Stage IV includes: (T4, Any N, M0); (Any T, N3, M0); (Any T, Any N, M1). T4: Penile cancer with tumor invading into adjacent structures (i.e., scrotum, prostate, pubic bone). N3: Penile cancer with extranodal extension of lymph node metastases or pelvic lymph node metastases. M1: Distant metastasis present. (AJCC 8th ed.) [from NCI]