genitourinary

Localised penile cancer is squamous cell cancer confined to the penis with no spread to the groin lymph nodes, and the aim of treatment is to remove the tumour while keeping as much of the penis as possible. Precancer and small tumours are treated with creams, laser or glans-sparing surgery, and the groin nodes are checked by sentinel node biopsy or surveillance rather than removed wholesale.

Node-positive penile cancer is squamous cell cancer of the penis that has reached the lymph nodes of the groin or pelvis, and it is where penile cancer becomes life-threatening. Treatment combines removal of the groin nodes with chemotherapy or chemoradiotherapy before or after surgery, the InPACT trial is testing the best order, and PD-1 antibodies are being added for advanced disease.

Penile cancer is a squamous skin-type cancer, about half of it caused by HPV. Caught early it is usually cured with organ-sparing surgery that has replaced amputation, and HPV vaccination and circumcision prevent it; the hard cases are those with lymph-node spread, where cisplatin-based chemotherapy plus surgery and now immunotherapy are being tested in the InPACT trial.

Testicular germ cell tumours are the most curable adult solid cancer: cisplatin-based chemotherapy cures the large majority even when the disease has spread to distant sites. Today's research is about giving less treatment to the majority who are cured, rescuing the minority who relapse, and limiting lifelong survivorship harms.

Urethral cancer grows in the tube that carries urine out of the body, with fewer than one case per million people a year. With no randomised trials, it is treated by borrowing from bladder, anal or vulvar cancer depending on cell type and location; chemotherapy with radiotherapy before or instead of surgery lets more patients keep their organs.