EAU 2019: The Role of HPV in Penile Cancer Pathogenesis: An Opportunity to Start Vaccination in Boys?
Dr. Burger began his lecture by showing the data that clearly links HPV infection with a higher risk of the development of penile cancer in males. This has been widely accepted for decades, and the mechanism of pathogenesis is a combination of chronic inflammation of the penile and urethral epithelium, as well as loss of alleles on chromosome 9, which can lead to loss of p16 and p53, two commonly known tumor suppressor genes. HPV infection additionally leads to abrupt damage to other genes, which can further contribute to penile cancer development. Oncogenes E6 and E7, which are associated with HPV infection can further inactive p16 and p53. It is estimated that roughly 50% of penile cancers are HPV-associated.
As part of his argument for vaccination of boys against HPV, he noted there are three main demands to make it efficacious. It must be effective, safe, and utilized by the target population. He proceeded to show data which suggests that HPV vaccination has robust data to show that it does help prevent the development of cervical cancer in women. He acknowledges that because of the rarity of penile cancer, there may likely never be prospective data to show that HPV vaccination prevents penile cancer, but he believes that the data regarding cervical cancer is compelling. He additionally presented data to show that there is a “herd effect” in which vaccination of both young women and men leads to further decreases in the development of cervical cancer in women. He next reviewed the data evaluating the safety of HPV vaccination, which finds that it appears to be a very safe vaccine, with extremely low rates of side-effects. Finally, he showed information regarding the availability of HPV vaccinations across multiple countries in Europe. Largely, there appears to be availability and, in most countries, insurance coverage for HPV vaccinations in both males and females.
Dr. Burger concluded by showing that despite the data to support the efficacy of HPV vaccinations, the safety profile of the vaccination, and widespread availability of the vaccination, the rates of vaccination in both males and females are relatively poor globally. He believes that this is an important area for improvement and that through better awareness of the availability of the vaccination for both men and women we can further drive down the rates of cervical, oropharyngeal, and cervical malignancies. He made a call to action for physicians to help bring this issue to light and make it known that both genders can mutually benefit from the HPV vaccination. At the completion of his lecture, he took a poll of the room to see how many felt it was reasonable to vaccinate males against HPV and the vast majority of the room raised their hands in agreement.
Presented by: Maximilian Burger, MD, Dept. of Urology, Caritas St Joseph Medical Center, University of Regensburg, Regensburg, Germany
Written by: Brian Kadow, MD. Society of Urologic Oncology Fellow, Fox Chase Cancer Center at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain from March 15-19, 2019.