Coordinated Chemoradiation Therapy With Genital Preservation for the Treatment of Primary Invasive Carcinoma of the Male Urethra

Cohen, Michael S.; Triaca, Veronica; Billmeyer, Brian; Hanley, Robert S.; Girshovich, Lyubov; Shuster, Todd D.; Oberfield, Richard A.; Zinman, Leonard

doi:10.1016/j.juro.2007.09.068

Cited by 58 publications

(39 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[3][4][5] Salvage surgery alone improves 5-year disease-free survival rates from 54% to 72%. 3,10 Multimodal treatment was planned for our patient. In spite of this, no additional treatment was carried out due to the patient's request and his other conditions.…”

Section: Discussionmentioning

confidence: 99%

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Ekin¹,

Yıldırım²,

Bayol³

et al. 2015

CUAJ

View full text Add to dashboard Cite

Primary urethral carcinomas are uncommon, with urothelial carcinoma as the most common subtype. Urethral diverticulum is also rarely seen in men. A 44-year-old male presented with voiding symptoms. Abdominoperineal resection, prostatectomy, bladder neck excision, and proximal urethral excision were performed. A pathological examination revealed a well-differentiated squamous cell carcinoma (SCC) located inside an urethral diverticulum. We report this unusual case because primary SCC of the male urethral diverticulum is extremely rare. To our knowledge, our patient is only the second reported case. IntroductionPrimary urethral carcinoma (UC) is rare and accounts for less than 1% of all cancers.1,2 UC is the most common subtype. Generally, UCs are seen in the 5th decade.1,2 Patients presented with non-specific and overlapping clinical signs and symptoms.1,3 Management of UC is still controversial and challenging due to lack of experience.3 The surgical approach depends on the location and extent of the tumour. In advanced urethral squamous cell carcinoma (SCC), a combination of surgery, radiotherapy, and chemotherapy is recommended.3-6 The 5-year overall survival in patients with UC is about 50% to 55%. 2,3,5 Case reportA 44-year-old male presented with voiding difficulty and constipation for 3 months. He had a history of right nephrectomy for non-functional kidney secondary to a kidney stone. Although digital rectal examination revealed a hard, fixed mass on the anterior rectal wall, his prostate-specific antigen level was 0.61 ng/mL. A transrectal prostate biopsy was performed, and the pathological examination revealed a welldifferentiated SCC. The patient was referred to our urology clinic with a preliminary diagnosis of primary SCC of the prostate. A magnetic resonance imaging (MRI) showed a 6 × 7.2 × 8.1-cm round mass with smooth margins and heterogeneous internal enhancement. The mass abutted the rectum and bladder, and extended to the apex of the prostate and the levator ani without sign of invasion (Fig. 1). The prostate and lymph nodes were normal. For the purpose of a differential diagnosis, a colonoscopy was performed and the mucosa was normal. The patient underwent a cystourethroscopy and biopsy under anesthesia. We demonstrated a large wide-mouthed urethral diverticulum and tumour growth in the bulbomembranous urethral diverticulum. The prostate was normal and the dimensions of the prostate were compatible with the patient's age. The bladder mucosa was intact, with external tumour compression. A histopathologic examination revealed a well-differentiated SCC with an inverted and warty growth pattern, keratinization with keratin pearl and dyskeratotic cells.The patient was informed about the radical cystoprostatectomy and abdominoperineal resection if organ preservation was unfavourable, and informed consent was obtained. Abdominoperineal resection, prostatectomy, bladder neck excision, and proximal urethral excision were performed. On gross examination of the excision specimen, there was the pr...

show abstract

Section: Discussionmentioning

confidence: 99%

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Ekin¹,

Yıldırım²,

Bayol³

et al. 2015

CUAJ

View full text Add to dashboard Cite

show abstract

“…These are the patients who probably need the greatest effort in terms of a multidisciplinary approach to ensure the best clinical outcomes. Earlier reports of comparable cohorts emphasized a radiation-based approach (with or without surgery and/or chemotherapy) [3,12–14]. However, those patients experienced significant radiation-related toxicity and, in addition, the studies contained relatively small numbers of patients and covered time spans as long as several decades, rendering decision-making regarding these patients difficult.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of survival outcomes and the role of cisplatin-based chemotherapy in patients with urethral carcinomas referred to medical oncologists

Dayyani

Pettaway

Kamat

et al. 2013

Urologic Oncology: Seminars and Original Investigations

View full text Add to dashboard Cite

Objectives Primary carcinomas of the urethra (PCU) are rare and often advanced when diagnosed. Treatment standards are lacking. We studied treatment response and survival in a cohort of patients with PCU, with emphasis on modern platinum-containing chemotherapy regimens plus surgery for advanced disease. Materials and methods This was a retrospective chart review of consecutive patients with PCU seen by medical oncologists at our institution over a recent 5-year period. Outcome was measured as best response to chemotherapy. Kaplan-Meier estimates were generated for survival and Cox proportional hazard was used for prognostic factors for survival. Results The 44 patients (64% women) included had a median age at diagnosis of 66.5 years. The most prevalent histologic subtypes of PCU were squamous cell carcinoma and adenocarcinoma. At diagnosis, 43% already had lymph node-positive [lymph node (LN)+] disease, and 16% had distant metastases. The entire cohort's overall survival (OS) was 31.7 months. The response rate to platinum-containing neoadjuvant chemotherapy was 72%. Twenty-one patients with locally advanced or LN+ PCU underwent chemotherapy plus surgery. Their median OS from chemotherapy initiation was 25.6 months. Four of 9 patients (44%) with LN+ PCU at diagnosis were alive at our review, with a minimum follow-up of more than 3 years. Conclusions Modern platinum-containing regimens appear to be effective in advanced PCU. Preoperative chemotherapy is associated with prolonged disease-free survival in a subgroup of LN+ cases.

show abstract

“…The following therapeutic options are currently available: surgical resection (often for distal and small urethral tumors), radiotherapy and chemotherapy (large tumors) for functional preservation of the penis, bladder and/or vagina), or a combination thereof in the case of more extensive tumors [10,[18][19][20]. Radical resections with urinary derivation [16] and partial resection with functional preservation of the urethra in cases of small injuries are among the surgical options [21].…”

Section: Discussionmentioning

confidence: 99%

“…Chemotherapy combined with local radiotherapy has also been used as primary treatment for organ preservation in tumors of the male urethra, especially in moderately or poorly differentiated squamous cell carcinoma [20][21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Urethral carcinoma: critical view on contemporary consecutive series

et al. 2010

View full text Add to dashboard Cite

Urethral carcinoma is a rare cancer of the urinary tract. Although most cases are of squamous cell carcinomas, there are several reports in the literature about transitional cell carcinoma and adenocarcinomas whose origin remains controversial. While the diagnosis of this condition is essentially clinical, magnetic resonance imaging (MRI) is the examination of choice for its staging, and a pathological confirmation is still necessary. There is no consensus on the treatment of these tumors because of its low incidence. The following therapeutic options are currently available: surgical resection (often for small and distal urethral tumors); radiotherapy and chemotherapy, for larger tumors, seeking a functional preservation of the penis, bladder and/or vagina; or a combination of these therapies thereof in case of more extensive tumors. The classic treatment involves surgery aiming loco-regional disease control, and continent urinary derivation provides satisfactory functional results in cases of radical urethrectomy. Much still needs to be learned about urethral cancer, and molecular diagnostics tools and therapeutic targets are promissory. The key to better understanding urethral cancer is the pooling of data from a wide range of sources including international consortia.

show abstract

Coordinated Chemoradiation Therapy With Genital Preservation for the Treatment of Primary Invasive Carcinoma of the Male Urethra

Abstract: The chemoradiation therapy protocol is an alternative primary treatment modality for invasive urethral carcinoma. It enables an unprecedented potential for organ preservation.

Cited by 58 publications

References 18 publications

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Retrospective analysis of survival outcomes and the role of cisplatin-based chemotherapy in patients with urethral carcinomas referred to medical oncologists

Urethral carcinoma: critical view on contemporary consecutive series

Contact Info

Product

Resources

About