This is the best summary I could come up with:

He was determined to find out what was going on.For five years João, not his real name, went back and forth to specialists who prescribed more medication and ordered new biopsies.

This resulted in more than 4,000 deaths and, over the past decade, there have been more than 6,500 amputations - averaging two each day.Maranhão, the poorest state in Brazil, was found to have the highest incidence rate globally at 6.1 per 100,000 men.Symptoms of penile cancer often start with a sore on the penis that does not heal and a strong-smelling discharge.

Some people get bleeding and colour changes of the penis, too.When detected early, there is a high chance of recovery through treatments such as the surgical removal of the lesion, radiotherapy and chemotherapy.But if left untreated, partial or total amputation of the penis, and possibly other nearby genital organs such as the testicles, may become necessary.João underwent a partial amputation in January and says it was a difficult time.

“However, in total amputation, the urethral orifice can be relocated to the perineum, between the scrotum and the anus, requiring the patient to urinate while sitting on the toilet.”

Mauricio Dener Cordeiro of the Brazilian Society of Urology says the persistent infection of human papillomavirus (HPV), a name given to a common group of viruses, is “one of the main risk factors”.

“When a man does not expose the glans and fails to clean the foreskin properly, it produces a secretion that accumulates,” Dr Cordeiro says.

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