Patient Survives Penile Cancer

Bill Mullins never realized that he would have a story to share with men. But what happened to him is, he feels, a tale of caution for those of his gender who are uncircumcised - who retain the foreskin of their penis.
 
Mullins, a 46-year-old retired Navy aircraft mechanic, is a survivor of penile cancer, a rare disease that affects only one in 100,000 men, most commonly uncircumcised males. His was an aggressive disease, and his treatment included a partial penectomy, which involved surgical removal of part of his penis and groin. But had Mullins been correctly diagnosed early on, such steps may not have been necessary.
 
And that is Mullins’ bottom-line message. “No one wants to hear you have cancer, but when things don’t add up, seek an answer,” he says. “You know your body better than you think you do.”
 
Seeking answers

He knew something was wrong when, in 1997, he was running on a beach where he lives with his family in Panama City, Florida, and was quickly tired. His doctor diagnosed a small lump Mullins knew he had in his groin as a hernia. Mullins thought that didn’t make sense. Could a hernia cause fatigue? But he didn’t argue.
 
That is, until the little lump grew, becoming the size of a tennis ball within several months. Mullins developed chills, fever and nausea and visited several physicians. He had a biopsy, in which a small piece of tissue in the lump was removed and examined. “They told me they didn’t know what it was, but it wasn’t cancerous,” he remembers. “I was given some antibiotics.”
 
The medication didn’t help, and now Mullins was becoming alarmed. “In my heart I knew after awhile it wasn’t a hernia.” Another physician told him that it was just his psoriasis “acting up and swelling.” He had long had a red spot on the end of his penis, within the foreskin, which was checked out around 1990 by a dermatologist as possible psoriasis, a benign skin condition. He was told then not to worry, that it was nothing.
 
Diagnosis

Finally, he went back to his dermatologist, who began to suspect cancer. On the advice of a friend, Mullins asked that his biopsy be sent to M. D. Anderson. The results confirmed penile cancer. “I was shocked, to say the least,” he says. “I had never heard of penile cancer.”
 
Mullins immediately went to the Internet and learned this cancer can occur in men who retain the foreskin covering the tip of their penis. In fact, the risk of developing invasive penile cancer among men who are not circumcised at birth, compared to those who are, is 22-to-1 in the United States. 
 
Why Mullins developed the cancer is unknown. Risk factors identified to date are issues of hygiene, infection by human papilloma virus (HPV), or even cigarette smoking. (See related story) These same carcinogens are implicated in the development of head and neck as well as cervical cancers.
 
He also learned from his research “that I probably had a bad prognosis.”
 
He did indeed. His M. D. Anderson oncologist, Curtis Pettaway, M.D., said Mullins’ disease had spread to lymph nodes on the left side of his groin and such an advanced prognosis usually meant limited survival. “For those patients with poor prognostic factors, the five-year survival rate is between zero and 10%,” says Pettaway, an associate professor in the Department of Urology.
 
In Mullins’ case, survival was estimated to be between six months and one year, given traditional treatment. “I went downhill for a little while after I heard that,” he says. “But Dr. Pettaway and his colleagues are a great group, and were doing everything to keep me calm.”
 
Treatment options

Pettaway wasn’t content to treat Mullins in a routine manner. Other cases at M. D. Anderson, which likely sees more cases of penile cancer than any other cancer center, suggested value in an aggressive approach that started with treating patients with chemotherapy before surgery.
 
“This is an unusual approach, but it helps reduce tumor size before surgery,” Pettaway says.
 
As a candidate for M. D. Anderson’s new treatment, Mullins received four cycles of a combination of three chemotherapy drugs normally used to treat head and neck squamous cell cancer. Then he had surgery, which included removal of affected lymph nodes on both sides of his groin, followed by chemotherapy.
 
That was in 1998. Mullins is now six years out from his treatment and is considered a cancer survivor. “Bill wanted to see his son and daughter grow up, and he was willing to go for aggressive systemic therapy,” Pettaway says. “It shows us that such an approach can successfully treat patients who were once considered incurable.” Mullins’ chance of recurrence is now less than 10%.
 
“I feel beyond lucky. Cancer is not going to get me,” Mullins says. “My life has definitely changed since my diagnosis, not necessarily for the worse, and I have never lost the love and support of my wife and family.
 
“The moral of my story is don’t take anything for granted,” he says, “especially your health.”