Abstract and Introduction
Abstract
Purpose of Review: This article presents a critical review of the current literature to provide a brief update on the contemporary advances in diagnosing and managing N1 penile cancer.
Recent Findings: Penile squamous cell carcinoma (pSCC) has evolved from being an orphan field for cancer innovation. Advances in the understanding tumour biology have enabled sophisticated diagnostics and predictive modelling to better characterize inguinal disease. Minimally invasive inguinal lymph node dissection is emerging as a technique that reduces morbidity while maintaining oncological safety. Furthermore, robust clinical trials are underway, which will provide level one evidence to guide treatment decisions. Exciting advances in the field of immune-oncology offer promise as adjuvant therapies. International collaboration and centralisation of care will be essential to driving translational research and equitable evidence-based care.
Summary: Improving outcomes for men with pSCC remains a global challenge. Radical inguinal lymph node dissection remains the gold standard for diagnosing and curing N1 disease. Although many promising developments are on the horizon, high-level evidence is required to guide therapy.
Introduction
Penile squamous cell carcinoma (PSCC) is a rare yet highly aggressive disease. The global incidence is approximately 36 000 cases with 13 000 deaths, with the highest burden of disease occurring in developing countries.[1] PSCC often arises from a painless ulceroproliferative lesion on the glans, which is prone to obscuration by phimosis. Penile tissue invasion occurs insidiously before rapid lymphatic dissemination. With few exceptions, PSCC tumours spread to a superficial sentinel lymph node, the deep inguinal chain then to nodes in the ipsilateral pelvis.[2,3] Distant metastasis occurs in the context of a high nodal disease burden.
Prognosis declines precipitously in men with metastatic disease.[4] However, due to a lack of awareness and psychosocial barriers, 20–40% of men present with malignant lymphadenopathy.[5–7] Effective management requires timely, aggressive and stage-specific treatment.
Centralization has recently improved evidence generation for applying new technologies and targeted therapeutics in the node-positive pSCC. This article presents a critical review of the current literature to provide a brief update on the contemporary advances in diagnosing and managing N1 pSCC.
Curr Opin Urol. 2023;33(1):64-69. © 2023 Wolters Kluwer Health, Inc.
