Prevention, diagnosis, and management of penile cancer in the LGBTQ+ community: A systematic review and meta-analysis.

Abstract

2 Background: Penile cancer is a rare but significant malignancy with unique prevention, diagnosis, and treatment challenges within the LGBTQ+ community. This systematic review and meta-analysis aims to evaluate the existing evidence on penile cancer for LGBTQ+ individuals, addressing disparities and unique needs to improve clinical outcomes. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Embase, Scopus, and clinical trial registries up to September 2024. Studies were included if they involved penile cancer prevention, screening, or treatment in LGBTQ+ populations, with no restrictions on study design or language. Data extraction focused on epidemiological patterns, risk factors (e.g., HPV infection), screening practices, diagnostic approaches, treatment modalities, and outcomes. The risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane risk-of-bias tool for randomized controlled trials. The meta-analysis used a random-effects model to pool prevention and treatment outcomes data. Results: Of the 872 studies screened, 18 met the inclusion criteria, encompassing 1,232 LGBTQ+ patients. High-risk populations included men who have sex with men (MSM) and transgender women with elevated rates of HPV-associated penile cancer. HPV vaccination was underutilized in these populations despite its potential to prevent penile cancer. Early diagnosis was often delayed due to stigma, lack of awareness, and healthcare access barriers. Treatment outcomes varied, with higher rates of post-surgical complications and psychological distress reported. Meta-analysis revealed that HPV vaccination reduced the risk of penile cancer by 60% (pooled relative risk: 0.40, 95% CI: 0.25-0.64), while early surgical intervention improved 5-year survival rates by 45% (HR: 0.55, 95% CI: 0.32-0.79). Conclusions: Penile cancer prevention and management in LGBTQ+ populations require tailored strategies, including increased HPV vaccination coverage, early screening, and culturally competent healthcare. Addressing barriers related to stigma and healthcare access could significantly improve outcomes. Further research is needed to optimize treatment protocols and incorporate LGBTQ+-specific considerations in penile cancer care. Summary of meta-analysis results. Outcome Measure Number of Studies Pooled Effect Estimate 95% Confidence Interval (CI) Heterogeneity (I²) % HPV Vaccination Effectiveness 8 Relative Risk (RR): 0.40 0.25–0.64 42 Barriers to Early Diagnosis 5 Odds Ratio (OR): 2.25 (higher risk) 1.45–3.51 38 Post-Surgical Complication Rate 4 Risk Ratio (RR): 1.30 (higher rate) 1.12–1.50 27 Psychological Distress Post-Treatment 3 Standard Mean Difference (SMD): 0.75 0.50–1.00 60 5-Year Survival Improvement with Early Surgery 6 Hazard Ratio (HR): 0.55 0.32–0.79 49