Primary urethral cancer is a rare malignancy; the most common histological subtype is squamous cell carcinoma. The aetiology of this cancer is similar to penile cancer and the human papilloma virus (HPV) is thought to be an important factor in tumourigenesis. Surgery with or without chemoradiotherapy is the accepted treatment for primary urethral cancer. Current practice supports penile-sparing surgery, to maximise functional and psychological outcomes. We have reviewed the literature to summarise the pathogenesis and management of primary urethral cancer.
SwartzMAPorterMPLinDW. Incidence of primary urethral carcinoma in the United States. Urology2006; 68: 1164–1168.
2.
DinneyCPJohnsonDESwansonDA. Therapy and prognosis for male anterior urethral carcinoma: An update. Urology1994; 43: 506–514.
3.
RabbaniF. Prognostic factors in male urethral cancer. Cancer2011; 117(11): 2426–2434.
4.
LiuAXZhouJHJinHM. Primary rhabdomyosarcoma of urethra in a 5-year-old girl: Case report and literature review. Urology2007; 69: e1208–1209.
5.
MasudaATsujiiTKojimaM. Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising from the male urethra. A case report and review of the literature. Pathol Res Pract2002; 198: 571–575.
6.
GokceOAcarOTuncM. Primary urethral plasmacytoma: A case report and literature review. Kaohsiung J Med Sci2008; 24: 274–277.
7.
SmithYHadwayPAhmedS. Penile-preserving surgery for male distal urethral carcinoma. Br J Urol Int2007; 100: 82–87.
8.
OberfieldRAZinmanLNLeibenhautM. Management of invasive squamous cell carcinoma of the bulbomembranous male urethra with coordinated chemo-radiotherapy and genital preservation. Br J Urol1996; 78: 573–578.
9.
GheilerELTefilliMVTiguertR. Management of primary urethral cancer. Urology1998; 52: 487–493.
10.
BakkaliHBenjaafarNMansouriA. Primary adenocarcinoma of the male urethra. A case report. Cancer Radiother2002; 6: 358–362.
11.
YachiaDTuraniH. Colonic-type adenocarcinoma of male urethra. Urology1991; 37: 568–570.
12.
Grussendorf-ConenEIDeutzFJDe VilliersEM.Detection of human papillomavirus-6 in primary carcinoma of the urethra in men. Cancer1987; 60: 1832–1835.
13.
WienerJSLiuETWaltherPJ. Oncogenic human papillomavirus Type 16 is associated with squamous cell cancer of the male urethra. Cancer Res1992; 52: 5018–5023.
14.
CuppMRMalekRSGoellnerJR. Detection of human papillomavirus DNA in primary squamous cell carcinoma of the male urethra. Urology1996; 48: 551–555.
15.
FerreuxELontAPHorenblasS. Evidence for at least three alternative mechanisms targeting the p16INK4A/ cyclin D/Rb pathway in penile carcinoma, one of which is mediated by high-risk human papillomavirus. J Pathol2003; 201: 109–118.
16.
KayesOAhmedHUAryaM. Molecular and genetic pathways in penile cancer. Lancet Oncol2007; 8: 420–429.
17.
AnderssonPKolaricAWindhalT. PIK3CA, HRAS and KRAS gene mutations in human penile cancer. J Urol2008; 179: 2030–2034.
18.
CouturierJSastre-GarauXSchneider-MaunouryS. Integration of papillomavirus DNA near myc genes in genital carcinomas and its consequences for proto-oncogene expression. J Virol1991; 65: 4534–4538.
19.
AlvesGFiedlerWGuentherE. Determination of telomerase activity in squamous cell carcinoma of the penis. Int J Oncol2001; 18: 67–70.
20.
TsaiYS. Experience with primary urethral carcinoma from the blackfoot disease-endemic area of South Taiwan: Increased frequency of bulbomembranous adenocarcinoma?Urol Int2005; 74: 229–234.
21.
DalbagniGZhangZFLacombeL. Male urethral carcinoma: Analysis of treatment outcome. Urology1999; 53: 1126–1132.
22.
HopkinsSCNagSKSolowayMS. Primary carcinoma of male urethra. Urology1984; 23: 128–133.
23.
MohanHBalAPuniaRP. Squamous cell carcinoma of the prostate. Int J Urol2003; 10: 114–116.
24.
ColapintoVEvansDH. Primary carcinoma of the male urethra developing after urethroplasty for stricture. J Urol1977; 118: 581–584.
VelazquezEFBarretoJERodriguezI. Limitations in the interpretation of biopsies in patients with penile squamous cell carcinoma. Int J Surg Pathol2004; 12: 139–146.
27.
ToujierAKDalbagniG. Role of voided urine cytology in diagnosing primary urethral carcinoma. Urology2004; 63: 33–35.
28.
DayyaniFPettawayCAKamatAM. Retrospective analysis of survival outcomes and the role of cisplatin-based chemotherapy in patients with urethral carcinomas referred to medical oncologists. Urol Oncol2013; 31(7): 1171–1177.
29.
SrinivasVAli khanS. Male urethral cancer. Int Urol Nephrol1988; 20(1): 61–65.
30.
KentDGeeJRAmatoRJ. Successful management of metastatic urethral cancer with organ preservation. J Urol2001; 166: 2308.
31.
ThyavihallyYBTongaonkarHBSrivistvaSK. Clinical outcome of 36 male patients with primary urethral carcinoma: A single center experience. Int J Urol2006; 13: 716–720.
HakenbergOWFrankeHJFroehnerM. The treatment of primary urethral carcinoma: The dilemmas of a rare condition: Experience with partial urethrectomy and adjuvant chemotherapy. Onkologie2001; 24: 48–52.
34.
KarnesRJBreauRHLightnerDJ. Surgery for urethral cancer. Urol Clin North Am2010; 37: 445–457.
35.
MinhasSKayesOHegartyP. What surgical resection margins are required to achieve oncological control in men with primary penile cancer?Brit J Urol Int2005; 96: 1040–1043.
36.
HoffmanMARenshawAALoughlinKR. Squamous cell carcinoma of the penis and microscopic pathologic margins: How much margin is needed for local cure?Cancer1999; 85: 1565–1568.
37.
ChristopherNAryaMBrownRSD. Penile preservation in squamous cell carcinoma of the bulbomembranous urethra. Brit J Urol Int2002; 89: 464–465.
38.
MoinuddinAMKleinFAHazraTA. Primary female urethral carcinoma. A retrospective comparison of different treatment techniques. Cancer1988; 62: 54–57.
39.
MilosevicMFWardPRBanerjeeD. Urethral carcinoma in women: Results of treatment with primary radiotherapy. Radiother Oncol2000; 56: 29–35.
40.
RaghavaiahN V. Radiotherapy in the treatment of carcinoma of the male urethra. Cancer1978; 41(4): 1313–1316.
41.
KoontzBFLeeWR. Carcinoma of the urethra: Radiation oncology. Urol Clin North Am2010; 37: 459–466.
42.
GerbauletAHaie-MederCMarsigliaH. Brachytherapy in cancer of the urethra. Ann Urol1994; 28: 312–317.
43.
NigroNDVaitkeviciusVKConsidineBJr. Dynamic management of squamous cell cancer of the anal canal. Invest New Drugs1989; 7: 83–89.
44.
CohenMS. Coordinated chemoradiation therapy with genital preservation for the treatment of primary invasive carcinoma of the male urethra. J Urol2008; 179: 536–541.
45.
LutzSTHuangDT. Combined chemoradiotherapy for locally advanced squamous cell carcinoma of the bulbomembranous urethra: A case report. J Urol1995; 153: 1616–1618.
46.
BaskinLSTurzanC. Carcinoma of male urethra: Management of locally advanced disease with combined chemotherapy, radiotherapy and penile-preserving surgery. Urology1992; 39: 21–25.
47.
NetoASTobias-MachadoMFicarraV. Dynamic sentinel node biopsy for inguinal lymph node staging in patients with penile cancer: A systematic review and cumulative analysis of the literature. Ann Surg Oncol2013; 18: 2026–2034.
