Introduction: Disparities exist amongst HPV-related cancer outcomes in urban versus rural populations, including squamous cell carcinoma (SCC) of the penis. West Virginia presents a unique opportunity for analysis in underserved areas with few tertiary care centers and large distances and travel time between centers. This study seeks to examine differences in penile cancer presentation (including TNM stage, grade, pertinent risk factors, presenting symptoms and duration), treatment, and outcomes between rural and urban populations in West Virginia. Identification is crucial to provide earlier intervention and improve outcomes in an underserved population. Methods: Following IRB approval, 89 patients with biopsy-proven SCC of the penis treated at Charleston Area Medical Center (CAMC) and West Virginia University over a fourteen-year period (2007-2022) were studied retrospectively. Distance and travel time from care centers were collected, and patients were stratified into urban and rural groups according to the US Census Bureau definition. T-stage, clinical node positivity, grade, risk factors, primary tumor size and location, and treatment modality and timing were analyzed. Appropriate statistical tests were performed using SPSS. Results: Patients living increased travel times from the respective centers were more likely to undergo radical penectomy as primary therapy (p=0.03), although advanced stage (pT2 or greater) and clinical nodal status did not vary with travel time. Those living in counties classified as “urban” had higher BMI on average (p=0.004) and were more likely to present with a lesion on the penile shaft (p=0.06). No difference exists in stage or grade at diagnosis, other risk factors (smoking status, circumcision), primary tumor size, clinically palpable lymph nodes, radiation and chemotherapy, symptom duration, or timing of therapy based on distance or travel time or when stratified based on rural/urban county of residence. Conclusions: Patients further from tertiary care centers in terms of travel time are more likely to undergo radical penectomy as definitive therapy for penile cancer. This was not significant when analyzed by distance from tertiary care center, as may be expected in a rural state where distance and travel time can vary markedly. Also, this did not occur due to higher risk disease based on pT stage. When stratified based on census definitions, rural patients had lower BMI and presented less often with disease of the penile shaft, suggesting they may opt for a definitive radical penectomy due to difficulties with healthcare access. SOURCE OF Funding: None.
