Investigating the risk factors and pathological profile of penile cancer at a south african referral centre: a case-control study

Background: Penile cancer is rare in developed countries but prevalent in developing regions. Known risk factors include phimosis, inflammation, and smoking. This study aims to determine the prevalence of these factors and explore potential novel ones in South Africa. Methods: A case-control study was performed with 23 cases diagnosed with penile cancer from January 2008 to October 2023, and 46 age-matched controls with benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS). Participants were interviewed using a standardized questionnaire. Pathological profiles and stage presentations were also documented. Results: The most common risk factors were phimosis (OR 34.2, 95 % CI 7.9 to 244.5), inflammation (OR 14.1, 95 % CI 3.2 to 100.4), and smoking (OR 3.3, 95 % CI 1.1 to 12.9). Phimosis remained a significant risk factor even after adjusting for smoking, low income, and inflammation (OR 22.7, 95 % CI 3.9 to 210.6). Smoking and inflammation lost significance after adjusting for phimosis. The pathological profile was consistent with international data, but our patients presented with more advanced disease. Conclusions: Phimosis was identified as the most important risk factor for penile cancer in this South African cohort, followed by smoking and preputial inflammation. The pathological profile was similar to international cohorts, though our patients presented at more advanced stages.