This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Urology, Subject name: Surgery
What is the best prognostic marker of CA penis 
Select and explain. 
A. Age <40 yrs, B. Lesion size <2 cm, C. Previous circumcision, D. Absent inguinal LN metastasis
D: Absent inguinal LN metastasis
Answer: D: Absent inguinal LN metastasis 
Explanation: The prognosis of penile cancer is primarily related to the presence or absence of inguinal node metastasis. Untreated patients with inguinal metastases rarely survive 2 years. Of those with clinically palpable adenopathy and histologically proven metastases, 20-50% are alive at 5 years following inguinal lymphadenectomy.The results are even better when the extent of the nodal involvement is considered. When the nodes are positive, the overall recurrence rate is 80%, and the 5-year survival rate is 10%-15%. Fixed lymph node status indicates the advancement of the disease. Reference : page 1065 SRB's manual of surgery 5th edition