Urethral Cancer

Question 1

UrCa

Female Surgical Resection

Answer 1

• The distal 1/3rd of the urethra can be resected without effecting continence
• High grade tumor resection should include anterior vaginal wall

Question 2

UrCa

Prostatic Urothelial Carcinoma Workup

Answer 2

• H&P with DRE
• Cystoscopy with bladder biopsies
• Cytology
• TUR of prostate including stroma
• PSA
• PBx if DRE is abnormal (select pts)
• CTU or MRU

Question 3

UrCa

Non-invasive Prostatic Urethral Treatment

Answer 3

Mucosla prostatic urethral cancer
* TURP and BCG
* Cystoprostatectomy +/- urethrectomy if recurrence

Ductal Acini
* CT A/P and CXR
* Cystoprostatectomy +/- urethrectomy or TURP + BCG
* Cystoprostatectomy /- urethrectomy if recurrence

Stromal Invasion
* CT A/P and CXR
* NAC with Cystoprostatectomy +/- urethrectomy

Question 4

UrCa

Metastatic Prostatic Urethral Treatment

Answer 4

Systemic Therapy
* Pembrolizumab and enfortumab vedotin (p) (cisplatin eligible or ineligible)
* Gemcitabine, cisplatin followed by avelumab maintenance
* Nivolumab, gemcitabine, cisplatin followed by avelumab maintenance
* ddMVAC followed by avelumab maintenance
* Gemcitabine carboplatin (cisplatin ineligible)

Question 5

UrCa

Metastatic Non-prostatic Urethral Carcinoma Treatment (Male or Female)

Answer 5

Systemic Therapy
* Pembrolizumab and enfortumab vedotin (p) (cisplatin eligible or ineligible)
* Gemcitabine, cisplatin followed by avelumab maintenance
* Nivolumab, gemcitabine, cisplatin followed by avelumab maintenance
* ddMVAC followed by avelumab maintenance
* Gemcitabine carboplatin (cisplatin ineligible)

Question 6

UrCa

Non-prostatic urethral carcinoma or female urethral carcinoma workup

Answer 6

• Cystoscopy with EUA and TUR vs transvaginal biopsy
• CXR or Chest CT
• MRI of pelvis with and without contrast

Question 7

UrCa

Stage I and II Non-prostatic male urethral carcinoma treatment (Tis-T2)

Answer 7

Tis, Ta T1
* Repeat TUR
* BCG or intravesical chemotherapy (select cases)

T2 Pendulous
* Distal urethectomy or partial penectomy
* Chemoradiotherapy, RT or additional surgery if positive margin

T2 Bulbar
* Urethrectomy +/- cystoprostatectomy
* Chemotherapy or chemoradiotherapy if pT3-4 or pN1-2

Question 8

UrCa

Stage I and II Female urethral carcinoma treatment (Tis-T2)

Answer 8

• Chemoradiotherapy
• Cystectomy with urethrectomy
• Distal urethrectomy (select pts depending on tumor and location)

Question 9

UrCa

Stage III and IV workup

Answer 9

• CT C/A/P
• Lymph node biopsy if palpable lymph nodes

Question 10

UrCa

Stage III and IV treatment

Answer 10

cN0
* Chemoradiation (p) +/- consolidative surgery
* NAC and consolidation surgery vs EBRT
* EBRT
* Urethectomy (non-UC histology)

cN1-2
* Chemoradiation (preferred for SCC)
* Systemic therapy +/- consolidative surgery
* Chemoradiotherapy +/- consolidative surgery