Treatment of Urethral Cancer in Urothelial Carcinoma of the Prostatic Urethra, Stage T2 (N0, M0)
This protocol addresses the management of urothelial carcinoma arising in the prostatic urethra at stage T2, including cases with proximal urethral extension (Ta–T2), without regional or distant spread (N0, M0).
Clinical scenario
The diagnosis is urothelial carcinoma of the prostatic urethra, stage T2, with or without proximal urethral extension (Ta–T2), N0, M0.
Clinicians should be aware that the risk of understaging local extension at transurethral resection (TUR) is high in patients with ductal or stromal involvement. Earlier series have reported superior oncological outcomes when radical surgery is used as the primary treatment in patients with ductal involvement.
Treatment approach
Recommended management involves radical surgical resection, with attention to the extent of lymph node dissection informed by the pattern of nodal spread in this disease.
The complete procedure, indications, and lymphadenectomy guidance are detailed in the full protocol.
References
- Risk of understaging local extension of prostatic urethral cancer at TUR is high in patients with ductal or stromal involvement.
- Some earlier series have reported superior oncological results for the initial use of radical cystoprostatectomy as a primary treatment option in patients with ductal involvement.
- In patients not responding to BCG, or in patients with ductal or stromal involvement, perform a cystoprostatectomy with extended pelvic lymphadenectomy.
- In 24 patients with prostatic stromal invasion treated with radical cystoprostatectomy, an LN mapping study found that 12 patients had positive LNs, with an increased proportion located above the iliac bifurcation.
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