When Alastair Munro, a 49-year-old Scottish engineer, noticed a small growth on his penis, he was far from imagining the ordeal that awaited him.
After six weeks of hesitation, the verdict fell: it was cancer. “That was quite a bold thing for the GP to say.”he remembers. “I was shocked. He couldn’t be 100% sure, but he thought it was cancer.“.
His story, filmed for the BBC, sheds light on an illness he never hadnever, never heard of it before”.
A diagnosis often delayed by embarrassment
Penile cancer is a rare pathology (around 450 new cases per year in France), mainly affecting the glans and the foreskin. The main obstacle to care remains modesty. As urological surgeon CJ Shukla, who operated on Alastair, explains: “It’s common for us to see patients who have kept this a secret for two or three months before seeing a doctor.”
Dr Mario Terlizzi, onco-radiotherapist at the Gustave Roussy Institute, interviewed by True Medical for a previous subject, confirms this problem.
“The appearance of abnormal lesions on the penis constitutes the main reason for consultation, but we still too often deplore a diagnostic delay”.
For Alastair, the wake-up call was the evolution of mass. “The bump wasn’t painful but it got worse, and at one point I noticed blood.”
Therapeutic strategy: from conservative to radical
Subsequently, the choice of treatment depends on the size and location of the tumor. For early stages, organ-preserving solutions are preferred. “The medical team can offer conservative non-surgical treatment including the application of a cytotoxic cream or excision of the tumor by laser”explains Dr. Terlizzi.
Another major option for small tumors is brachytherapy. According to Dr. Terlizzi, “this form of radiotherapy uses a radioactive source which passes through catheters inserted in and around the tumor.. It offers excellent results in terms of penis preservation. However, for more complex cases like Alastair’s, surgery becomes essential.
Surgery and reconstruction: a technical challenge
For Alastair, the cancer’s spread to the lymph nodes required a complex seven-hour operation. “This palpation of the lymph nodes is essential because it constitutes a prognostic factor and guides the therapeutic decision” underlines the expert.
Surgeons had to remove the tumor and 30% of his penis. Before proceeding with reconstruction using a skin graft taken from his thigh.
Dr. Terlizzi also specifies that “wherever possible, surgeons try to preserve the genital organ in order to limit both physical and psychological consequences.”
HPV and hygiene: identified risk factors
If smoking and obesity are aggravating factors, infection by human papillomavirus (HPV) is the cause in nearly 50% of cases.
“HPV infection is a common sexually transmitted infection that can contribute to the development of penile cancer.” underlines Dr Terlizzi. He recalls that vaccination of young boys is today “the best means of prevention”.
Dr. Shukla also notes that hygiene and phimosis (tightness of the foreskin) play a crucial role. According to him, the lack of information also affects the medical profession. “GPs may also mistake the diagnosis of cancer as yeast candidiasis.”
Break the taboo to save lives
Today on the road to recovery despite complications such as lymphedema, Alastair has chosen to publicize his fight.
“The aim is to raise awareness about cancer in men“, he asserts forcefully. “If there is even one person with a problem with their penis, who is ashamed to go to the doctor, and who, seeing this show, says to himself, ‘I better go,’ the goal will be achieved.”
Its message is clear: surveillance is everyone’s business. “If anyone finds a lump or has erection or blood problems, just get checked out“. A quick examination which, as with Alastair, may simply save a life. “Dr. Shukla practically saved my life“, he concludes with gratitude.
The documentary ‘Surgeons: At The Edge of Life’ will be broadcast on BBC Scotland at 9pm on Monday 11 May and will then be available on BBC iPlayer.