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Testo Vitality survival rates at the 5 and 10-year mark the worst prognosis is often just associated with basal oeid and Carson sarcoma toit subtypes with metastatic spread seen up to a hundred percent of the patients and most of these patients that come to disease now with the clinical diagnosis of penile cancer you know as we do with anything else a good history is very important focused and detailed nodes is very important and the description of whether or not they're small or grossly evident if they're mobile are fixed and if there's any evidence of underlying infection for when it comes to investigations the biopsy is the gold standard and that includes their punch biopsy incisional biopsy or excisional biopsy and these are oftentimes done in the office and i although biopsy will help determine the pathology - pathology of the tumor and the grading in combination with other modalities including penile imaging it might be more beneficial there was a study by the Dutch group led by horn blasts that showed that physical exam by itself is insufficient and incorrectly established actual pathologic pathologic state in 26% of the cases with under staging about 10 percent of the cases and over staging in 16 percent and they found that an ultrasound examination can is is also insufficient on its own so they did report that you