Diagnostic and treatment delays in penile cancer: a call to improve awareness and referral

Abstract Introduction : In men with penile cancer (PeCa), timely referral is crucial for optimizing clinical outcomes. We investigated the association between time from initial presentation to first surgical treatment and its effect on patient outcomes. Material and methods : Data from a single center prospectively maintained database of patients with PeCa who underwent primary surgery between 2010 and 2024 were analyzed, excluding those treated elsewhere. We assessed time intervals from initial disease appearance to referral across general practitioners (GP), urology or dermatology specialists (SP), and our center. We also compared disease characteristics, surgical approach, and oncological outcomes among patients referred before or after 12 months from disease appearance. Results : Overall, 48 patients were included. Median (IQR) time from presentation to our center was 12.4 (6.8-25.4) months. Referral pathways included: 13 (27%) patients were referred through GP, SP and our center [median time to treatment 13.9 (9.7-20.4)], 8 (17%) were directly referred by the GP to our center [18.2 (9.1-26)], 10 (21%) saw the SP first and were then referred to our center [6.8 (6.1-10.5)], and 17 (36%) went directly to our center [14.3 (11-24.8)]. Overall, 28 (58.3%) (Group 1) and 20 (41.7%) (Group 2) patients were surgically treated before or after 12 months of disease presentation, respectively. In Group 1, pT stage and lymphovascular invasion were significantly lower (both P ≤ 0.02). Surgery after 12 months was associated with higher risk of recurrence [OR 4.28 (CI 1.26, 22.5); P=0.03] and lower 2-year recurrence free-survival (33.8% vs. 84%; P=0.005). Conclusion : Even in a high-income country, the median time from the initial presentation of PeCa to a tertiary center is alarmingly prolonged. This delay is associated to more advanced disease at treatment and potentially worse oncological outcomes. Raising public awareness about PeCa and establishing streamlined, dedicated referral pathways should be prioritized as essential strategies.