Kyle Rose, MD, on optimizing lymph node dissection in penile cancer

In this interview, Kyle M. Rose, MD, discusses key considerations for optimizing the timing and sequencing of inguinal and pelvic lymph node dissection (ILND), with an emphasis on balancing oncologic outcomes and patient experience. Rose is a urologic oncologist at Ochsner MD Anderson Cancer Center in New Orleans, Louisiana.

Rose explains that the optimal timing of ILND depends on the clinical presentation, particularly whether inguinal nodes are palpable. For patients with nonpalpable disease, he emphasizes completing ILND within 6 weeks of the primary tumor procedure, whereas for those with palpable disease, a window of up to 3 months may be acceptable. However, he underscores that earlier intervention is generally preferred whenever feasible, performing procedures as soon as the patient has adequately healed. In practice, logistical and patient-related barriers—such as reluctance to undergo a second operation and scheduling delays—can impede timely care. To address this, Rose highlights a proactive strategy of scheduling potential staged procedures in advance, ensuring that patients have a reserved operative date if additional surgery is needed.

Regarding pelvic lymph node dissection (PLND), Rose notes that decision-making is increasingly nuanced and guided by both pathologic findings and imaging. Current guidelines support PLND even in the absence of radiographically enlarged pelvic nodes, particularly when adverse features are identified in inguinal node pathology. He points to a growing role for PET imaging in patients with palpable inguinal disease, where FDG avidity may help identify pelvic involvement and guide the extent of surgical dissection.

Overall, Rose emphasizes that optimizing the patient journey requires both adherence to evidence-based timing thresholds and practical workflow solutions that reduce delays and improve patient readiness for treatment.