**Question:** Which one of the following does not indicate good prognosis in Ca penis?

**Core Concept:** Prognosis in penile cancer refers to the likely outcome or course of the disease based on various factors. Good prognosis is associated with early detection, localized disease, and favorable clinical characteristics.

**Why the Correct Answer is Right:** Option C, "Pain on examination," does not indicate a good prognosis in penile cancer. Pain during examination could be due to invasion of surrounding structures, which usually portends a poorer prognosis.

**Why Each Wrong Option is Incorrect:**

A. "Small tumor size" does indicate a good prognosis as it suggests localized disease, which is associated with a better prognosis.

B. "No lymphadenopathy" indicates a good prognosis as it suggests localized disease, while lymphadenopathy often indicates regional spread and poorer prognosis.

D. "No urethral involvement" indicates a good prognosis as it indicates disease limited to the skin or subcutaneous tissues, while urethral involvement indicates deep infiltration and poorer prognosis.

**Clinical Pearl:**

In penile cancer, prompt diagnosis and early intervention can significantly improve prognosis and patient outcomes. Regular penile self-examinations and timely medical advice should be encouraged for early detection.

**Correct Answer:** C. Pain on examination

**Explanation:** Pain on examination indicates advanced disease with structural invasion, which is associated with a poorer prognosis compared to localized disease without pain on examination. Regular self-examinations and prompt medical advice are crucial in improving penile cancer prognosis.