Unmet needs in penile cancer: Review and perspectives from the Global Society of Rare Genitourinary Tumors.

Penile cancer is an uncommon yet aggressive disease, especially at advanced stages. Management can be morbid, and patients often face a significant psychosocial impact alongside a lack of patient advocacy/support system in most parts of the globe. Local treatments can preserve penile function and provide acceptable oncologic control in selected patients. The use of organ-sparing treatments is higher in experienced centers, where adherence to guidelines is greater. Inguinal lymph node dissection remains essential in the management of this disease as it is both diagnostic and therapeutic. Several modifications to the initially described technique have been proposed with the intention of decreasing the morbidity of this procedure, which is approximately 30% for all comers. However, lack of standardization on the complication reporting and limited high-quality evidence further hinders progress in this field. For locally advanced and metastatic disease, the combination of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy is the gold standard. However, this regimen offers limited benefit in advanced stages. In contrast, chemoimmunotherapy and other systemic therapies show promising results in a few small prospective, single-arm trials several of which are still under investigation. The objective of this manuscript is to synthesize evidence on the 4 main unment needs in penile cancer: patient advocacy/quality of life, local/organ-sparing treatment, inguinal lymph node dissection (ILND), and systemic therapy, highlighting gaps in clinical care and research priorities. A focused effort in those areas is needed to advance further patient care, quality of life, and their ability to navigate this disease.