Workup/Staging

Question 1

What is the workup of urethral cancer?

Answer 1

H&P, including palpation of length of urethra in men, inguinal nodal exam, and bimanual exam. Cystourethroscopy with EUA and transurethral or transvaginal Bx, pelvic CT or MRI, and chest imaging (x-ray or CT). If there is palpable inguinal LNs, perform CT C/A/P and LN Bx. (NCCN 2018)

Question 2

What is the workup for urothelial carcinoma of the prostate?

Answer 2

H&P, PSA, DRE, cystoscopy with bladder Bx, TURP that includes the prostatic stroma. If DRE is abnl, perform needle Bx to exclude primary adenocarcinoma of the prostate. Image upper urinary tract. If stromal or acinar invasion present, perform chest imaging.

Question 3

What is the AJCC 8th edition (2017) T and N staging for primary tumors of the male penile urethra and female urethra?

Answer 3

Ta: noninvasive papillary carcinoma

Tis: CIS

T1: tumor invades subepithelial connective tissue

T2: tumor invades either corpus spongiosum or periurethral muscle

T3: tumor invades either corpus cavernosum or ant vagina

T4: invasion of other adjacent organs (e.g., bladder wall)

N1: single involved LN in the pelvis or inguinal region

N2: multiple involved LNs in the pelvis or inguinal region

Question 4

What is the AJCC 8th edition (2017) T staging for urothelial carcinoma of the prostate?

Answer 4

Tis: CIS with involvement of prostatic urethra or periurethral or prostatic ducts without stromal invasion

T1: tumor invades urethral subepithelial connective tissue immediately underlying the urothelium

T2: tumor invades the prostatic stroma surrounding ducts either by direct extension from the urothelial surface or by invasion from prostatic ducts

T3: tumor invades the periprostatic fat

T4: tumor invades other adjacent organs (e.g., extraprostatic invasion of the bladder wall, rectal wall)