Management of bulky inguinal/pelvic metastases in squamous penile cancer

Lymph node metastases constitute a major prognostic factor in penile cancer patients. Therefore, rapid and meticulous evaluation of penile cancer patients is crucial in making timely treatment decisions. This is especially critical for penile cancer patients with bulky inguinal and pelvic lymph node metastases due to the poor prognosis and potentially narrow curative window associated with these metastases. In order to provide these patients with the most favorable outcomes, the management of these patients should follow an aggressive multidisciplinary approach that includes surgery, chemotherapy, and occasionally radiotherapy. Currently, there are ongoing studies investigating the optimal sequencing and combination regimens of the abovementioned lines of treatment. Furthermore, novel investigational therapies such as tumor kinase inhibitors and immune check point inhibitors are also being investigated and have shown promising outcomes. In this chapter, we will review and discuss the current advances in the management of penile cancer patients in the setting of bulky inguinal or pelvic lymph node metastases.