Philippe E. Spiess, MD, MS, FRCS(C), FACS, Editor

The first articles of this issue are dedicated to discussing the fundamental role of the human papillomavirus in a significant subset of patients with penile cancer offering great potential for prevention using vaccination strategies among high-risk male populations. We subsequently discuss the role of penile-sparing surgical approaches in appropriately selected patients using a host of penile reconstructive techniques and principles. The role of radiation therapy as a treatment modality for both primary penile neoplasms and occult sites of disease is discussed by Dr Crook. The selective role of radiation therapy in the neoadjuvant and adjuvant setting is touched upon as part of this discussion. The merit of minimally invasive diagnostic and surgical approaches in the evaluation of inguinal nodes is addressed by leading international experts in the field, Dr Horenblas and Dr Minhas. My group and I thereafter illustrate in our article some of the technical tips and tricks to inguinal lymph node surgery, which enhances oncologic outcomes while minimizing morbidity. One of the major advances in the field of penile cancer has been the adoption of a multimodal approach encompassing neoadjuvant systemic chemotherapy followed by surgical consolidative surgery among chemotherapy responders in patients with bulky (cN2/3) inguinal metastases secondary to penile cancer. This novel treatment paradigm was validated by a phase II clinical trial led by Dr Pagliaro, who has dedicated an article in the present issue in which he and his coauthor highlight the merits and curative potential of such an approach. We complete the present section by discussing emerging systemic therapies in the management of penile cancer, which encompasses very exciting advances in immunotherapeutics and targeted therapies specific to the epidermal growth factor receptor (among other) signal transduction pathways.

In the subsequent section, we highlight some of the suitable treatment strategies in the management of distal and noninvasive urethral tumors. We thereafter delve into the merits of multimodal therapy in the management of proximal primary urethral tumors, which typically have an aggressive phenotype and have had traditionally disappointing oncologic outcomes with single-modality therapy, whether this be surgery, radiation, or systemic chemotherapy. We thereafter discuss the management of urethral recurrences of both urothelial and nonurothelial origin, which typically present late and portend an unfavorable prognosis.

In a section devoted to the management of primary scrotal cancer, colleagues from the Fudan University Shanghai Cancer Center highlight our current state of understanding with regard to the pathophysiology and diagnostic evaluation of primary scrotal cancer and its underlying preneoplastic condition. A detailed discussion of the surgical management of primary scrotal cancer follows. Last, a detailed overview of key surgical reconstructive techniques and approaches in the management of these penoscrotal neoplastic conditions is provided by colleagues from the University of South Florida.

I am confident this body of work will be greatly beneficial to colleagues and health care providers caring for patients facing such potentially debilitating diagnoses. In this regard, I would like to dedicate this issue to our patients and their families, whose heroism when faced with such adversity serves as an inspiration to us all. Thank you for the realization that good is not good enough and that until the complete eradication of cancer is accomplished, our mission is not achieved and we must quite simply do better.