Penile Cancer

1. INTRODUCTION

1.1. Aim and objectives

The European Association of Urology (EAU) – American Society of Clinical Oncology (ASCO) Guidelines on Penile Cancer provide up-to-date information on the diagnosis and management of penile squamous cell carcinoma (SCC).

It must be emphasised that clinical guidelines present the best level of evidence available to the experts, but following guideline recommendations will not necessarily result in the best treatment-related outcomes for a given patient. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather, help to focus decisions. Taking patient’s personal values and preferences/individual circumstances into account is of paramount importance. Guidelines are not mandates and do not purport to be a legal standard of care. 

1.2. Panel composition

The EAU-ASCO Penile Cancer Guidelines Panel consists of an international, multidisciplinary group of clinicians, including urologists, pathologists, oncologists, radiation oncologists and patient advocates. The members of this Panel have been selected based on their expertise and to represent the multidisciplinary professionals caring for patients with penile cancer. All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU website Uroweb: http://uroweb.org/guideline/penile-cancer/.

1.3. Available publications

A quick reference document (Pocket Guidelines) is available in print and on the EAU website. The Pocket Guidelines are an abridged version of the full-text Guidelines, which may require consultation together with the full text version. This updated 2026 document presents a complete revision of the prior (2023) publication. All prior versions can be viewed at the EAU website: https://uroweb.org/guidelines/archive/penile-cancer.

An EAU Guidelines App is also available for iOS and Android devices containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, guidelines cheat sheets and links to the extended guidelines.

1.4. Publication history and summary of changes

1.4.1. Publication history

The EAU Penile Cancer Guidelines were first published in 2000. The 2023 EAU-ASCO publication was a complete revision of the prior print, and the 2026 version represents another major update.

1.4.2. Summary of changes

The literature for the complete document has been assessed, and all Chapters of the 2026 Penile Cancer Guidelines have been updated. New data have been included in the following Sections, resulting in new Sections, and new and revised guidelines:

• New text additions and references throughout Chapter 3.
• Incorporation of new text and references throughout Chapter 5, including a new Section 5.3 on genomic testing, as well as a new Figure 5.1 providing information on clinical cN0 management.
• New text additions and references throughout Chapter 6, with an updated summary of evidence in Section 6.1.5 on local treatment of penile carcinoma. A new figure is provided in Section 6.2: Figure 6.1, which provides information on regional lymph node management: clinically evident disease (cN1–cN3). Section 6.5.2.a on immunotherapy has also been restructured.
• A new figure in Section 6.5, Figure 6.2, provides information on systemic and palliative therapies for advanced disease.
• Substantial text additions have been made to Section 7, and the Section has been restructured, including the new Section 7.4.1 on the advantages of centralised care, Section 7.4.2 on Guidelines adherence, Section 7.4.3 on survival, and Section 7.4.4 on the disadvantages of centralised care.
• Updated summary of evidence and new guideline in Chapter 7 regarding follow-up and quality of life.

1.5. Preface

Penile cancer has a significant impact on quality of life (QoL) in many ways. Patients are not only exposed to the psychological and emotional stress of a cancer diagnosis and what that means for the rest of their lives, but also the psychological impact and stigma of cancer on an intimate part of the body. The treatments also cause significant physical and emotional changes, resulting in feelings of mutilation, loss of masculinity and coping with the impact on voiding and sexual function, which in turn can result in relationship breakdowns and withdrawal from society. Long-term management of lymphoedema also presents a challenge for many of these men.

As a Guidelines Panel, we have chosen to stress the importance of QoL in penile cancer at the beginning of these Guidelines. We believe strongly that these significant emotional, social and physical needs must be discussed and addressed early in the patient pathway through a holistic and multidisciplinary approach. An important part of a holistic approach is access to palliative care. The World Health Organization (WHO) definition of palliative care states it: ‘is a crucial part of integrated, people-centred health services. Relieving serious health-related suffering, be it physical, psychological, social, or spiritual, is a global ethical responsibility’ [1]. As a result, access to palliative care should be available to patients throughout their cancer pathway.

It is important to recognise the evolving needs of a patient with a diagnosis of penile cancer, even many months following the completion of treatment, and therefore appropriate follow-up and patient support services are also a critical aspect of penile cancer care.

The reality is that much of the literature on this rare cancer over the last two decades has focused on oncological outcomes rather than functional and QoL outcomes. So much more needs to be done to investigate these issues and address the many unmet needs of patients diagnosed with penile cancer, some of which are described in Table 1.1 [2].

Table 1.1: Unmet needs of patients with penile cancer