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Philippe E Spiess - One of the best experts on this subject based on the ideXlab platform.

  • adherence to eau guidelines on Penile Cancer translates into better outcomes a multicenter international study
    World Journal of Urology, 2019
    Co-Authors: Luca Cindolo, Philippe E Spiess, Juan Chipollini, Maida Bada, Peter Nyirady, Paolo Chiodini, Judith Varga, Pasquale Ditonno, Michele Battaglia, Cosimo De Nunzio
    Abstract:

    We aimed to evaluate adherence to the EAU guidelines (GL) on Penile Cancer (PC) with regard to primary surgical treatment and management of lymph nodes and to estimate the influence of adherence to GL on clinical outcome. This is a retrospective multicenter study (Penile Cancer ADherence study, PECAD Study) on PC patients treated at 12 European and American centers between 2010 and 2016. Adherence to the EAU GL on the surgical management of the primary Penile tumor and lymphadenectomy was evaluated. Descriptive analyses were performed, and survival curves were estimated. Data on 425 patients were considered for the analysis. The EAU GL on surgical treatment of the primary tumor and lymphadenectomy were respected in 74.8% and 73.7% of cases, respectively. Survival analysis showed that adherence to the GL on primary Penile surgery was significantly associated with a good overall survival [adjusted HR 0.40 (95% CI 0.20–0.83, p value = 0.014)]. Also, the adherence to the GL on lymphadenectomy was statistically significantly associated with overall survival [adjusted HR 0.48 (95% CI 0.24–0.96, p value = 0.038)]. Limited follow-up and retrospective design represent limitations of this study. Our findings suggest that there is a good adherence to the EAU GL on PC. However, this should be further reinforced, endorsed and encouraged as it might translate into better clinical outcomes for PC patients.

  • important therapeutic considerations in t1b Penile Cancer prognostic significance and adherence to treatment guidelines
    Annals of Surgical Oncology, 2019
    Co-Authors: Yao Zhu, Wen Jun Xiao, Bei He Wang, Mounsif Azizi, Philippe E Spiess
    Abstract:

    The clinical implications and contemporary management of T1b Penile Cancer are unknown. National treatment guidelines advocate surgical lymph node examination (SLNE) for T1b disease. The aim of this study was to evaluate the prognosis of T1b disease and adherence to corresponding treatment guidelines. We analyzed 296 patients from two academic centers, and 1263 patients from the Surveillance, Epidemiology, and End Results (SEER) registry (median follow-up 48.3 and 21 months, respectively). Multivariate Cox and Fine–Gray regressions were applied for Penile Cancer-specific survival (PCSS) analyses. In the academic center cohort, 28.3% of T1 patients had T1b disease, all of whom underwent SLNE. Nodal metastases were detected in 86.7% of T1b patients and 13.2% of T1a patients (p < 0.001). Using T1a as a reference, PCSS was significantly poorer in the T1b patients, with an adjusted hazard ratio (aHR) of 4.10 (p = 0.03). In the SEER cohort, 16.8% of T1 patients were classified as T1b. SLNE was performed in 21.7% of the T1b patients versus 38.2% of the T2 patients (p = 0.002). The probability of nodal metastases was 2.23-fold higher in T1b patients than in T1a patients (p < 0.001). In clinical N0M0 patients without SLNE, compared with T1a disease, T1b was associated with an aHR of 4.40 and a subdistribution HR of 4.53 for PCSS (both p = 0.003). T1b Penile Cancer is strongly associated with nodal metastases and adverse PCSS, and is poorly managed according to guidelines recommended in the nationwide registry.

  • relationship between human papillomavirus and Penile Cancer implications for prevention and treatment
    Translational Andrology and Urology, 2017
    Co-Authors: Laura Kidd, Philippe E Spiess, Anna R Giuliano, Sharon Chaing, Juan Chipollini, Pranav Sharma
    Abstract:

    Penile Cancer is a rare disease in the United States, but rates are increasing, causing concern. Several risk factors have been associated with the disease, including human papillomavirus (HPV) infection. Knowledge of HPV pathogenesis has led to the development of a vaccine, which has proven instrumental in reducing the incidence of female HPV-related Cancers, but results in men have yet to be elucidated. Fortunately, rates of vaccination are up-trending in both males and females in the past several years. In addition, targeted therapies are the focus of several ongoing research efforts. Some of these therapeutics are currently in use, while several are in trials. With continued patient education and research, both treatment and prevention of HPV-related pre-malignant lesions and Penile Cancer will likely diminish.

  • contemporary management of patients with Penile Cancer and lymph node metastasis
    Nature Reviews Urology, 2017
    Co-Authors: Andrew R Leone, Curtis A Pettaway, Gregory Diorio, Viraj A Master, Philippe E Spiess
    Abstract:

    Penile Cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in Penile Cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary Penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with Penile Cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with Penile Cancer.

  • management of Penile Cancer
    Urology, 2016
    Co-Authors: Gregory Diorio, Andrew Leone, Philippe E Spiess
    Abstract:

    Although rare, Penile Cancer carries high morbidity and mortality particularly when pertaining to the management of locally advanced or metastatic disease. The current scientific literature lacks level 1 evidence and current guidelines are based largely on retrospective studies and small single center studies. Despite these limitations, there has been paradigm shifts in the management of both local and systemic disease. Current guidelines emphasize Penile sparing strategies, minimizing morbidity from surgical management of loco-regional metastasis and multimodal management of bulky inguinal lymph node metastases. The present review highlights the current state of knowledge and recommended treatment strategies of Penile carcinoma.

Simon Horenblas - One of the best experts on this subject based on the ideXlab platform.

  • neoadjuvant taxane based combination chemotherapy in patients with advanced Penile Cancer
    Clinical Genitourinary Cancer, 2015
    Co-Authors: Rosa S Djajadiningrat, Erik Van Werkhoven, Andries M Bergman, Erik Vegt, Simon Horenblas
    Abstract:

    Abstract Introduction/Background Neoadjuvant taxane-based combination chemotherapy has shown promising results in unresectable squamous cell carcinoma of the head and neck area, and the penis. Our primary aim was to assess the objective response in Penile Cancer patients neoadjuvantly treated with taxane-based combination chemotherapy. Secondary outcomes were progression-free survival (PFS), disease-specific survival (DSS), and toxicity. Patients and Methods Twenty-six patients were treated within the framework of a nonrandomized institutional registration study with 4 courses of TPF (docetaxel, cisplatin, and 5-fluorouracil) for advanced Penile Cancer between 2008 and 2012. Response was measured using computed tomography (CT) and/or fluorodeoxyglucose positron emission tomography/CT according to Response Evaluation Criteria in Solid Tumours 1.1 criteria and European Organisation for Research and Treatment of Cancer recommendations, respectively. Toxicity, PFS, and DSS were analyzed using either the Common Toxicity Criteria of Adverse Events version 4.0 or the Kaplan-Meier methods. To analyze possible association with survival, univariable and multivariable Cox regression analyses were performed for tumor differentiation, N-category, recurrent disease, tumor margins, and administration of radiotherapy. Results During a median follow-up of 30 months, an imaging-based response was obtained in 60% (95% confidence interval [CI], 39%-79%) (15/25) of patients. However, pathologic complete response was observed in 1 of 25 evaluable patients (4%; 95% CI, 0%-20%). Toxicity was considerable with registered toxicity in every patient. The 2-year PFS and DSS probability were 12% and 28%, respectively. Patients responsive to chemotherapy had significantly better survival than nonresponsive patients. Conclusion Despite a fairly good response percentage, TPF chemotherapy was poorly tolerated with disappointing survival rates. Therefore, other treatment options should be considered.

  • human papillomavirus prevalence in invasive Penile Cancer and association with clinical outcome
    The Journal of Urology, 2015
    Co-Authors: Rosa S Djajadiningrat, Peter J F Snijders, Simon Horenblas, Ekaterina S Jordanova, Bin K Kroon, Erik Van Werkhoven, Jeroen De Jong, Divera T M Pronk, Danielle A M Heideman
    Abstract:

    Purpose: The incidence of Penile Cancer is increasing, and is suggested to be explained by changes in sexual practice and increased exposure of men to sexually transmitted high risk human papillomavirus infection. In Penile Cancers from a Dutch population treated in 1963 to 2001 we found a high risk human papillomavirus prevalence of about 30%. In this study we assessed the prevalence of high risk human papillomavirus-DNA in a more recent, contemporary Penile Cancer cohort and its association with patient survival.Materials and Methods: High risk human papillomavirus-DNA presence was assessed by GP5+6+ polymerase chain reaction in 212 formalin fixed, paraffin embedded invasive Penile tumor specimens of patients treated between 2001 and 2009. The 5-year disease specific survival was calculated using the Kaplan-Meier method with the log rank test and Cox regression.Results: High risk human papillomavirus-DNA was detected in a subset of Penile Cancer cases (25%, 95% CI 19–31). HPV16 was the predominant type,...

  • Penile Cancer organ sparing techniques
    BJUI, 2014
    Co-Authors: Paul K Hegarty, Suks Minhas, Philippe E Spiess, Nick Watkin, Ian Eardley, Axel Heidenreich, Scott W Mcdougal, Simon Horenblas
    Abstract:

    To compare the oncological safety of treating patients with Penile Cancer with conservative techniques developed to preserve function, cosmesis and psychological well-being with more radical ablative strategies. We conducted an extensive review of the literature of Penile-preserving and ablative techniques and report on the oncological as well as functional outcomes. There were no randomised studies comparing Penile-preserving and ablative techniques. Most studies consisted of retrospective cohorts. The quality of evidence was level 3 at best. Cancer-specific survival is similar in Penile-preserving and ablative approaches for low-stage disease. Penile preservation is better for functional and cosmetic outcomes and should be offered as a primary treatment method in men with low-stage Penile Cancer.

  • quality of life for patients treated for Penile Cancer
    The Journal of Urology, 2014
    Co-Authors: Jacobien M Kieffer, Simon Horenblas, Rosa S Djajadiningrat, Erik Van Muilekom, Niels M Graafland, Neil K Aaronson
    Abstract:

    Purpose: We assessed the impact of primary surgery, including Penile sparing surgery vs (partial) penectomy and lymphadenectomy, on sexuality and health related quality of life.Materials and Methods: We invited 147 patients surgically treated for Penile Cancer at our institution between 2003 and 2008 to complete the IIEF-15, SF-36®, IOC (version 2) and questions on urinary function. We evaluated the impact of primary surgery type and lymphadenectomy on these outcomes. We also compared patient SF-36 scores with those of an age and gender matched normative sample from the general Dutch population.Results: A total of 90 patients (62%) returned a completed questionnaire. Surgery type and extent were not associated significantly with most of the study outcomes assessed. However, men who underwent (partial) penectomy reported significantly more problems than those treated with Penile sparing surgery, including orgasm (effect size 0.54, p = 0.031), appearance concerns (effect size 0.61, p = 0.008), life interfer...

  • population based survival of Penile Cancer patients in europe and the united states of america no improvement since 1990
    European Journal of Cancer, 2013
    Co-Authors: Rob H A Verhoeven, Simon Horenblas, Maryska L G Janssenheijnen, Kaiuwe Saum, Roberto Zanetti, Adele Caldarella, Bernd Holleczek, D H Brewster, Timo Hakulinen, Hermann Brenner
    Abstract:

    Abstract Introduction Penile Cancer is a rare neoplasm in Western countries, and detailed studies on trends in population-based survival of Penile Cancer have never been published before. We examined population-based trends in survival in Europe and the United States of America (USA). Methods Data from 3297 European and 1820 American Penile Cancer patients, contributed by 12 European Cancer registries and the Surveillance, Epidemiology, and End Results (SEER) Program of the USA were included in this study. Period analysis techniques were used to examine relative survival trends overall, as well as for four geographic regions in Europe, and for the age groups 15–54, 55–64, 65–74 and 75+ for both populations between 1990–1995 and 2002–2007. Survival trends were assessed in a multiple regression model of relative excess risk including period of diagnosis, age and continent. Results The 5-year relative survival of Penile Cancer patients increased statistically non-significantly from 65% to 70% in Europe and decreased (significantly) from 72% to 63% in the USA. Trends in age-specific 5-year relative survival did not find any significant improvement in either Europe or the USA. The multiple regression analysis confirmed the lack of survival trend, and found significantly higher relative excess risk with age, and, apparently due to lower survival before 2002–2007, higher risk in Europe. Conclusion Survival for Penile Cancer patients has not improved in either Europe or the USA since at least 1990. The reasons for the decrease of survival in the USA remain unknown and to be explored. Stronger international cooperation in clinical research may be important to facilitate clinical progress in treatment and thereby improvement of survival of this rare malignancy.

Pheroze Tamboli - One of the best experts on this subject based on the ideXlab platform.

  • association between lymph node density and disease specific survival in patients with Penile Cancer
    The Journal of Urology, 2009
    Co-Authors: Robert S. Svatek, Jordan M Kincaid, Paul K Hegarty, Joel W Slaton, Erik J Busby, Kris E Gaston, Lance C Pagliaro, Mark F Munsell, Philippe E Spiess, Pheroze Tamboli
    Abstract:

    Purpose: We assessed the value of lymph node density for predicting disease specific survival after lymphadenectomy for Penile Cancer.Materials and Methods: Data were collected retrospectively in 75 and prospectively in 88 consecutive patients with squamous cell carcinoma of the penis treated at M. D. Anderson Cancer Center between 1979 and 2007. We identified 45 patients with Penile Cancer and nodal metastasis who underwent lymphadenectomy with curative intent. Lymph node density was analyzed as a categorical variable by grouping patients into 2 or 3 categories based on equal percents. We explored the prognostic value of lymph node density for predicting disease specific survival in this cohort.Results: Median followup was 23.7 months in all patients. By the time of analysis 22 patients had died, including 18 (82%) of Penile Cancer and 4 (18%) of other causes. Median lymph node density in patients alive or dead of other causes was 3.4% (IQR 2.9–5.9) compared to 43.3% (IQR 15.6–80) in those dead of diseas...

  • preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging Penile Cancer results with pathological correlation
    The Journal of Urology, 2007
    Co-Authors: Philippe E Spiess, Pheroze Tamboli, Jonathan I Izawa, Roland L Bassett, Daniel Kedar, Joseph E Busby, Franklin Wong, Teresa Eddings, Curtis A Pettaway
    Abstract:

    Purpose: We assessed the sensitivity of preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging the inguinal region of patients with Penile Cancer and no palpable inguinal adenopathy.Materials and Methods: The records of 31 patients with invasive Penile Cancer and nonpalpable (29) or nonsuspicious (2) inguinal lymph nodes were reviewed. Preoperatively lymphoscintigraphy plus dynamic sentinel node biopsy with 99mtechnetium labeled sulfur colloid and isosulfan blue dye was performed in 21 patients and dynamic sentinel node biopsy alone with blue dye only was done in 10. All patients underwent superficial lymph node dissection regardless of preoperative lymphoscintigraphy or dynamic sentinel node biopsy findings to establish pathological nodal status.Results: Six of 32 groins that showed drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. The sensitivity of preoperative lymphoscintigraphy drainage for Cancer detection was 8...

Curtis A Pettaway - One of the best experts on this subject based on the ideXlab platform.

  • contemporary management of patients with Penile Cancer and lymph node metastasis
    Nature Reviews Urology, 2017
    Co-Authors: Andrew R Leone, Curtis A Pettaway, Gregory Diorio, Viraj A Master, Philippe E Spiess
    Abstract:

    Penile Cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in Penile Cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary Penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with Penile Cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with Penile Cancer.

  • preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging Penile Cancer results with pathological correlation
    The Journal of Urology, 2007
    Co-Authors: Philippe E Spiess, Pheroze Tamboli, Jonathan I Izawa, Roland L Bassett, Daniel Kedar, Joseph E Busby, Franklin Wong, Teresa Eddings, Curtis A Pettaway
    Abstract:

    Purpose: We assessed the sensitivity of preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging the inguinal region of patients with Penile Cancer and no palpable inguinal adenopathy.Materials and Methods: The records of 31 patients with invasive Penile Cancer and nonpalpable (29) or nonsuspicious (2) inguinal lymph nodes were reviewed. Preoperatively lymphoscintigraphy plus dynamic sentinel node biopsy with 99mtechnetium labeled sulfur colloid and isosulfan blue dye was performed in 21 patients and dynamic sentinel node biopsy alone with blue dye only was done in 10. All patients underwent superficial lymph node dissection regardless of preoperative lymphoscintigraphy or dynamic sentinel node biopsy findings to establish pathological nodal status.Results: Six of 32 groins that showed drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. The sensitivity of preoperative lymphoscintigraphy drainage for Cancer detection was 8...

Alex Freeman - One of the best experts on this subject based on the ideXlab platform.

  • glansectomy and split thickness skin graft for Penile Cancer
    European Urology, 2018
    Co-Authors: Angela Parnham, Michelle Christodoulidou, P Malone, Maarten Albersen, Varun Sahdev, Raj Nigam, Alex Freeman
    Abstract:

    Abstract Background Penile Cancer is a rare malignancy that is confined to the glans in up to four out of five cases. Although descriptions of glansectomy exist, there are no contemporary video explanations or large published single centre series. Objective To show the efficacy and safety of glansectomy and split-thickness skin graft (STSG) reconstruction. Design, setting, and participants Data were collected retrospectively for patients identified from surgical theatre diaries between February 2005 and January 2016. 177 patients with histologically proven squamous-cell carcinoma on the glans underwent glansectomy and STSG at a tertiary referral centre in the UK. The median follow-up was 41.4 mo. Surgical procedure The skin is incised at the subcoronal level and deepened onto Buck's fascia. Dissection is performed over or under Buck's fascia, depending on suspicion of invasion or risk of disease. The glans is excised and a neoglans is created using a STSG. Measurements Local recurrence, Cancer-specific survival, overall survival, and complications. Results and limitations Sixteen out of 172 patients (9.3%) experienced local recurrence during the follow-up period. Eighteen out of 174 (10.7%) patients died of Penile Cancer, while 29 patients in total died during the follow-up period. Of 145 patients, 9% required operative intervention for complications, including graft loss and meatal stenosis. Limitations include the retrospective data collection and the lack of functional and sexual outcomes. Conclusions Glansectomy and STSG comprise a safe procedure in terms of oncologic control and complications for patients with Penile Cancer confined to the glans penis. Further studies are required to assess functional and sexual outcomes in these patients. Patient summary We report on the management of Penile Cancers confined to the head of the penis using glansectomy and a split-thickness skin graft to recreate the appearance of a glans. This technique is safe and effective, with limited complications.

  • glansectomy and split thickness skin graft for Penile Cancer
    European Urology, 2018
    Co-Authors: Angela Parnham, Michelle Christodoulidou, P Malone, Maarten Albersen, Varun Sahdev, Raj Nigam, Alex Freeman
    Abstract:

    Abstract Background Penile Cancer is a rare malignancy that is confined to the glans in up to four out of five cases. Although descriptions of glansectomy exist, there are no contemporary video explanations or large published single centre series. Objective To show the efficacy and safety of glansectomy and split-thickness skin graft (STSG) reconstruction. Design, setting, and participants Data were collected retrospectively for patients identified from surgical theatre diaries between February 2005 and January 2016. 177 patients with histologically proven squamous-cell carcinoma on the glans underwent glansectomy and STSG at a tertiary referral centre in the UK. The median follow-up was 41.4 mo. Surgical procedure The skin is incised at the subcoronal level and deepened onto Buck's fascia. Dissection is performed over or under Buck's fascia, depending on suspicion of invasion or risk of disease. The glans is excised and a neoglans is created using a STSG. Measurements Local recurrence, Cancer-specific survival, overall survival, and complications. Results and limitations Sixteen out of 172 patients (9.3%) experienced local recurrence during the follow-up period. Eighteen out of 174 (10.7%) patients died of Penile Cancer, while 29 patients in total died during the follow-up period. Of 145 patients, 9% required operative intervention for complications, including graft loss and meatal stenosis. Limitations include the retrospective data collection and the lack of functional and sexual outcomes. Conclusions Glansectomy and STSG comprise a safe procedure in terms of oncologic control and complications for patients with Penile Cancer confined to the glans penis. Further studies are required to assess functional and sexual outcomes in these patients. Patient summary We report on the management of Penile Cancers confined to the head of the penis using glansectomy and a split-thickness skin graft to recreate the appearance of a glans. This technique is safe and effective, with limited complications.

  • the role of magnetic resonance imaging in the local staging of Penile Cancer
    European Urology, 2007
    Co-Authors: Oliver Kayes, Suks Minhas, Alex Freeman, Clare Allen, Chris Hare, David J Ralph
    Abstract:

    Abstract Objectives To assess the accuracy of magnetic resonance imaging (MRI) as a local staging technique in Penile Cancer and its role in selecting patients for conservative surgical management. Methods Fifty-five men diagnosed with invasive Penile carcinoma on biopsy were locally staged with the use of MRI. Prostaglandin E1 (alprostadil) was injected into the corpora to induce an artificial erection. Radiologic staging was compared against final histopathologic stage of the tumour. Sensitivity, specificity, and kappa agreement values were calculated for each tumour stage. Additionally, corpora cavernosa involvement was reviewed in 20 consecutive cases and suitability for conservative surgery assessed. Results A good correlation between radiologic and histologic staging was achieved with an overall kappa value of 0.75 ( p Conclusions This study demonstrates that Penile MRI is highly accurate in the local staging of Penile Cancer. Associated improvements in surgical planning allow the provision of conservative surgical treatments over more radical procedures.

  • a prospective study of 100 cases of Penile Cancer managed according to european association of urology guidelines
    BJUI, 2006
    Co-Authors: Paul K Hegarty, Alex Freeman, Oliver Kayes, David J Ralph, N Christopher, Suks Minhas
    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. PATIENTS AND 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. CONCLUSION 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.