Although rare, penile cancer is a disease with a high morbidity and mortality. Insight into its precursor lesions and risk factors offers measures for prevention. Careful monitoring of men with both HPV-related genital Bowen's disease, erythroplasia of Queyrat and Bowenoid papulosis and non-HPV related lichen sclerosus seems useful either to prevent penile cancer or to recognize penile cancer at an early stage, thereby offering conservative therapeutic options. Special attention is given to flat penile lesions, which contain high numbers of HPV and are highly prevalent in the male population. Their role in HPV transmission to sexual partners is highlighted, but their potential to transform as a precursor lesion into penile cancer has been explored unsatisfactorily. To date, the etiology of penile cancers is not completely understood and additional research is necessary to fully delineate the sequence of molecular events involved in HPV, non-HPV, and common (both HPV and non-HPV) mediated pathways leading to penile cancer (see Chap. 2). Options for prevention of penile cancer include (neonatal) circumcision thereby negating the effects of phimosis, limitation of penile HPV infections (either by prophylactic vaccination or condom use), and smoking cessation.

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