Expanding the Horizon of Dynamic Sentinel Node Biopsy in Penile Cancer Staging: A Call for Inclusive Indications

Abstract

In their recent publication, Prakash et al. present here the details of an online survey to capture the variations in penile cancer care across different regions of the world and identify areas for collaborative research. About a third of the respondents choose observation for the intermediate risk clinically node negative (cN0) groin. This study also highlighted that 28.4% of the respondents chose dynamic sentinel node biopsy (DSLNB) for staging the groin. Presently, guidelines recommend surgical staging for high-risk patients, while DSLNB has shown low morbidity rates in high-volume centers. The authors propose expanding DSLNB indications to include low-risk patients, supported by their data indicating a 4% nodal positivity rate in this group. The evolving framework should consider not just morbidity but also compromised survival in low-risk patients with delayed nodal manifestation. DSLNB represents a transformative advancement in penile cancer staging, prompting a reevaluation of its applicability across risk categories, considering the delicate balance between risk, morbidity, and survival in shaping future management strategies.