The 2026 European Association of Urology and American Society of Clinical Oncology (EAU-ASCO) guideline update reflects significant developments in the diagnosis and management of penile cancer. This review summarises the key changes and contrasts them with previous recommendations, with particular focus on staging, treatment, quality of life and emerging personalised approaches.
The summary is based on a critical appraisal of the full 2026 guideline and its underpinning systematic reviews, with comparison to earlier versions. Recommendations were informed by structured literature assessment and expert panel consensus, incorporating evaluation of benefits and harms, evidence uncertainty and patient values.
Major updates include refined pathological risk stratification, routine ultrasound (US)-guided nodal assessment, and broader guidance on organ-preserving surgery. There is support for selective genomic testing and clearer, restructured algorithms are introduced, including newly developed flow diagrams for nodal management, alongside an expanded evidence base for systemic therapy. Greater emphasis is placed on survivorship, centralisation of care and rationalisation of follow-up. However, many recommendations remain informed by retrospective data and expert consensus, reflecting the rarity of the disease and limited prospective evidence.
The updated guideline promotes more nuanced selection of organ-preserving strategies, earlier detection of regional lymphatic disease, and holistic palliative care, while reinforcing the central role of shared decision-making.
The new guidance for penile cancer aims to improve care, personalise treatment and better address quality of life, while acknowledging that further research is still needed.
European urology. 2026 Apr 27 [Epub ahead of print]
Arie Parnham, Maarten Albersen, Benjamin Ayres, Juanita Crook, Peter A S Johnstone, Pedro Oliveira, Lance C Pagliaro, Curtis Pettaway, Chris Protzel, R Bryan Rumble, Diego F Sánchez Martínez, Philippe E Spiess, Michel S van der Heijden, Lenka Barreto, Herney A Garcia-Perdomo, Isabella Greco, Kenneth Patterson, Kenneth Manzie, Jack David Marcus, John Osborne, Carla Bezuidenhout, Scott Tagawa, Oscar Brouwer
Department of Urology, The Christie NHS Foundation Trust, Manchester, UK. Electronic address: ., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, St George's University Hospitals NHS Foundation Trust, London, UK., University of British Columbia, Kelowna, Canada., Departments of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA., Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK; Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trásos-Montes and Alto Douro, Vila Real, Portugal; Veterinary Sciences Department, University of Trásos-Montes and Alto Douro, Vila Real, Portugal., Department of Oncology, Mayo Clinic, Rochester, MN, USA., The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Helios Clinics Schwerin, Schwerin, Germany., American Society of Clinical Oncology, Alexandria, VA, USA., Grupo de Bioinformática, Facultad Politécnica. Universidad Nacional de Asunción, San Lorenzo, Paraguay., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA., Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam., Department of Urology, University Hospital Nitra, Nitra, Slovakia., Division of Urology/Uro-oncology, Department of Surgery, School of Medicine, Universidad Del Valle, Cali, Colombia., Department of Urological Minimally Invasive and Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, The Christie NHS Foundation Trust, Manchester, UK., Orchid, London, UK., Multicancer Fighter Patient Advocate, Us TOO, New York, NY, USA., European Association of Urology Guidelines Office, Arnhem, The Netherlands., Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA., The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.