Penile Cancer Treatments and Their Psychiatric Sequelae: A National Analysis

Patients with penile cancer may be particularly vulnerable to depression, anxiety, and social isolation, yet population-level data on mental health outcomes are limited. We investigated the incidence and predictors of mental health disease (MHD) after penile cancer diagnosis and treatment using nationally representative data sets.

We conducted a retrospective analysis of the deidentified MarketScan Commercial Claims (MCCD) and Medicare supplemental (MSD) databases (2009-2023). Eligible patients were 18 years or older with confirmed penile cancer. Those with preexisting MHD were excluded. Treatments were categorized as radical (radical penectomy/perineal urethrostomy), partial (partial penectomy), topical (imiquimod/5-fluorouracil), or local excision. The primary outcome was new-onset MHD (major depressive disorder or generalized anxiety disorder) within 36 months. Multivariable Cox models identified predictors.

Among 1633 patients (1044 MCCD; 589 MSD), 151 (14.5%) and 83 (14.1%) developed MHD, respectively. In MCCD, radical penectomy (HR 3.33, 95% CI 1.72-6.47, P < .001), Charlson Comorbidity Index (CCI) 2 (HR 1.74, 95% CI 1.03-2.96, P = .040), and CCI 3+ (HR 2.45, 95% CI 1.54-3.91, P < .001) predicted increased MHD risk compared with local excision and a CCI of 0, respectively, while age in the third quartile was protective (HR 0.47, 95% CI 0.30-0.75, P = .001). These variables did not significantly correlate with MHD in the MSD cohort.

Patients with penile cancer face high rates of MHD, particularly after radical surgery, in the presence of comorbidities. This relationship appeared to differ between MSD and MCCD cohorts. Survivorship models should integrate timely mental health support and address access disparities.