title: A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines.
abstract: OBJECTIVE
  To prospectively assess the outcome of patients treated according to the European Association of Urology (EAU) guidelines on the management of penile cancer, a system originally based on retrospective series.
  
  
  METHODS
  Between 2002 and 2005, 100 consecutive patients (median age 62 years) with penile cancer were treated at one institution; all were categorized and treated according to EAU guidelines. Data were analysed using the z-test, with significance defined as P < 0.05.
  
  
  RESULTS
  Survival curves were limited to those with >12 months of follow-up (mean 29); the survival of the whole group was 92%. Of men with palpable nodes, 72% had lymph node involvement, whereas 18% of those with impalpable nodes who had lymphadenectomy according to the guidelines had lymph node disease. The grade of the primary tumour was more predictive than T stage for lymph node involvement and survival. The 3-year disease-specific survival for N0, N1 and N2 disease was 100%, 100% and 73%, respectively, and survival at 12 months for N3 disease was 67%. The median survival for those with metastases was 3 months.
  
  
  CONCLUSIONS
  The overall survival of men with penile cancer is high, with a clear benefit for early lymphadenectomy in men with positive nodal disease. However, the current EAU guidelines are limited in predicting those patients with micrometastatic disease, with the result that 82% of patients undergo unnecessary prophylactic lymphadenectomy. There is a need to identify more accurate molecular markers for predicting lymph node disease, or the role of novel staging techniques must be assessed.
authors.affiliation: Urology, Institute of Urology, and Pathology, University College Hospital London, London, UK. Paulhego@hotmail.com
authors.forename: Paul K
authors.initials: PK
authors.lastname: Hegarty
authors.forename: Oliver
authors.initials: O
authors.lastname: Kayes
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.forename: Nim
authors.initials: N
authors.lastname: Christopher
authors.forename: David J
authors.initials: DJ
authors.lastname: Ralph
authors.forename: Suks
authors.initials: S
authors.lastname: Minhas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies