title: EAU guidelines on penile cancer: 2014 update.
abstract: BACKGROUND
  Penile cancer has high mortality once metastatic spread has occurred. Local treatment can be mutilating and devastating for the patient. Progress has been made in organ-preserving local treatment, lymph node management, and multimodal treatment of lymphatic metastases, requiring an update of the European Association of Urology guidelines.
  
  
  OBJECTIVE
  To provide an evidence-based update of treatment recommendations based on the literature published since 2008.
  
  
  METHODS
  A PubMed search covering the period from August 2008 to November 2013 was performed, and 352 full-text papers were reviewed. Levels of evidence were assessed and recommendations graded. Because there is 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.
  
  
  RESULTS
  Penile squamous cell carcinoma occurs in distinct histologic variants, some of which are related to human papilloma virus infection; others are not. Primary local treatment should be organ preserving, if possible. There are no outcome differences between local treatment modes in superficial and T1 disease. Management of inguinal lymph nodes is crucial for prognosis. In impalpable nodes, invasive staging should be done depending on the risk factors of the primary tumour. Lymph node metastases should be treated by surgery and adjuvant chemotherapy in N2/N3 disease.
  
  
  CONCLUSIONS
  Organ preservation has become the standard approach to low-stage penile cancer, whereas in lymphatic disease, it is recognised that multimodal treatment with radical inguinal node surgery and adjuvant chemotherapy improves outcome.
  
  
  RESULTS
  Approximately 80% of penile cancer patients of all stages can be cured. With increasing experience in the management of penile cancer, it is recognized that organ-preserving treatment allows for better quality of life and sexual function and should be offered to all patients whenever feasible. Referral to centres with experience is recommended.
authors.affiliation: Department of Urology, University Hospital Rostock, Rostock, Germany. Electronic address: oliver.hakenberg@med.uni-rostock.de.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.affiliation: Department of Pathology, Hôpital La Pitié-Salpétrière, Université Pierre et Marie Curie University Paris VI, Paris, France.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Compérat
authors.affiliation: Department of Urology, University College Hospital, London, UK.
authors.forename: Suks
authors.initials: S
authors.lastname: Minhas
authors.affiliation: Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Department of Urology, University Hospital Rostock, Rostock, Germany.
authors.forename: Chris
authors.initials: C
authors.lastname: Protzel
authors.affiliation: Department of Urology, St George's Hospital, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Watkin
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D010412:Penile Neoplasms / Q000473:pathology* / Q000628:therapy*
keywords: Chemotherapy; European Association of Urology; Follow-up; Guidelines; Invasive disease; Laser; Lymph node; Metastasis; Penile cancer; Quality of life; Reconstruction; Squamous cell carcinoma; Surgery