title: Metastatic penile carcinoma - an update on the current diagnosis and treatment options.
abstract: BACKGROUND
  Penile carcinoma has an incidence of 4,000 cases in Europe. The therapy and prognosis depend decisively on the lymph node status. Lymph node metastases are detected in 23-65% cases depending on the histopathological pattern. Due to improved diagnostic methods an early detection of tumor stage is possible. Multimodal therapeutic concepts can offer curability for a subset of patients, even those suffering from advanced disease.
  
  
  METHODS
  Current data on penile cancer based on a selective review of the literature by PubMed and the EAU guidelines 2009.
  
  
  RESULTS
  Invasive diagnostic tools, such as fine-needle biopsy (FNB) and dynamic sentinel node biopsy (DSNB), improved the diagnosis of lymph node status considerably and reduced the morbidity in specialized centers. The application of 18F-FDG-PET/CT for metastases detection needs further evaluation due to inconsistent results. Inguinal lymphadenectomy is the therapeutic standard in case of metastases proof. It was possible to reduce the complications due to the new modified operation techniques. Patients with extended lymph node and distant metastases have a poor prognosis. Different systemic polychemotherapy regimes are applied currently and are associated with poor outcome (response rates <50%) and high morbidity. Neoadjuvant chemotherapy is recommended in patients with unresectable and relapsing lymph node metastases.
  
  
  CONCLUSIONS
  Currently, inconsistent therapy regimens are applied for metastatic penile cancer. Standardization is urgently needed through the development of high-quality studies and long-term registers in order to lower the morbidity and increase the efficiency of diagnosis and therapy.
authors.affiliation: Department of Urology, Lukas Hospital, Neuss, Germany.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Barski
authors.affiliation: Department of Urology, Lukas Hospital, Neuss, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Georgas
authors.affiliation: Department of Urology, Lukas Hospital, Neuss, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Gerullis
authors.affiliation: Helios Hospital, Bad Saarow, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Ecke
keywords: adjuvant chemotherapy; diagnostic imaging; lymphadenectomy; penile cancer; sentinel lymph node biopsy