This is an overview of current approaches in prevention, diagnosis, staging, treatment, and follow-up of penile cancer, with a particular perspective on elderly patients. Specific biologic and histologic features of penile squamous cell carcinoma (SCC) in the elderly are reported, focusing on the more typical precancerous and accompanying lesions occurring in these patients. Conservative approaches in early disease are discussed as well as timing of lymph-node dissection (LND), the possible innovative role of dynamic sentinel node identification, and treatment modalities for (locally or metastatic) advanced disease. If issues concerning conservative options are probably simpler in elderly patients who are not often interested in aesthetic and function preservation, problems can arise when facing more advanced disease, which is aggressive independently of age and deserves the best available treatment. Caution is advised in administering multimodal therapy that can have severe toxicity in elderly people.