Penile cancer and lymph node management: a call for standardization.

Area of Science:

• Oncology
• Surgical Oncology
• Urology

Background:

• Lymph node (LN) involvement is critical in penile cancer (PC) management.
• Early detection and treatment of nodal disease significantly impact survival and morbidity.

Purpose of the Study:

• To compare and organize international guidelines on penile cancer lymph node staging and treatment.
• To identify areas of consensus and divergence among major guidelines.

Main Methods:

• Comparative analysis of recommendations from leading international guidelines (NCCN, ESMO-EURACAN, EAU-ASCO).
• Focus on lymph node staging and treatment strategies for penile cancer.

Main Results:

• Open inguinal lymphadenectomy (ILND) is standard for non-superficial cancers, but minimally invasive options like video-endoscopic inguinal lymphadenectomy (VEIL) are emerging.
• Minimally invasive approaches are established for node-negative (cN0) patients, with ongoing investigation for node-positive (cN+) cases.
• Advanced disease (cN3, pelvic nodes) requires multimodal therapy (chemotherapy, surgery, radiotherapy).

Conclusions:

• Significant variability exists among current penile cancer lymph node guidelines.
• Collaborative efforts and high-quality prospective trials are essential to standardize recommendations.
• Refined, standardized guidelines will improve the management of lymph node involvement in penile cancer.