In this paper cancer-specific and other-cause mortality in patients with node-negative low stage penile cancer who did not undergo initial treatment of the regional lymph nodes was examined. The 5-year cancer-specific mortality increased from 2.6%, 10.0% to 15.9% for G1, G2 and G3 tumours, respectively. Similar to the European Association of Urology (EAU) guidelines, the authors consider a lymph node dissection justified in patients with G3 tumours and wait and see in G1 tumours. In oncology a risk reduction of 5%–10% is considered more than enough to advise a host of adjuvant or neoadjuvant therapies (breast cancer, bladder cancer, colon cancer etc.). From that perspective the EAU guidelines rightly advise a lymph node dissection or sentinel node biopsy in T1G2 tumours.
The challenge of modern surgical oncology is to just do the right thing – not too much and not too little. Sentinel node biopsy has replaced standard lymphadenectomy in melanoma and in breast cancer in N0 disease. Also for penile cancer this is a valuable strategy omitting unnecessary lymph node dissection. As of 1994 sentinel node biopsy is a standard procedure in our institute. Cancer-specific mortality for clinically node-negative patients decreased from 15% over the period 1956–1993 to 6.7% over the period from 1994 to the present (736 patients). Although not comparable to the results in this paper, these figures underline the safety of the procedure.
Moreover the sentinel node procedure eliminates the dilemma concerning the risk level at which a lymph node dissection is justified, a procedure not devoid of complications and unnecessary in the majority of patients.