Management of penile carcinoma: past, present and future

Penile carcinoma is a relatively rare disease in the Western world. In this thesis it was shown that 25% of penile tumours in a Dutch cohort are associated with human papillomavirus (HPV). Patients with HPV-positive tumours had significantly better prognosis than those with non-HPV related tumours. Due to centralisation of penile carcinoma care in the Netherlands knowledge about diagnosis and treatment has improved. This thesis shows that survival of clinically node-negative patients has improved since the introduction of sentinel node biopsy to stage the inguinal nodes. Secondly, penile preserving therapies are increasingly used with time and can be safely performed. Although such therapies are associated with more local recurrences, survival of patients treated that way was not jeorpardised. Despite the introduction of multimodality treatments, survival of patients with advanced stage of disease has not improved. For this group new strategies are needed. Furthermore, the importance of tumour microenvironment in penile carcinoma is described in this thesis. Immune escape mechanisms, such as human leukocyte antigen (HLA) downregulation, occur frequently in penile carcinoma and show a link with prognosis. Knowledge about this and tumour microenvironment is important for development and efficacy of future immune therapies.