EAU Guidelines on Primary Urethral Carcinoma

• Published in: European urology Vol. 64; no. 5; pp. 823 - 830
• Main Authors: Gakis, Georgios, Witjes, J. Alfred, Compérat, Eva, Cowan, Nigel C., De Santis, Maria, Lebret, Thierry, Ribal, Maria J., Sherif, Amir M.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.11.2013; Elsevier
• Subjects: Antineoplastic Combined Chemotherapy Protocols - standards; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Biopsy; Carcinoma - diagnosis; Carcinoma - mortality; Carcinoma - therapy; Chemotherapy; Chemotherapy, Adjuvant - standards; Cystoscopy; Cytology; Dermatology; Diagnostic Imaging - standards; Diagnostic Techniques, Urological - standards; EAU; Guidelines; Humans; Medical sciences; MRI; Neoadjuvant Therapy - standards; Nephrology. Urinary tract diseases; Penile-preserving surgery; Predictive Value of Tests; Primary; Prognosis; Radiotherapy; Radiotherapy - standards; Risk Factors; Squamous cell carcinoma; Tumors of the skin and soft tissue. Premalignant lesions; Tumors of the urinary system; Urethra-sparing surgery; Urethral carcinoma; Urethral neoplasms; Urethral Neoplasms - diagnosis; Urethral Neoplasms - mortality; Urethral Neoplasms - therapy; Urethral stricture; Urinary tract. Prostate gland; Urologic Surgical Procedures - standards; Urology; Urology - standards; Squamous cell carcinoma; Urethral carcinoma; MRI; Urethral neoplasms; Cytology; Cystoscopy; Radiotherapy; Guidelines; Chemotherapy; Biopsy; Urethra-sparing surgery; Primary; EAU; Penile-preserving surgery; Urethral stricture; Skin disease; Nephrology; Urethral disease; Basal cell carcinoma; Urology; Conservative surgery; Urethra; Urethra tumor; Urinary system disease; Urinary tract disease; Malignant tumor; Male genital system; Nuclear magnetic resonance imaging; Recommendation; Anatomic pathology; Treatment; Penis; Medical imagery; Urethral stenosis; Cancer
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2013.03.044

The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). To review the current literature on the diagnosis and treatment of patients with primary UC and assess its level of scientific evidence. A systematic literature search was performed to identify studies reporting urethral malignancies. Medline was searched using the controlled vocabulary of the Medical Subject Headings database, along with a free-text protocol. Primary UC is considered a rare cancer, accounting for <1% of all malignancies. Risk factors for survival include age, tumour stage and grade, nodal stage, presence of distant metastasis, histologic type, tumour size, tumour location, and modality of treatment. Pelvic magnetic resonance imaging is the preferred method to assess the local extent of urethral tumour; computed tomography of the thorax and abdomen should be used to assess distant metastasis. In localised anterior UC, urethra-sparing surgery is an alternative to primary urethrectomy in both sexes, provided negative surgical margins can be achieved. Patients with locally advanced UC should be discussed by a multidisciplinary team of urologists, radiation oncologists, and oncologists. Patients with noninvasive UC or carcinoma in situ of the prostatic urethra and prostatic ducts can be treated with a urethra-sparing approach with transurethral resection and bacillus Calmette-Guérin (BCG). Cystoprostatectomy with extended pelvic lymphadenectomy should be reserved for patients not responding to BCG or as a primary treatment option in patients with extensive ductal or stromal involvement. The 2013 guidelines document on primary UC is the first publication on this topic by the EAU. It aims to increase awareness in the urologic community and provide scientific transparency to improve outcomes of this rare urogenital malignancy. Clinical awareness is of utmost importance for early diagnosis and improved outcomes in primary urethral carcinoma. Patients with locally advanced stages should be discussed by a multidisciplinary team of urologists, radiation oncologists, and oncologists.