Key changes for the 2018 print:

Chapter 3 - Epidemiology, aetiology and pathology. New information has been added on the various

histological subtypes of penile carcinomas, risk factors and human papilloma virus (HPV) association.

New and changed recommendations can be found in sections:

3.4.8 Guidelines for the pathological assessment of tumour specimens

Recommendations	Strength rating
The pathological evaluation of penile carcinoma specimens must include an assessment of the human papilloma virus status.	Strong
The pathological evaluation of penile carcinoma specimens must include a diagnosis of the squamous cell carcinoma subtype.	Strong
The pathological evaluation of penile carcinoma surgical specimens must include an assessment of surgical margins including the width of the surgical margin.	Strong

4.2 Guidelines on staging and classification

Recommendations	Strength rating
The pathological evaluation of penile carcinoma specimens must include the Ptnm stage and an assessment of tumour grade.	Strong

5.4 Guidelines for the diagnosis and staging of penile cancer

Recommendations	Strength rating
Primary tumour
Obtain a penile Doppler ultrasound or MRI with artificial erection in cases with intended organ-sparing surgery.	Weak

6.2.6 Guidelines for treatment strategies for nodal metastases

Regional lymph nodes	Management of regional lymph nodes is fundamental in the treatment of penile cancer	Strength rating
Radiotherapy	Not recommended for nodal disease except as a palliative option.	Strong

6.3.6 Guidelines for chemotherapy

Recommendations	Strength rating
Offer patients with pN2-3 tumours adjuvant chemotherapy after radical lymphadenectomy (three to four cycles of cisplatin, a taxane and 5-fluorouracil or ifosfamide).	Strong
Offer palliative chemotherapy to patients with systemic disease.	Weak

A systematic review (SR) was performed by the Panel on ‘Risks and benefits of adjuvant radiotherapy after inguinal lymphadenectomy in node-positive penile cancer’. Even though not fully published, the review findings support the information presented in Section 6.2.2.3 Adjuvant treatment.

This review was performed using standard Cochrane SR methodology: http://www.cochranelibrary.com/about/about-cochrane-systematic-reviews.html

Summary of changes