Primary carcinoma of male urethra

Urethral cancer: a comprehensive review endorsed by the Global Society of Rare Genitourinary Tumours

OBJECTIVE

To determine the effectiveness and adverse effects of urethrectomy alone or as part of multimodal therapy (MMT).

METHODS

A comprehensive search was conducted across MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, from their inception to the present date. The study cohort comprised individuals aged 16 years and older diagnosed with urethral tumours at any stage who underwent either isolated urethrectomy or urethrectomy as an integral component of MMT.

RESULTS

Ninety-two studies comprising 25 480 patients met the inclusion criteria. Surgical outcomes for urethral cancer vary considerably, with 5-year overall survival (OS) ranging from 10% to 68% based on disease extent, approach, and gender. Radiotherapy (RT) alone provides 5-year OS of approximately 40%. Combined regimens provide better outcomes compared to single modalities, including reduced recurrence and enhanced survival. However, trimodal therapy showed survival benefits only for urothelial subtypes, indicating the need to tailor management according to cancer type. MMT with neoadjuvant chemotherapy prior to surgery demonstrated the most consistent survival gains.

CONCLUSIONS

The management of urethral cancer demands a nuanced, personalised approach, accounting for factors such as tumour location, sex, and tumour stage. MMT combining surgery, chemotherapy and RT has shown the ability to enhance outcomes in advanced disease. More extensive collaborative studies through specialised centres are imperative to advance evidence-based protocols and refine treatment in order to improve survival.

The role of inguinal lymph node dissection in men with urethral squamous cell carcinoma

INTRODUCTION

Urethral squamous cell cancer is a rare disease with limited clinical recommendations regarding management of the inguinal lymph nodes. Despite the similarities to penile cancer in terms of squamous cell carcinoma (SCC) histology and lymphatic drainage, there is not enough evidence to recommend for or against a prophylactic inguinal lymph node dissection (ILND) in patients with clinically negative groins and a primary tumor stage of T1b or higher. The objective of the study was to identify the rate of prophylactic inguinal lymph node dissection, node positive rate, and overall survival in patients with clinical T1 to T4 stage. The patients were separated into clinical N stage and the rates of node positivity were compared. We hypothesize that the node positivity rate would be similar to that observed in penile cancer of similar clinical T and N stage and provide evidence for prophylactic inguinal lymph node dissection in urethral squamous cancer. We also sought to determine the value of ILND in clinically node positive (cN+) and clinically node negative (cN-) patients.

METHODS

The National Cancer Database was queried for all cases of primary urethral cancer in men from 2004 to 2014. Patients with other cancer diagnoses, metastasis, nonsquamous histology, female patients, and patients with a history of radiation therapy were excluded. Male patients with urethral squamous cell cancer of the anterior urethra with T1 or higher T stage were included in this study. All-cause mortality was compared using multivariable Cox regression controlling for covariates.

RESULTS

The study included 725 men with urethral SCC with T1 or higher clinical T stage. The median age was 63 years (33-83 interquartile range). Of the 725 men, 536 men did not receive an ILND and 189 (26%) underwent ILND. Patients who received LND had significantly higher clinical T and clinical N stage. There was no difference in age, sex, or histology between those with ILND versus no ILND. In patients with T1 to T4 and clinical N0, the ILND rate was 21.8% (89/396). The lymph node positive rate in patients with N0 and T1 to T4 primary tumor was 9%. In patients with clinically node positive disease (N1/N2), the overall ILND rate was 76%. The lymph node positive rate for patients with clinical nodal disease was 84%. On multivariable analysis cox regression, lymph node positivity was associated with worse overall survival when controlling for T stage, clinical N stage, and age (HR 1.56, 95% 1.3-1.9, P = 0.000). On multivariable analysis after controlling for T stage, sex, and age, having an ILND was associated with improved OS in patients with clinical N1 or N2 disease (HR 0.46, 95% 0.28-0.78 P = 0.002).

CONCLUSION

The node positivity rate in patients with T1 to T4 and N0 is 9%, much lower than reported in penile cancer with a high-risk primary tumor but clinically negative groins. This argues against routine prophylactic inguinal ILND in patients with urethral SCC who are clinically N0, perhaps suggesting different biological behavior of urethral SCC compared to penile SCC. Performing a lymph node dissection in patients with clinically N1 or N2 disease is associated with improved OS.

Secondary Urethral Malignancies Following Prostate Brachytherapy

OBJECTIVE

To understand urethral secondary malignancies among patients treated with brachytherapy (BRT) for primary prostate cancer.

PATIENTS AND METHODS

Institutional retrospective review identified 13 patients evaluated from 2003 to 2014 with urethral cancer and history of BRT monotherapy for prostate cancer. All patients were biochemically free of their primary disease and radiation-associated secondary malignancies (RASMs) were confirmed pathologically to be histologically distinct from primary tumor. BRT characteristics, patient age, presentation, staging workup, and clinical course were evaluated.

RESULTS

The mean time from BRT to presenting symptoms of hematuria, urinary retention, and/or renal failure was 71 months. Symptom onset to RASM diagnosis interval was 24 months. Mean time from BRT to RASM diagnosis was 95 months. Eighty-five percent of patients had an undetectable prostate-specific antigen level (<0.2 ng/mL) at last follow-up. Types of RASM included sarcomatoid carcinoma (6), small cell carcinoma (2), urothelial carcinoma with squamous differentiation (2), squamous cell carcinoma (1), rhabdomyosarcoma (1), and urothelial carcinoma (1). A majority of patients were diagnosed with advanced disease with either distant metastases (54%) or local progression (23%). Ten patients died during this study period with median time to death after RASM diagnosis of 6 months.

CONCLUSION

RASMs localized to the posterior urethra displayed advanced disease and high mortality rates. Refractory lower urinary tract symptoms, hematuria, and history of prostate BRT should raise suspicion for urethral RASMs. Further studies are warranted to determine patient and disease characteristics that correlate with disease-specific mortality of secondary urethral malignancies.

Contemporary Management of Primary Distal Urethral Cancer

Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function.

Urethral carcinoma in situ: recognition and management

PURPOSE

Urethral carcinoma in situ (CIS) is an uncommon malignancy that is poorly described in the published literature and is often under-recognized in the clinical setting. This short case series reports some challenges associated with the recognition and management of this disease.

METHODS

A retrospective chart review was done over a 12-year period of patients presenting with urethral cancer to the Johns Hopkins Hospital. Four patients were identified with CIS of the anterior urethra, and their demographic and clinical data were recorded.

RESULTS

Three patients presented with meatal lesions that were initially treated as infectious/inflammatory diseases before diagnoses of malignancy were determined following lesion biopsy. The fourth patient presented with painless hematuria and had a cystoscopy and biopsy of urethral polyps. All patients were treated surgically by sequential distal urethrectomy and various reconstructive procedures. Concurrent lymph node dissections were undertaken in two patients who had clinical or radiologic evidence of lymphadenopathy. One patient had persistent disease even after aggressive urethral resection, and he succumbed to his illness 2 years later.

CONCLUSION

This is the largest series of urethral CIS, a disease with potentially serious consequences. A high index of suspicion should be maintained when evaluating and managing these patients.

Outcomes and Prognostic Factors of Primary Urethral Cancer

OBJECTIVE

To identify prognostic and treatment factors for primary urethral cancer using a nationwide database.

MATERIALS AND METHODS

The National Cancer Database was queried for all cases of primary urethral cancer from 2004 to 2013. Patients with other cancer diagnoses, metastasis, or diagnosis on autopsy were excluded. Proportional hazards regression was used to identify independent predictors of overall survival in patients with primary urethral cancer. Because we hypothesized that predictors may covary by sex, we also performed regression analysis stratified by sex.

RESULTS

We identified 1268 men and 869 women with primary urethral cancer. Women tended to have more advanced tumors and adenocarcinoma histology. Median survival for the entire cohort was 49 months (43-55), with 5- and 10-year survival rates of 46% and 31%, respectively. On multivariate analysis, age, race, stage, grade, and Charlson comorbidity index were independent predictors of overall survival. Histology was not a predictor of overall survival in the combined model; however, adenocarcinoma in women increased hazards of death, whereas it decreased hazards of death in men when compared with squamous cell carcinoma.

CONCLUSION

Men and women with primary urethral cancer had significant differences in histology, grade, and nodal status. In addition to several expected disease-related factors, black race was associated with increased mortality for patients with primary urethral cancer.

A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma: A Case Report and Literature Review

Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches.A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and "en bloc" removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy.The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery.Patients with advanced stage tumors of the bulbomembranous urethra should be managed with radical surgery including the corporas up to the ischiatic tuberosity attachment, and membranous urethra in continuity with the prostate and bladder. Neo-adjuvant treatment may be advisable with the aim of improving the poor prognosis, even if the efficacy is not certain while it can delay the radical treatment of the disease.

The contemporary management of primary urethral carcinoma

Primary urethral cancer is a rare malignancy; the most common histological subtype is squamous cell carcinoma. The aetiology of this cancer is similar to penile cancer and the human papilloma virus (HPV) is thought to be an important factor in tumourigenesis. Surgery with or without chemoradiotherapy is the accepted treatment for primary urethral cancer. Current practice supports penile-sparing surgery, to maximise functional and psychological outcomes. We have reviewed the literature to summarise the pathogenesis and management of primary urethral cancer.

[Penis-preserving surgery in patients with primary penile urethral cancer]

BACKGROUND

Primary urethral cancer in males is a rare entity with only approximately 800 cases described, which is why it is difficult to formulate evidence-based guidelines for treatment. For tumors in the pT2 stage with a localization distal to the membranous urethra, a penis-preserving operation can be carried out.

METHODS

In the period from November 2006 to February 2014 a total of 4 patients with primary urethral cancer underwent a penis-preserving urethral resection. The tumor characteristics and treatment results were collated retrospectively.

RESULTS

Of the four patients one had a transitional cell carcinoma of the mid-penile urethra in stage pT2 G2. In two out of the four patients a squamous cell carcinoma (PEC) was present in the mid-penile urethra in stages pT2 G2 and pT2 G3, respectively, with concomitant carcinoma in situ (CIS). The fourth patient had a PEC of the fossa terminalis in stage pT2 G2. Initially all patients underwent a penis-preserving resection. In one case, despite an initial R0 resection a local recurrence occurred and a complete penectomy was performed. Irradiation and lymphadenectomy were not carried out. At a mean follow-up of 37 months all patients are currently in complete remission.

CONCLUSION

Primary penile urethral cancer can be treated by a penis-preserving operation. Close follow-up is essential because recurrence can arise despite an initial R0 resection.

Prognostic factors in male urethral cancer

BACKGROUND

Male urethral cancer is a rare neoplasm, with the published literature consisting of small single-institution retrospective series. As such, there is no objective analysis of prognostic factors and treatment outcome. The author sought to use the population-based Surveillance, Epidemiology, and End Results (SEER) database to evaluate prognostic factors in male urethral cancer.

METHODS

From 1988 to 2006, 2065 men were identified in the SEER database as having primary urethral cancer. Median follow-up was 2.5 years. Cancer-specific and overall survival was computed using the Kaplan-Meier method, and Cox proportional hazards analysis was used to evaluate patient age at diagnosis, year of diagnosis, race, histologic type, grade, T stage, nodal status, M stage, extent of surgery, and type of radiation as potential significant independent predictors of survival.

RESULTS

Overall survival at 5 and 10 years was 46.2% (95% confidence interval [CI], 43.9-48.6%) and 29.3% (95% CI, 26.6-32.0%), respectively, whereas cancer-specific survival at 5 and 10 years was 68.0% (95% CI, 65.5-70.5%) and 60.1% (95% CI, 57.0-63.2%), respectively. Advanced age, higher grade, higher T stage, systemic metastases, other histology versus transitional cell carcinoma (TCC), and no surgery versus radical resection were predictors of death and death from disease, whereas adenocarcinoma was associated with a lower likelihood of death and death from disease as compared with TCC. In addition, nodal metastasis was a predictor of death. Surgery had a better outcome than radiation for stage T2 -T4 nonmetastatic disease.

CONCLUSIONS

Age, grade, TNM stage, histology, and extent of surgery were predictive of overall and cancer-specific survival.

Penile-preserving surgery for male distal urethral carcinoma

OBJECTIVE

To evaluate medium-term outcome data from patients with distal urethral cancers treated with penile-preserving surgery.

PATIENTS AND METHODS

We analysed prospectively 18 consecutive men referred for the management of urethral carcinoma. All had a specialist review in a supra-regional multidisciplinary team meeting, where the histology findings were reviewed by one pathology consultant. Tumours were staged according to the Tumour-Node-Metastasis classification and the patients offered penile-preserving surgery when tumours were limited to the glanular or penile urethra.

RESULTS

All 18 patients were suitable for penile-preserving surgery; the procedures were: three hypospadias formation with or without topical chemotherapy; four buccal mucosa urethroplasty; three glansectomy and reconstruction; six glansectomy, distal corporectomy, reconstruction and hypospadias formation; two urethrectomy with or with no excision of adjacent tunica albuginea. The mean (median, range) follow-up was 26 (20.5, 9-58) months. There were no local recurrences; four patients with regional nodal disease progressed and of these, two died from metastatic disease, and one died from an unrelated condition.

CONCLUSION

Medium-term data show that penile-preserving surgery is a feasible treatment for men with distal urethral carcinoma, providing excellent local control without prejudicing survival; a longer follow-up is needed.

Clinical outcome of 36 male patients with primary urethral carcinoma: a single center experience

AIM

Retrospective analysis of male urethral carcinoma to assess the best therapeutic approach to the management of this tumor.

METHODS

A review of 36 cases of male urethral carcinoma diagnosed and treated at our center was performed. Clinical features, treatment modality and outcomes were analysed.

RESULTS

The overall median survival time was 55.16 months. The 5-year overall and disease-free survival rate for the cohort was 49% and 23%, respectively. The 5-year survival is 67% for low-stage versus 33% for high-stage tumors and is significantly different (P = 0.001). The survival was 72% for tumors of the distal urethra versus 36% for tumors of the proximal, with a P-value of 0.02.

CONCLUSION

The tumor location and clinicopathological stage were the most important predictors of the disease-free and overall survival. Multimodal approach is necessary for achieving local control especially for proximal and higher stage tumors.

Incidence of primary urethral carcinoma in the United States

OBJECTIVES

Primary urethral carcinoma is rare, and the demographic correlates of its incidence have not been examined using population-based data.

METHODS

The National Cancer Institute Surveillance, Epidemiology, and End Results database was used to identify persons diagnosed with primary urethral carcinoma from 1973 to 2002. During this period, the Surveillance, Epidemiology, and End Results program included population-based tumor registries in nine geographic areas that represented approximately 10% of the U.S. population. The incidence rates were tabulated for the major histologic subtypes according to age, sex, and race.

RESULTS

Primary urethral carcinoma was identified in 1075 men and 540 women, with an annual age-adjusted incidence rate of 4.3 per million and 1.5 per million, respectively. The annual incidence rate increased with age to a peak of 32 per million men and 9.5 per million women in the 75 to 84-year age group. The rate was 5.0 per million and 2.5 per million for African Americans and whites, respectively. The histologic types were transitional cell carcinoma in 888 patients (55%), squamous cell carcinoma in 348 (21.5%), and adenocarcinoma in 265 (16.4%). The incidence of the three primary histologic types varied by race and sex.

CONCLUSIONS

In the United States, the incidence of urethral carcinoma is relatively higher in men and African Americans, with a histologic profile differing from that previously described.

[Epidermoid carcinoma of the urethra and glans penis: two independent tumors?]

A 64 years-old man is treated in our hospital presenting a big tumor in glans penis. During the surgical act, another neoplasm is detected in the urethra. The microscopic study showed a concomintant epidermoid carcinoma of glans penis and urethra with non-affected tissue between both tumors.

[Advanced urethral carcinoma. Which is the best management of a infrequent disease?]

Urethral cancer is an uncommon tumor (<0.1% of all genitourinary neoplasms). Most of them are squamous carcinoma, adenocarcinomas are about 5% of all urethral cancer. Surgery is the only curative treatment. Surgical technics depend of tumoral location and extension. Conservative surgery is elective if survival is not compromised. Extensive surgery is needed in large lesions. Chemotherapy (CT) and radiotherapy (RT) must be used in patients in which surgery is not possible. Due to the low incidence of this neoplasm is not well established the best therapeutic approach. We present the case of a female (35 years old) with a diagnosis of urethral adenocarcinoma. The initial stage was IV due to non-regional lymph nodes metastases. Surgery was impossible and the patient received chemotherapy and radiotherapy. The patient achieved complete response with CT but a progression was observed in course of RT. The patient died due to systemic progression.

[Ureteral adenocarcinoma in men: a case report]

Adenocarcinoma of urethra is a rare tumour, which occurs more often in female than in male. The localizations on bulbomenbranous urethra, most frequent, have worse prognostic than those of penile urethra. Because of scarcity of these tumours there is not therapeutic consensus. The treatment is based on the tripod surgery, more or less mutilating, chemotherapy and radiotherapy associated or managed in a separate way. We report the case of a young patient with adenocarcinoma of the posterior urethra treated by a protocol of radio-chemotherapy.

[Primary adenocarcinoma of the male urethra. A case report]

Primary adenocarcinoma of the male urethra is very uncommon, accounts for 5% of primary urethral cancers. All types of urethral carcinomas account for less than 1% of urinary malignancies in man. The prognosis remains poor despite the wide surgical treatment. The place of chemotherapy combined with radiotherapy must be defined by other studies. We report a case of primary locally advanced adenocarcinoma arising in the bulbo-membranous urethra. The patient was 29 years old, without any previous history of venerian disease. He was treated by combined external beam radiotherapy (total dose 67Gy) and chemotherapy (Cisplatinum). A marked reduction of tumor volume has been noted but the patient died because of the appearance of bone metastasis which failed to the systemic therapy.

Primary malignant melanoma of the male urethra

We report a case of primary malignant melanoma of the male urethra in a patient whose penile shaft was successfully preserved, but who proceeded to acute renal failure (ARF) after interferon (IFN)-beta adjuvant immunotherapy. Primary malignant melanoma of the male urethra is rare and usually shows highly malignant potential. Therefore, urologists must often perform phallectomy, which impacts on the patient both sexually and mentally. A 64-year-old man presented at Saiseikai Sendai Hospital with asymptomatic gross hematuria and was diagnosed as distal urethral tumor. We predicted the highly malignant potential of this tumor from the urethroscopic finding and from urinary cytological examination. We did not select trans-urethral resection (TUR), but selected partial urethrectomy. This patient proceeded to ARF 1 month after natural IFN-beta treatment as an adjuvant immunotherapy. As IFN-beta rarely induces the delayed renal failure, urologists should be aware of renal dysfunction after IFN-beta therapy for the treatment of malignant melanoma.

Primary malignant melanoma of the male urethra

BACKGROUND

We describe a rare case of malignant melanoma originating from the male urethra.

METHODS/RESULTS

This case, which presented a tan-colored lesion at the distal urethra on urethroscopy, was considered as transitional cell carcinoma by transurethral biopsy. Pathologic examination of widely resected urethra revealed scattering cells, which included melanin granules in cytoplasm, and then immunohistochemical stains established the diagnosis as amelanotic melanoma. Although partial penectomy and inguinal lymph node dissection were subsequently performed, 7 months later, total cystourethrectomy was required because of multifocal recurrence at the residual urethra.

CONCLUSIONS

In cases of amelanotic melanoma, it should be noted that a lack of melanin granules in tumor cells may lead pathologists and urologists to a misdiagnosis due to the histologic non-specific appearance. With respect to surgical management, of significance is the fact that malignant melanoma may progress multifocally along the total urethra; therefore, total urethrectomy should be considered as radical surgery for the primary site, even if the tumor is confined to the distal urethra.

Phallus preservation for urethral cancer: subcutaneous penectomy

PURPOSE

We present a new alternative to amputating penectomy, subcutaneous penectomy, in the male patient with urethral cancer.

MATERIALS AND METHODS

The surgical management and followup of 3 men with squamous cell cancers of the urethra are reviewed.

RESULTS

At 22, 9 and 6 months postoperatively all patients were without evidence of local recurrence and were satisfied with phallic appearance. In 1 of 2 patients in whom the dorsal neurovascular bundle was not preserved there was distal glans necrosis and wound separation which resolved after conservative management. One of the 3 patients is contemplating phallus reconstruction. The patient who had pelvic lymph node metastases before penectomy died of metastatic complications without local failure 9 months postoperatively.

CONCLUSIONS

Phallus preservation in men with urethral cancer can be accomplished successfully with this type of procedure. The dorsal neurovascular bundle should be preserved when feasible. We contend that the cosmetic and potential reconstructive outcomes are superior to amputation without sacrificing cancer therapy in the appropriately selected patient.

Urinary system

BACKGROUND

Although site-specific cancer frequencies and incidence rates for the United States are regularly reported by the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program, they have not been reported by histologic type within a specific site. This report presents data for 76,303 cancers of the urinary tract by histologic type.

METHODS

Cancer data were obtained from the SEER program. Urinary tract cancers were eligible if they were histologically confirmed, in situ or invasive, and diagnosed between 1973 and 1987. The urinary tract was divided into the following sites: kidney and renal pelvis, ureter, urinary bladder, urethra, and other urinary. Histologic types were evaluated by site, age, sex, race, incidence, and survival.

RESULTS

Of the 76,303 cancers, 72.0% were transitional cell carcinomas and 22.0% were adenocarcinomas. Adenocarcinoma was the most common histologic type in the kidney and renal pelvis (also referred to as renal cell carcinoma), whereas transitional cell carcinoma was the most common histologic type in the remainder of the urinary tract. For the more common histologic types, age-adjusted incidence rates were always higher among males than females.

CONCLUSIONS

Because adenocarcinomas represent most kidney and renal pelvis cancers and transitional cell carcinomas represent most urinary bladder cancers, these histologic types largely explain incidence and survival trends reported for these two common cancer sites. Future population-based cancer epidemiologic studies should try to focus more on specific histologic types within a cancer site to better clarify risk factors and incidence and survival trends for cancer.

Therapy and prognosis for male anterior urethral carcinoma: an update

OBJECTIVE

The scarcity of reports evaluating the effect of current treatment strategies for male urethral carcinoma has prompted a review of our recent experience. Since our last report (1980), we have seen 23 patients with this disease.

METHODS

We performed a retrospective chart review of 23 patients seen in our institution between 1979 and 1990 with this type of cancer.

RESULTS

Fifty-two percent of our patients are alive without evidence of disease, after a mean follow-up of fifty months (range, 5 to 156 months). Treatment analysis indicates that distal urethrectomy and partial penectomy are adequate in controlling local disease for tumors arising in the fossa navicularis and penile urethra, respectively, and that en bloc excision of the penis, scrotum, prostate, and bladder together with resection of the inferior pubic rami, using myocutaneous flaps to cover the surgical defect, can provide long-term disease-free survival for patients whose tumor originates in the bulbomembranous urethra. Use of cisplatin-based chemotherapy resulted in a prolonged survival for patients who presented with metastatic disease.

CONCLUSIONS

We conclude that the prognosis for patients with urethral carcinoma has improved, and some of the patients are having a prolonged disease-free survival due, in part, to more effective local and regional control and improved chemotherapy.

Primary carcinoma of the distal male urethra: a case treated with lymphadenectomy and interstitial radiation therapy

We report a case of primary squamous cell carcinoma of the distal male urethra with a single inguinal node metastasis. Treatment consisted of unilateral pelvic and inguinal lymphadenectomy, and a combined course of external beam and interstitial radiation therapy to the distal urethra and penis by the Henschke modification of the Paris technique.

Primary squamous cell carcinoma of the male urethra: nuclear deoxyribonucleic acid ploidy studied by flow cytometry

Flow cytometry analysis was performed on 30 primary male urethral squamous cell carcinoma specimens. Nuclei were extracted from paraffin-embedded archival material and isolated nuclei were stained with propidium iodide. Bulbomembranous urethral tumors had a higher incidence of abnormal deoxyribonucleic acid ploidy patterns than penile urethral tumors (69 and 29 per cent, respectively). Of the tumors exhibiting a deoxyribonucleic acid diploid pattern and an abnormal (deoxyribonucleic acid tetraploid or aneuploid) histogram 18 and 93 per cent, respectively, showed tumor progression (p less than 0.001). None (0 per cent) of the low grade (grade 1 or 2) tumors with a deoxyribonucleic acid diploid pattern developed local recurrence or distant metastases, whereas 90 per cent of the low grade tumors with an abnormal deoxyribonucleic acid pattern progressed (p less than 0.002). Patients with tumors exhibiting deoxyribonucleic acid diploid ploidy had 5 and 10-year rates free of disease of 85 per cent. In contrast, patients with tumors with abnormal deoxyribonucleic acid ploidy patterns had 5 and 10-year rates of 20 and 0 per cent, respectively (p less than 0.001). Determination of deoxyribonucleic acid ploidy pattern by flow cytometry provides important prognostic information for male patients with primary squamous cell carcinoma of the urethra.

Carcinoma of deep male urethra

Carcinoma of the deep male urethra is a rare disease. Conservative measures yielding dismal outcomes were standard until 1957, with the report of an 80 per cent five-year survival rate after radical surgery. To assess the value of this surgery, we reviewed all cases of carcinoma of the deep male urethra managed at UCLA Medical Center and its affiliated hospitals between 1952 and 1980. Of the patients managed with radical surgery, 1 died of a myocardial infarction between staged surgical procedures, and 5 died of their disease between twelve and fifty-two months postoperatively (mean survival, 26 months). There were 2 long-term disease-free survivors, yielding a survival rate of 25 per cent. We have also compiled the results of all major series dealing with deep urethral carcinoma published subsequent to the 1957 report. This review of the literature supports the concept that radical extirpative surgery is mandatory in the management of carcinoma of the deep male urethra.