Urethral Cancer Associated With Invasive Bladder Cancer
Approximately 10% (range, 4%–17%) of patients who undergo cystectomy for bladder cancer can be expected to have or to later develop clinical neoplasm of the urethra distal to the urogenital diaphragm. Factors associated with the risk of urethral recurrence after cystectomy include:[1,2]
- Tumor multiplicity.
- Papillary pattern.
- Carcinoma in situ.
- Tumor location at the bladder neck.
- Prostatic urethral mucosal or stromal involvement.
The benefits of urethrectomy at the time of cystectomy need to be weighed against the morbidity factors, which include added operating time, hemorrhage, and the potential for perineal hernia. Tumors found incidentally on pathologic examination are much more likely to be superficial or in situ in contrast to those that present with clinical symptoms at a later date when the likelihood of invasion within the corporal bodies is high. The former lesions are often curable, and the latter are only rarely so. Indications for urethrectomy in continuity with cystoprostatectomy are:
- Visible tumor in the urethra.
- Positive swab cytology of the urethra.
- Positive margins of the membranous urethra on frozen section taken at the time of cystoprostatectomy.
- Multiple in situ bladder tumors that extend onto the bladder neck and proximal prostatic urethra.
If the urethra is not removed at the time of cystectomy, follow-up includes periodic cytologic evaluation of saline urethral washings.
Standard treatment options:
- In continuity cystourethrectomy.
- Monitor urethral cytology and delayed urethrectomy, if necessary.
The level of evidence for these treatment options is 3iiiDiv.Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with urethral cancer associated with invasive bladder cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.References
- Trabulsi DJ, Gomella LG: Cancer of the urethra and penis. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1272-79.
- Sherwood JB, Sagalowsky AI: The diagnosis and treatment of urethral recurrence after radical cystectomy. Urol Oncol 24 (4): 356-61, 2006 Jul-Aug. [PUBMED Abstract]