lumps and bleeding.

The establishment of nine specialist treatment centres in England in 2002, such as The Christie in Manchester, has led to improved and centralised treatment, contributing to a 10 per cent improved survival rate from penile cancer over the past 25 years, says Mr Parnham.

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

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

Penectomies – removing the whole or part of a man’s penis – were previously undertaken for large or advanced cancers, but are uncommon now.

A crucial advance has been improved techniques for penile-preserving surgery.

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

This means that a patient can often continue having sexual intercourse, for instance.

The most common procedures currently are a glansectomy – where the head of the penis is removed, making the organ shorter – or glans resurfacing, where only the outer layer of tissue on the head of the penis is removed.

In both operations, the penis is rebuilt using a skin graft from the patient’s thigh.

Both operations ‘sound quite terrifying for patients, but the outcomes are pretty good,’ says Mr Parnham.

Many patients undergoing these procedures ‘can have erections, penetrative sex and still father children afterwards’, he says, although some may find intercourse more difficult due to length loss and psychological distress.

The survival rate for penile cancer is more than 90 per cent, but this ‘falls off a cliff edge’ if the cancer has spread, adds Mr Parnham. ‘Early detection makes so much difference.’

Penile cancer tends to spread into the lymph nodes in the groin and pelvis – at this point, survival chances could be less than 50 per cent, says Mr Parnham.

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

Previously, surgeons had routinely removed all of the lymph nodes as a precaution. However, this proved unnecessary in around 80 per cent of cases, and exposed patients to needless risks, including lymphoedema, where fluid builds up in the body’s tissues, causing swelling in the legs for instance.

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

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.

Of 48 participants, half received cemiplimab alone while the rest had it alongside chemotherapy. Full results are expected next year, but early findings suggest that combining the two treatments may improve response rates compared with either treatment used individually.

Following his diagnosis, Patrick was told he needed glans resurfacing to remove his tumour.

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

Patrick found support from the charity Orchid Fighting Male Cancer invaluable in helping to reassure him before his operation, which took place in February 2022.

After the top layer of tissue containing the lump was removed, a two-inch skin graft was taken from his left thigh and used to rebuild the penis head.

During 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 the surgery.

‘I was highly emotional and in lots of pain as the dressing was removed,’ he recalls. ‘At first, I couldn’t look down at it. The junior doctor held my hand as we looked together.

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

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

‘I was hobbling around for a week at home,’ says Patrick, who took painkillers to alleviate his discomfort.

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

Two months later, in April, Patrick was able to walk up a mountain while holidaying in Ireland, and back playing gigs with his band.

Despite losing some sensitivity in his penis, post-surgery, he was comfortable having sex and otherwise functioning normally three months later.

Today he is still cancer free and receiving annual check-ups at the Christie.

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

‘I’m confident talking about penile cancer when I’m on stage at gigs. I try and help people learn about it - and know that even if you do have it, it’s not a case of “game over”, which I feared would be the case with me when I heard I had penile cancer. I’m still here enjoying my life.’

(nameit.theurologyfoundation.org)