Primary Urethral Carcinoma

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G. Gakis, , J.A. Witjes, , E. Compérat, , N.C. Cowan, , M. De Santis,, T. Lebret, , M.J. Ribal, , A. Sherif, , A.G. van der Heijden

1.INTRODUCTION

1.1.Aims and scope

The aim of these guidelines is to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). When the first carcinoma in the urinary tract is detected in the urethra, this is defined as primary UC, in contrast to secondary UC, which presents as recurrent carcinoma in the urethra after prior diagnosis and treatment of carcinoma elsewhere in the urinary tract. Most often, secondary UC is reported after radical cystectomy for bladder cancer [1,2] (see Chapter 7.4 of the EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer [2] of the full text versions).

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account.

1.2.Panel composition

The EAU Guidelines Panel on Muscle-invasive and Metastatic Bladder Cancer (MIBC) is responsible for this publication. This is an international multidisciplinary group of clinicians, including a pathologist, an oncologist and a radiologist. Members of this panel have been selected based on their expertise to represent the professionals treating patients suspected of harbouring urethral carcinoma. All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU Website Uroweb: www.uroweb.org/guidelines/primary-urethral-carcinoma/.

1.3.Publication history and summary of changes

The Primary Urethral Carcinoma Guidelines were first published in 2013 [3]. This is the first update of this document.

1.3.1.Summary of changes

The literature for the complete document has been assessed and updated, where relevant.

Key changes for the 2015 publication:

  • Evaluation of recent data on prognostic factors on oncologic outcomes in primary UC;
  • Evaluation of recent data on the degree of concordance between clinical and pathologic staging;
  • Evaluation of recent data on distal urethrectomy in men;
  • Evaluation of recent data on the prognostic effect of multimodal treatment in advanced primary UC.

Conclusions and recommendations have been rephrased and added to throughout the document, with no changes in the level of evidence (LE) and grade of recommendation (GR). These changes can be found in the following sections:

6.2 Predictors of survival in primary urethral carcinoma

Summary of evidence

LE

Risk factors for survival in primary UC are: age, race, tumour stage and grade, nodal stage, presence of distant metastasis, histological type, tumour size, tumour location, concomitant bladder cancer and type and modality of treatment.

3

7.1 Treatment of localised primary urethral carcinoma in males

Recommendation

LE

GR

Offer distal urethrectomy as an alternative to penile amputation in localised anterior urethral tumours, if surgical margins are negative.

3

B

7.2.2 Radiotherapy

Recommendation

LE

GR

Offer local radiotherapy as an alternative to urethral surgery to women with localised urethral tumours, but discuss local toxicity.

3

C

7.3.2 Preoperative chemoradiotherapy in locally advanced squamous cell carcinoma of the urethra

Summary of evidence

LE

In locally advanced UC, cisplatin-based chemotherapy with curative intent prior to surgery improves survival compared to chemotherapy alone or surgery followed by chemotherapy.

4

In locally advanced squamous cell carcinoma (SCC) of the urethra, the prognostic role and timing of surgery after completion of chemoradiotherapy is unclear.

4

Recommendations

LE

GR

Use cisplatinum-based chemotherapeutic regimens with curative intent prior to surgery.

4

C

In locally advanced SCC of the urethra, offer the combination of curative radiotherapy with radiosensitising chemotherapy for genital preservation.

4

C

SCC=squamous cell carcinoma; UC=urethral carcinoma.

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