Management of Local, Regional, and Metastatic Penile Cancer

Penile cancer is an uncommon disease, with 2320 new cases in the United States in 2018. In carefully selected patients, organ-preservation strategies are possible for low-risk disease, including topical chemotherapy, glans resurfacing, Mohs micrographic surgery, laser ablation, and radiation. Amputation with partial or radical penectomy remains the standard for high-risk tumors. As the most important predictor of survival is involvement of lymph nodes in penile cancer, careful attention must be paid to its management. In clinically negative nodes, high risk features still necessitate invasive staging with upfront modified inguinal lymph node dissection. Despite improved technique and selection, complications and morbidity are prevalent. With locally advanced disease, management has shifted more recently to a strategy of neoadjuvant chemotherapy followed by consolidative surgery. Recurrent and metastatic disease are a therapeutic challenge with a scarcity of high-level evidence and poor prognosis. With new therapies emerging in the domains of targeted therapy, immunotherapy, and foundation testing, the landscape of penile cancer continues to evolve.