Penile Cancer

Published online ahead of print in European Urology on March 10, 2023. DOI: 10.1016/j.eururo.2023.02.027

Oscar R. Brouwer, Maarten Albersen, Arie Parnham, Chris Protzel, Curtis A. Pettaway, Benjamin Ayres, Tiago Antunes-Lopes, Lenka Barreto, Riccardo Campi, Juanita Crook, Sergio Fernández-Pello, Isabella Greco, Michiel S. van der Heijden, Peter A.S. Johnstone, Kenneth Manzie, Jack David Marcus, Andrea Necchi, Pedro Oliveira, John Osborne, Lance C. Pagliaro, Herney A. Garcia-Perdomo, R. Bryan Rumble, Ashwin Sachdeva, Vasileios I. Sakalis, Łukasz Zapala, Diego F. Sánchez Martínez, Philippe E. Spiess, and Scott T. Tagawa. 

Objective

This guideline is a collaboration between EAU and ASCO, presenting a complete revision of the prior EAU version, with the aim to offer worldwide physician and patient guidance in the management of penile cancer.

Evidence Acquisition

Comprehensive literature searches were performed for each section topic. In addition, three systematic reviews were conducted. Levels of evidence were assessed, and a strength rating for each recommendation was added based on GRADE methodology.

Evidence Synthesis

Penile cancer is a rare disease but the global incidence is rising. Human papilloma virus (HPV) is the main risk factor of penile cancer and pathology should include an assessment of HPV status. The main aims of primary tumour treatment are complete tumour eradication, which has to be balanced against optimal organ preservation without compromising oncologic control. Early detection and treatment of lymph node [LN] metastasis is the main determinant of survival. Surgical LN staging with sentinel node biopsy is recommended for cN0 patients with a high risk (≥ pT1b) tumour. While (inguinal) LN dissection remains the standard for node-positive disease, multimodal treatment is needed in patients with advanced disease. Due to a lack of controlled trials or large series, the levels of evidence and grades of recommendation are low compared with those for more common diseases.

Conclusions

The EAU-ASCO Collaborative Penile Cancer Guidelines provide updated information on the diagnosis and treatment of penile cancer for incorporation into clinical practice. Organ-preserving surgery should be offered for treatment of the primary tumour when feasible. Adequate and timely LN management remains a challenge, especially in advanced disease stages. Referral to centres of expertise is recommended.

Guideline and Conflicts of Interest

This joint EAU-ASCO Clinical Practice Guideline was led by the EAU and developed following their guideline methodology, which met Council of Medical Specialty Societies (CMSS) standards.  The Expert Panel was assembled in accordance with EAU’s Guidelines Conflict of Interest Policy (found at https://uroweb.org/eau-guidelines/methodology-policies). 

Guideline Disclaimer

The clinical practice guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. ("ASCO") to assist practitioners in clinical decision making. The information therein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating physician, as the information does not account for individual variation among patients. Recommendations reflect high, moderate or low confidence that the recommendation reflects the net effect of a given course of action. The use of words like "must," "must not," "should," and "should not" indicate that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating physician in the context of treating the individual patient. Use of the information is voluntary. ASCO provides this information on an "as is" basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions.