[Centralization or individualization in penile cancer care : Evidence, international insights, and a future framework for Germany].

backgroundPenile cancer is a rare and aggressive malignancy associated with considerable morbidity and mortality. International evidence consistently demonstrates superior oncological and functional outcomes when treatment is delivered in specialized centers. In Germany, however, care is provided predominantly in a decentralized manner.

objectiveTo critically analyze the management of penile cancer in Germany in an international context and to develop an evidence-based centralization model aimed at reducing outcome disparities.

methodsA scoping review of epidemiological data, registry analyses and outcome studies from national and international high-volume centers was performed, including a comparative assessment of algorithms for organ-preserving surgery, lymph node management and survival outcomes.

resultsIn Germany, treatment of penile cancer is largely undertaken in low-volume hospitals with inconsistent adherence to guidelines. International experience indicates that strict centralization significantly improves stage-adapted organ preservation, surgical lymph node staging, perioperative chemotherapy, and ultimately overall survival. Key barriers include the federal healthcare structure, the absence of mandatory referral pathways, and a heterogeneous hospital landscape.

conclusionWithout mandatory centralization, patients with penile cancer in Germany will continue to experience inferior outcomes compared with international standards. Establishing an evidence-based network of specialized centers with minimum caseload requirements, modelled on international best practice, is essential to improve care quality and equity of outcomes. Until full implementation, compulsory registration of all patients in a national second-opinion portal should be mandated.