How We Developed a New Protocol for Treatment of Urethral Carcinoma

How We Developed a New Protocol for Treatment of Urethral Carcinoma
How We Developed a New Protocol for Treatment of Urethral Carcinoma

The incidence of urethral cancer is rare. It represents less than 1.0% of all male malignancies, with its occurrence in African American males being double that of white males.1 Due to the nature of this disease, finding the research necessary to provide the best care for a patient is challenging.  This study depicts how a collaborative effort by the multidisciplinary treatment team, including the patient, obtained the most favorable outcome. It also describes the steps involved in developing a new protocol when usual standards of care are not available.

Patient History

The patient is a 64-year-old male whose bladder cancer was initially treated via surgical interventions. His first surgery was a transurethral resection of bladder tumor (TURBT), performed in 2008. This was followed by multiple resections, and later a series of surveillance cystoscopies.

In May 2015, a surveillance cystoscopy and subsequent biopsy revealed positive nodes for papillary urethral carcinoma. The nodes extended from the fossa navicularis to the bulbar urethra. At this time the only treatment offered was a penectomy, which the patient declined.

Shortly afterward the patient relocated and presented to the urology department at our facility. He was offered the option of treatment with intraurethral mitomycin.

As with this patient, many cases of urethral cancer develop in patients whose original cancer was in the urinary bladder, with their urethral cancer developing some time after treatment is complete.2 Patients present most often with hematuria or dysuria, and their urethral cancer is found on follow-up cystoscopy. Further follow-up is usually CBC, chemistry, and liver function tests to determine if metastases are present.3 Biopsies are usually obtained in the operating room to avoid patient discomfort. MRI and CT are increasingly used to determine local invasiveness and for staging.4 The final diagnosis and determination of treatment plan is made on the basis of pathologic findings on biopsy.  

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