Penile preservation surgery in penile cancer

: Penile cancer (PC) is a rare disease in developed countries, with an estimated incidence of 1 in 100,000 men in the US and Europe. However, in certain regions, such as South America, Africa, and Asia, the incidence is higher. A common histological subtype of PC is squamous cell carcinoma (SCC), with more frequent involvement of the distal regions of the penis. Several risk factors for PC have been identified. There is a strong relationship between phimosis and SCC, likely due to chronic infections. The classical treatment for primary PC has been partial or total penectomy with perineal urethrostomy. Yet, both of these surgical procedures are mutilating and have a significant negative impact on the patient’s quality of life. The then-standard 2-cm surgical margins are no longer mandatory, and today, 5-mm margins are considered to be oncologically safe. Thus, penile preservation surgery has become the standard approach. In this chapter, we discuss the current knowledge on penile preservation surgery for PC, introducing laser therapy, Mohs micrograph procedure, wide local incision, glans resurfacing, glansectomy, partial penectomy, other focal therapies, and radiotherapy. Organ-sparing surgery (OSS) should be applied in PC whenever possible, and when performed properly, conservative techniques add significant benefits to quality of life but require strict follow-up and a collaborative patient.