Penile cancer articles from across Nature Portfolio

In this Review, Joshi and colleagues describe the immune landscape of penile cancer, examine existing and novel immune-based therapeutic targets, and discuss the future directions of immune-based therapies in penile cancer based on preclinical and clinical studies.

Penile cancer is a growing health-care concern worldwide. Despite its rarity, penile cancer has a disproportionate impact on some countries, as the location with the highest incidences are invariably those with low resources and few registries or trials. In this Perspective, the authors discuss how global collaboration and centralization of care can help to improve management of penile cancer worldwide, but especially in areas where resources are limited.

Centralization of care for penile cancer has been underscored in the 2023 updated EAU–ASCO guidelines. Expertise consolidation enhances patient care, addressing penile cancer complexities from diagnosis to treatment. Centralization initiatives, like the European Reference Networks, and dedicated scientific societies have crucial roles in guiding centralized care pathways to ultimately improve patient outcomes.

Controversies over how, why and when pelvic lymph node dissection (PLND) should be performed persist. Available data suggest that a limited number of patients will experience a curative benefit from PLND, but it remains the most tried and tested diagnostic tool for staging. New techniques aim to improve noninvasive detection of diseased nodes.

Organ-sparing surgery for the management of penile cancer is a dogma underpinned by previous research demonstrating no change in cancer-specific survival in cases of local recurrence. However, a new multicentre study of 897 patients treated with glansectomy for penile cancer challenges this view.

Detection of positive nodes in men with moderate-risk to high-risk penile cancer and impalpable inguinal nodes is an important step in the therapeutic pathway. Detection using dynamic sentinel node biopsy with patent blue dye and radioisotope is associated with false negatives; indocyanine green might offer an alternative adjunct to improve detection rates.