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García-Perdomo HA, Dávila-Raigoza AM, Summers E, Billingham L, Necchi A, Griffiths G, Spiess PE. Urethral cancer: a comprehensive review endorsed by the Global Society of Rare Genitourinary Tumours. BJU Int 2024; 134:175-184. [PMID: 38587299 DOI: 10.1111/bju.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
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.
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Affiliation(s)
- Herney Andrés García-Perdomo
- UROGIV Research Group, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | | | - Ellie Summers
- Cancer Research U.K., Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lucinda Billingham
- Cancer Research U.K., Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Andrea Necchi
- Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Gareth Griffiths
- Cancer Research U.K., Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Philippe E Spiess
- Department of Genitourinary Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Urology and Oncology, University of South Florida, Tampa, FL, USA
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Farrell MR, Xu JT, Vanni AJ. Current Perspectives on the Diagnosis and Management of Primary Urethral Cancer: A Systematic Review. Res Rep Urol 2021; 13:325-334. [PMID: 34104638 PMCID: PMC8180270 DOI: 10.2147/rru.s264720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Primary urethral cancer (PUC) is a rare but highly aggressive malignancy that causes malignant urethral obstruction. We conducted a literature review using PubMed to identify original research studies that assessed the diagnosis and management of primary urethral cancer. PUC affects men more than women, is more common in African Americans than Caucasians, and is associated with history of chronic inflammation and irritation of the urinary tract. Patients suspected of PUC should undergo a complete work-up including cystoscopy, magnetic resonance imaging, and biopsy. In men and women, surgical monotherapy ranging from organ-sparing to more radical reconstructive procedures has adequate survival rates for early stage PUC and has been shown to be similarly as effective as radiation monotherapy, while multimodal therapy has become the standard of treatment for advanced stage PUC. Salvage surgery or radiation therapy has been linked with increased survival rates. Nodal involvement at the time of diagnosis is a negative prognosticator and should be treated with multimodal therapy. Further prospective studies with greater sample sizes and standardized clinical trials would allow for greater consistency in evaluating the different treatment modalities for PUC.
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Affiliation(s)
- M Ryan Farrell
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Jonathan T Xu
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Alex J Vanni
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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High-dose-rate brachytherapy - a novel treatment approach for primary clear cell adenocarcinoma of male urethra. J Contemp Brachytherapy 2015. [PMID: 26207115 PMCID: PMC4499518 DOI: 10.5114/jcb.2015.52316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of male urethral cancer is rare with age preponderance of 50 to 60 years. The standard management approach is surgery. Here, we present a novel treatment approach for male urethral cancer. Thirty-six year old male, case of primary clear cell adenocarcinoma of urethra who refused surgery, underwent cystoscopic assisted intraluminal HDR brachytherapy. Patient received a dose of 36 Gy in 9 fractions (4 Gy per fraction) followed by a boost of 24 Gy in 6 fractions. At 11 months post treatment, disease is well controlled with no post treatment toxicity so far. Intraluminal brachytherapy seems to be an effective novel treatment for male urethral cancer.
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Thyavihally YB, Tongaonkar HB, Srivastava SK, Mahantshetty U, Kumar P, Raibhattanavar SG. Clinical outcome of 36 male patients with primary urethral carcinoma: a single center experience. Int J Urol 2006; 13:716-20. [PMID: 16834649 DOI: 10.1111/j.1442-2042.2006.01392.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Ahmad NA, Memon A, Hussainy A. Abdominoperineal excision of male lower urinary tract for synchronous adenocarcinoma of urethra and urinary bladder. Urology 2005; 65:591. [PMID: 15780385 DOI: 10.1016/j.urology.2004.09.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Accepted: 09/14/2004] [Indexed: 10/25/2022]
Abstract
Urethral adenocarcinoma is the least common histologic subtype of a rare primary carcinoma of the male urethra. Its site of origin remains speculative. The scarcity of reported cases in the literature makes it difficult to define the optimal management. This report is of a 40-year-old morbidly obese man with synchronous adenocarcinoma of the bulbar urethra and bladder, treated surgically by en bloc abdominoperineal penoprostatocystectomy. The pleural recurrence, after a disease-free period of 2 years, responded well to platinum-docetaxel-based systemic chemotherapy. Synchronous occurrence of adenocarcinoma of the urethra and bladder has not been previously reported. This case also highlights the possible role of upcoming adjuvant chemotherapeutic agents.
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Affiliation(s)
- Nazim Ali Ahmad
- Department of Surgery, The Aga Khan University, Karachi, Pakistan
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VanderMolen LA, Sheehy PF, Dillman RO. Successful treatment of transitional cell carcinoma of the urethra with chemotherapy. Cancer Invest 2002; 20:206-7. [PMID: 11901541 DOI: 10.1081/cnv-120001148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Licht MR, Klein EA, Bukowski R, Montie JE, Saxton JP. Combination Radiation and Chemotherapy for the Treatment of Squamous Cell Carcinoma of the Male and Female Urethra. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67354-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mark R. Licht
- Department of Urology, Sections of Urologic Oncology, Hematology and Medical Oncology and Radiation Therapy, Cleveland Clinic Foundation, Cleveland, Ohio, and Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Eric A. Klein
- Department of Urology, Sections of Urologic Oncology, Hematology and Medical Oncology and Radiation Therapy, Cleveland Clinic Foundation, Cleveland, Ohio, and Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Ronald Bukowski
- Department of Urology, Sections of Urologic Oncology, Hematology and Medical Oncology and Radiation Therapy, Cleveland Clinic Foundation, Cleveland, Ohio, and Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - James E. Montie
- Department of Urology, Sections of Urologic Oncology, Hematology and Medical Oncology and Radiation Therapy, Cleveland Clinic Foundation, Cleveland, Ohio, and Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jerrold P. Saxton
- Department of Urology, Sections of Urologic Oncology, Hematology and Medical Oncology and Radiation Therapy, Cleveland Clinic Foundation, Cleveland, Ohio, and Department of Urology, University of Michigan, Ann Arbor, Michigan
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Combination Radiation and Chemotherapy for the Treatment of Squamous Cell Carcinoma of the Male and Female Urethra. J Urol 1995. [DOI: 10.1097/00005392-199506000-00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Theyer G, Jones EC, Sullivan LD. Single-step procedure for the radical resection of an adenocarcinoma in the deep male urethra. BRITISH JOURNAL OF UROLOGY 1995; 75:99-101. [PMID: 7850312 DOI: 10.1111/j.1464-410x.1995.tb07246.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- G Theyer
- Department of Urology, Wilhelminenspital der Stadt Wien, Vienna, Austria
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THE ROLE OF RADIATION THERAPY IN THE MANAGEMENT OF CARCINOMA OF THE MALE AND FEMALE URETHRA. Urol Clin North Am 1992. [DOI: 10.1016/s0094-0143(21)00401-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Baskin LS, Turzan C. Carcinoma of male urethra: management of locally advanced disease with combined chemotherapy, radiotherapy, and penile-preserving surgery. Urology 1992; 39:21-5. [PMID: 1728791 DOI: 10.1016/0090-4295(92)90035-u] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Squamous cell carcinoma of the urethra is a rare urologic malignancy. In spite of aggressive management with radical and often times disfiguring surgery and/or radiation therapy, prognosis remains poor. Initial success in treating squamous cell carcinoma of the esophagus and anal canal has been reported with a combined radiation and chemotherapy protocol. In hopes for improving the treatment outcome for patients with squamous cell carcinoma of the urethra, we have applied the new combination chemotherapy/radiation therapy protocol. Herein, we report the successful downstaging (clinical Stage C to pathologic Stage TO) and treatment of squamous cell carcinoma of the anterior urethra with combination chemotherapy/radiation therapy. This was followed with penile-preserving surgery to document local control of disease and to avoid the morbidity of a radical disfiguring operation.
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Affiliation(s)
- L S Baskin
- Department of Urology, University of California, San Francisco
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Ticho BH, Perez-Tamayo C, Konnak JW. Primary carcinoma of the distal male urethra: a case treated with lymphadenectomy and interstitial radiation therapy. J Urol 1988; 139:1302-3. [PMID: 3131546 DOI: 10.1016/s0022-5347(17)42901-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- B H Ticho
- Department of Urology, University of Michigan Medical School, Ann Arbor
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Abstract
The authors report a case of primary urethral carcinoma which seems to be linked to human papillomavirus (HPV) infection. Southern blot hybridization of phosphorus 32 (32P)-labeled DNA extracted from the cancer tissue gave a positive reaction with HPV-6. Specimens of the tumor material subjected to in situ hybridization with 3H-labeled HPV-6 DNA showed numerous tumor cell clusters with clearly labeled nuclei. Using immunoperoxidase staining the authors found papillomavirus structural antigen within cell nuclei of the tumor tissue.
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Il Tumore Primitivo Dell'Uretra Prostatica. Urologia 1987. [DOI: 10.1177/039156038705400516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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