A urologist's contemporary guide to penile cancer

Few urologists deal with penile cancer on a daily basis. Owing to the rarity of the disease and its diversity in presentation, clinical experience accumulates slowly and new paradigms spread sporadically. This review provides a concise update on the background, clinical features and multidisciplinary management strategies of penile cancer. The evidence base of penile cancer management recommendations is devoid of randomized controlled trials and relies mainly on retrospective cohort studies from single institutions. In recent years, international multicentre collaboration has increased the quality of evidence. Larger study cohorts allow researchers to engage in subgroup analysis of patients with poor prognosis, of which the literature so far has been scarce. Comprehensive evidence-based guidelines are available through the European Association of Urology. This review highlights the importance of early and minimally invasive regional lymph-node staging of all patients of stage T1G2 or higher, and underlines the therapeutic potential of inguinal lymph-node dissection in lymph-node positive patients. A discussion of the oncological safety of current trends towards more phallus-sparing treatment techniques emphasizes the importance of proper case selection, thorough patient information, consequent follow-up and the possibility of a reconstructive procedure after organ-sparing ablative penile surgery. The aetiological role of human papilloma virus (HPV) is touched upon and the evidence for circumcision and HPV vaccination of boys is briefly weighed. The value of multidisciplinary treatment of advanced penile cancer is underlined and the role of chemotherapy, radiotherapy and radiochemotherapy is discussed. Finally, the perspectives for hybrid tracer sentinel node, robot-assisted lymph-node surgery and targeted therapies are addressed.