Managing advanced penile cancer in 2014

Purpose of review To highlight the recent treatment recommendations that are proposed to improve the outcomes of patients with advanced penile cancer. Recent findings Penile cancer is a rare disease that presents with many diagnostic and treatment specificities. Adequate treatment requires interdisciplinary discussions involving urologist oncologists, medical oncologists and radiation oncologists as well as many other health professionals. Localized disease can now be adequately treated with many different penile-sparing approaches associated with close surveillance. However, many patients present with high-risk features associated with an unfavorable outcome. Recent data and multiple interdisciplinary collaborative groups have fueled a more standardized approach to the treatment of these patients, leading to better survival outcomes and improved quality of life. This review will focus on the recognition of high-risk disease; the indications of lymph node dissections and minimally invasive surgical approaches; the role of neoadjuvant therapy in the setting of advanced lymph node involvement as well as the potential role of targeted therapy for the salvage treatment of metastatic disease. Summary Improved outcomes in advanced penile cancer requires an integrated approach, including better identification of high-risk disease, use of novel dynamic sentinel lymph node identification techniques and use of neo-adjuvant chemotherapy in selected patients with advanced lymph node involvement. Such cases should preferentially be managed by a dedicated interdisciplinary team.