Treatment of Urothelial Carcinoma of the Prostatic Urethra or Prostatic Ducts — Stage Ta, Tis, or T1 (N0, M0)
This protocol applies to patients with urothelial carcinoma arising in the prostatic urethra or prostatic ducts at a non-invasive or superficially invasive stage — Ta, Tis, or T1 — with no regional nodal involvement and no distant metastasis.
Non-invasive or in-situ urothelial carcinoma of the prostatic urethra or prostatic ducts (stage Ta, Tis, or T1, N0, M0) is a setting in which organ-sparing, urethra-preserving management is the goal. The tumour is localised and has not spread beyond the prostate or to lymph nodes or distant sites.
The standard approach involves a local surgical intervention directed at the prostatic urethra, followed by intravesical instillation therapy. Evidence from a systematic review supports this combined approach as effective for local control in this population, with favourable disease-free and progression-free outcomes compared with instillation alone.
References
- Local conservative treatment with extensive TUR and subsequent bacillus Calmette-Guérin (BCG) instillation is effective in patients with Ta or Tis prostatic urethral carcinoma.
- A systematic review reported that patients treated with transurethral resection of the prostate (TURP) before BCG show a better local response in the prostatic urethra with a higher disease-free survival (80-100% vs. 63-89%) and progression-free survival (PFS) (90-100% vs. 75-94%) than patients in studies in which no TURP was performed.
- Offer a urethra-sparing approach with transurethral resection and bacillus Calmette-Guérin (BCG) to patients with non-invasive urethral carcinoma or carcinoma in situ of the prostatic urethra and prostatic ducts.