Urethral cancer in men
- Ralph Madeb, MD
Ralph Madeb, MD
- Assistant Professor of Urology
- Department of Urology
- University of Rochester School of Medicine and Dentistry
- Dragan Golijanin, MD
Dragan Golijanin, MD
- Director Section GU Oncology
- Urology Division, Brown University
- Edward Messing, MD, FACS
Edward Messing, MD, FACS
- Professor of Urology and Oncology
- University of Rochester School of Medicine and Dentistry
- Bridget F Koontz, MD
Bridget F Koontz, MD
- Assistant Professor of Radiation Oncology
- Duke University School of Medicine
- Section Editors
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter
- Section Editor — Urologic Surgery
- Section Editor — Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
Primary urethral cancer is a rare malignancy in men . Differences in anatomy and etiology lead to important differences in the clinical presentation, diagnosis, and treatment of urethral cancer in men compared with women.
Information about the natural history and prognosis of urethral cancer in men is derived from small cases series, and recommendations for treatment are based upon general oncologic principles and extrapolation from other diseases.
The diagnosis, evaluation, and treatment of male urethral cancer will be reviewed here. Female urethral cancer is discussed separately. (See "Urethral cancer in women".)
The male urethra extends from the base of the bladder to the external urethral meatus and averages 21 cm in length. It is customarily divided into prostatic, bulbomembranous, and penile segments , or alternatively, into posterior (membranous and prostatic) and anterior (glanular, penile and bulbous) portions .
The normal prostatic and bulbomembranous urethral segments are lined with transitional epithelium that is similar to the upper urinary tract. The penile urethra is lined with pseudostratified columnar epithelium, and the meatus is lined with stratified squamous epithelium.
- Ali SL, Dorf TB, Pagnini PG, and Quinn DI.. Urethral Cancer. In: Textbook of Uncommon Cancer, 4, Raghavan D, Blanke C, Johnson DH, et al. (Eds), Wiley-Blackwell, Hoboken, NJ 2012. p.35.
- Carroll PR, Dixon CM. Surgical anatomy of the male and female urethra. Urol Clin North Am 1992; 19:339.
- Krieg R, Hoffman R. Current management of unusual genitourinary cancers. Part 2: Urethral cancer. Oncology (Williston Park) 1999; 13:1511.
- Fair WR, Chi-Rei Y. Urethral carcinoma in males. In: Current Therapy in Genitourinary Surgery, 2nd, Resnick MI, Kursh BC (Eds), Decker, 1997. p.157.
- Herr HW. Surgery of Penile and Urethral Carcinoma. In: Campbell's Urology, 7th, Walsh PC, Retik AB, Vaughan ED, et al (Eds), WB Saunders, 1998. p.3401.
- Johnson DW, Kessler JF, Ferrigni RG, Anderson JD. Low dose combined chemotherapy/radiotherapy in the management of locally advanced urethral squamous cell carcinoma. J Urol 1989; 141:615.
- Cheon J, Kim CS, Lee ES, et al. Survey of incidence of urological cancer in South Korea: a 15-year summary. Int J Urol 2002; 9:445.
- Swartz MA, Porter MP, Lin DW, Weiss NS. Incidence of primary urethral carcinoma in the United States. Urology 2006; 68:1164.
- Hopkins SC, Nag SK, Soloway MS. Primary carcinoma of male urethra. Urology 1984; 23:128.
- Rudloff U, Amukele SA, Moldwin R, et al. Small cell carcinoma arising from the proximal urethra. Int J Urol 2004; 11:674.
- Masuda A, Tsujii T, Kojima M, et al. Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising from the male urethra. A case report and review of the literature. Pathol Res Pract 2002; 198:571.
- Boyle M, Gaffney EF, Thurston A. Paraganglioma of the prostatic urethra. A report of three cases and a review of the literature. Br J Urol 1996; 77:445.
- Hofmockel G, Dämmrich J, Manzanilla Garcia H, et al. Primary non-Hodgkin's lymphoma of the male urethra. A case report and review of the literature. Urol Int 1995; 55:177.
- Applewhite JC, Hall MC, McCullough DL. Urethral Carcinoma. In: Adult and Pediatric Urology, 4th, Gillenwater JY, Grayhack JT, Howards SS, et al (Eds), Lippincott Williams and Wilkins, 2002. p.1791.
- Vapnek JM, Hricak H, Carroll PR. Recent advances in imaging studies for staging of penile and urethral carcinoma. Urol Clin North Am 1992; 19:257.
- Anderson KA, McAninch JW. Primary squamous cell carcinoma of anterior male urethra. Urology 1984; 23:134.
- Dalbagni G, Zhang ZF, Lacombe L, Herr HW. Male urethral carcinoma: analysis of treatment outcome. Urology 1999; 53:1126.
- Kaplan GW, Bulkey GJ, Grayhack JT. Carcinoma of the male urethra. J Urol 1967; 98:365.
- McMillan A, Pakianathan M, Mao JH, Macintyre CC. Urethral stricture and urethritis in men in Scotland. Genitourin Med 1994; 70:403.
- Park S, McAninch JW. Straddle injuries to the bulbar urethra: management and outcomes in 78 patients. J Urol 2004; 171:722.
- Raghavaiah NV. Radiotherapy in the treatment of carcinoma of the male urethra. Cancer 1978; 41:1313.
- Wiener JS, Liu ET, Walther PJ. Oncogenic human papillomavirus type 16 is associated with squamous cell cancer of the male urethra. Cancer Res 1992; 52:5018.
- Wiener JS, Walther PJ. A high association of oncogenic human papillomaviruses with carcinomas of the female urethra: polymerase chain reaction-based analysis of multiple histological types. J Urol 1994; 151:49.
- Tsai YS, Yang WH, Tong YC, et al. Experience with primary urethral carcinoma from the blackfoot disease-endemic area of South Taiwan: increased frequency of bulbomembranous adenocarcinoma? Urol Int 2005; 74:229.
- Mostofi FK, Davis CJ Jr, Sesterhenn IA. Carcinoma of the male and female urethra. Urol Clin North Am 1992; 19:347.
- Messing EM. Urethrectomy in men and women. In: Master of Surgery: Urologic Surgery, Fowler JE (Ed), Little, Brown, 1992. p.495.
- Bretton PR, Herr HW, Whitmore WF Jr, et al. Intravesical bacillus Calmette-Guerin therapy for in situ transitional cell carcinoma involving the prostatic urethra. J Urol 1989; 141:853.
- Pavlica P, Barozzi L, Menchi I. Imaging of male urethra. Eur Radiol 2003; 13:1583.
- Urethra. In: American Joint Committee on Cancer Staging Manual, 7th, Springer, New York 2010. p.507.
- Zeidman EJ, Desmond P, Thompson IM. Surgical treatment of carcinoma of the male urethra. Urol Clin North Am 1992; 19:359.
- Dinney CP, Johnson DE, Swanson DA, et al. Therapy and prognosis for male anterior urethral carcinoma: an update. Urology 1994; 43:506.
- Eng TY, Naguib M, Galang T, Fuller CD. Retrospective study of the treatment of urethral cancer. Am J Clin Oncol 2003; 26:558.
- Farrer JH, Lupu AN. Carcinoma of deep male urethra. Urology 1984; 24:527.
- Konnak JW. Conservative management of low grade neoplasms of the male urethra: a preliminary report. J Urol 1980; 123:175.
- Kourambas J, Delvecchio FC, Preminger GM. Low-power holmium laser for the management of urinary tract calculi, structures, and tumors. J Endourol 2001; 15:529.
- Bernstein G, Forgaard DM, Miller JE. Carcinoma in situ of the glans penis and distal urethra. J Dermatol Surg Oncol 1986; 12:450.
- Nash PA, Bihrle R, Gleason PE, et al. Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction for glanular carcinoma in situ with significant urethral extension. Urology 1996; 47:108.
- Davis JW, Schellhammer PF, Schlossberg SM. Conservative surgical therapy for penile and urethral carcinoma. Urology 1999; 53:386.
- Heysek RV, Parsons JT, Drylie DM, Million RR. Carcinoma of the male urethra. J Urol 1985; 134:753.
- Gheiler EL, Tefilli MV, Tiguert R, et al. Management of primary urethral cancer. Urology 1998; 52:487.
- Cohen MS, Triaca V, Billmeyer B, et al. Coordinated chemoradiation therapy with genital preservation for the treatment of primary invasive carcinoma of the male urethra. J Urol 2008; 179:536.
- Dalbagni G, Donat SM, Eschwège P, et al. Results of high dose rate brachytherapy, anterior pelvic exenteration and external beam radiotherapy for carcinoma of the female urethra. J Urol 2001; 166:1759.
- Klein FA, Whitmore WF Jr, Herr HW, et al. Inferior pubic rami resection with en bloc radical excision for invasive proximal urethral carcinoma. Cancer 1983; 51:1238.
- Ray B, Canto AR, Whitmore WF Jr. Experience with primary carcinoma of the male urethra. J Urol 1977; 117:591.
- Hussein AM, Benedetto P, Sridhar KS. Chemotherapy with cisplatin and 5-fluorouracil for penile and urethral squamous cell carcinomas. Cancer 1990; 65:433.
- Baskin LS, Turzan C. Carcinoma of male urethra: management of locally advanced disease with combined chemotherapy, radiotherapy, and penile-preserving surgery. Urology 1992; 39:21.
- Licht MR, Klein EA, Bukowski R, et al. Combination radiation and chemotherapy for the treatment of squamous cell carcinoma of the male and female urethra. J Urol 1995; 153:1918.
- Kent M, Zinman L, Girshovich L, et al. Combined Chemoradiation as Primary Treatment for Invasive Male Urethral Cancer. J Urol 2014.
- Garden AS, Zagars GK, Delclos L. Primary carcinoma of the female urethra. Results of radiation therapy. Cancer 1993; 71:3102.
- Rabbani F. Prognostic factors in male urethral cancer. Cancer 2011; 117:2426.
- Dalbagni G, Zhang ZF, Lacombe L, Herr HW. Female urethral carcinoma: an analysis of treatment outcome and a plea for a standardized management strategy. Br J Urol 1998; 82:835.
- Catalona WJ. Re: Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 1988; 140:836.
- VanderMolen LA, Sheehy PF, Dillman RO. Successful treatment of transitional cell carcinoma of the urethra with chemotherapy. Cancer Invest 2002; 20:206.
- EPIDEMIOLOGY AND RISK FACTORS
- Risk factors
- - Chronic inflammation
- - HPV infection
- - Other factors
- CLINICAL PRESENTATION
- EVALUATION OF SUSPECTED DISEASE
- Staging system
- Early stage lesions
- - Local treatment approaches
- - Penectomy
- Partial penectomy
- Radical penectomy
- Approach to the scrotum
- - Non-surgical management
- Locally advanced lesions
- - Multimodality therapy
- Neoadjuvant therapy
- Surgical management
- - Role of lymphadenectomy
- Adjuvant therapy
- Definitive chemoradiation
- POSTTREATMENT SURVEILLANCE
- TREATMENT OF RECURRENT OR METASTATIC DISEASE
- SUMMARY AND RECOMMENDATIONS