Urologie最新文献

Penile cancer is a rare disease that is associated with significant psychological and physical burdens. The pattern of metastasis in penile cancer is typically stepwise, starting from the inguinal lymph nodes, progressing to the pelvic lymph nodes, and eventually leading to distant metastases. Patient survival varies considerably: patients with a small number of regionally confined lymphatic metastases often have long-term survival prospects following surgical treatment, whereas advanced lymphatic metastasis is associated with a poorer prognosis. Current therapeutic strategies for patients with metastatic lymph node involvement aim to reduce morbidity related to radical inguinal lymphadenectomy, with appropriate risk stratification being essential to optimize oncological control and treatment success. This article discusses the current challenges of invasive lymph node management in patients with penile cancer.

Background: Penile cancer is a rare urological malignancy with approximately 36,000 new cases worldwide each year. In the first-line setting of locally advanced or metastatic disease, platinum-based chemotherapy is recommended, but it yields only moderate response rates, short remission durations, and considerable toxicity. Effective second-line treatment options are largely lacking, underscoring the urgent need for innovative therapeutic approaches.

Objective: This article aims to summarize current evidence on immunotherapeutic and targeted treatment strategies in advanced penile cancer.

Material and methods: A systematic literature search was conducted in PubMed, complemented by recent abstracts and presentations from major congresses (American Society of Clinical Oncology, ASCO; ASCO Genitourinary, ASCO GU; European Society for Medical Oncology, ESMO) and clinical trial registries (clinicaltrials.gov).

Results: Immune checkpoint inhibitor monotherapy demonstrates response rates of 13-17% in unselected cohorts, with improved outcomes in patients with high tumor mutational burden or exclusively nodal metastases. In combination with chemotherapy, response rates increased to around 40%. Epidermal growth factor receptor (EGFR)-targeted antibodies achieved remissions in approximately one third of patients, albeit generally of short duration. Based on expression patterns of various surface proteins (EGFR, HER2, Nectin‑4, Trop-2), several antibody-drug conjugates are currently being evaluated in phase II trials. Moreover, poly ADP ribose polymerase (PARP) inhibition may represent a rational option in tumors harboring alterations in homologous recombination repair genes.

Conclusion: Immuno- and targeted therapies open new perspectives for the management of advanced penile cancer. Because of the rarity of this malignancy, international collaborations are crucial to ensure adequate trial recruitment. Such efforts are essential to render innovative approaches accessible to a broader patient population and to strengthen the evidence base for future treatment strategies.

Penile cancer is a rare yet highly aggressive urological malignancy, the management of which has undergone a fundamental paradigm shift in recent years. Organ-preserving strategies have gained increasing importance and, particularly in early-stage disease, provide an oncologically safe alternative to radical surgery. This article examines the stage-specific management of the primary tumor, integrating current guideline recommendations, surgical techniques, and functional as well as psychosocial considerations. Special attention is given to the role of intraoperative frozen section analysis, the determination of adequate surgical margins, and the prognostic significance of local recurrence for overall survival. The findings underscore the necessity of individualized, risk-adapted treatment planning within specialized centers.

Background: Penile cancer is a rare and aggressive malignancy associated with considerable morbidity and mortality. International evidence consistently demonstrates superior oncological and functional outcomes when treatment is delivered in specialized centers. In Germany, however, care is provided predominantly in a decentralized manner.

Objective: To critically analyze the management of penile cancer in Germany in an international context and to develop an evidence-based centralization model aimed at reducing outcome disparities.

Methods: A scoping review of epidemiological data, registry analyses and outcome studies from national and international high-volume centers was performed, including a comparative assessment of algorithms for organ-preserving surgery, lymph node management and survival outcomes.

Results: In Germany, treatment of penile cancer is largely undertaken in low-volume hospitals with inconsistent adherence to guidelines. International experience indicates that strict centralization significantly improves stage-adapted organ preservation, surgical lymph node staging, perioperative chemotherapy, and ultimately overall survival. Key barriers include the federal healthcare structure, the absence of mandatory referral pathways, and a heterogeneous hospital landscape.

Conclusion: Without mandatory centralization, patients with penile cancer in Germany will continue to experience inferior outcomes compared with international standards. Establishing an evidence-based network of specialized centers with minimum caseload requirements, modelled on international best practice, is essential to improve care quality and equity of outcomes. Until full implementation, compulsory registration of all patients in a national second-opinion portal should be mandated.