Unveiling the variations in penile cancer care: identifying knowledge gaps and research priorities

Penile cancer (PeCa) is a rare malignancy with substantial global variation in clinical presentation, staging practices and treatment approaches. This scoping review synthesises current evidence across key domains of PeCa management, including tumour classification, human papillomavirus (HPV) integration, organ preservation, nodal staging, systemic therapy and survivorship care. Despite recent updates in the American Joint Committee on Cancer staging system, limitations persist, particularly the absence of biologically relevant factors such as HPV status. While HPV-associated tumours may exhibit different responses to radiotherapy and systemic treatments, routine HPV testing and serotyping are not yet standardised in clinical practice. Early-stage PeCa remains amenable to organ-sparing approaches-including brachytherapy and reconstructive surgery-yet access to these modalities varies widely. Nodal management remains an area of controversy, with global inconsistencies in surgical templates and staging algorithms. Dynamic sentinel lymph node biopsy is emerging as a minimally invasive alternative but remains underused outside of high-volume centres. For node-positive disease, there is growing support for treatment intensification with chemotherapy and radiotherapy; however, prospective evidence is limited. Survivorship issues, particularly regarding psychosocial support and functional outcomes, remain poorly addressed in both research and routine care. This review identifies persistent gaps in the literature and highlights the need for international consensus-building, longitudinal data collection and equitable access to multidisciplinary care through collaborative efforts.