What is the commonest cause of death in Ca penis?

HPV-16 and HPV-18 have been found in one third of men with penile cancer. Risk factors included early and high sexual activity, the lifetime number of sexual paners, the number of sexual paners prior to age 20 years, age at first occurrence of intercourse, penile-oral sex, a history of anogenital was, and never having used condoms. Metastasis to the femoral and inguinal lymph nodes is the earliest path for tumor dissemination. Untreated metastatic enlargement of the regional nodes leads to skin necrosis, chronic infection, and, eventually, death from sepsis or hemorrhage secondary to erosion into the femoral vessels.