If the malignancy is at or just within the meatus and superficial parameters (stage 0/Tis, Ta), open excision or electroresection and fulguration is possible. Tumor destruction using Nd:YAG or CO2 laser vaporization-coagulation represents an alternative option. For large lesions and more invasive lesions (stage A and stage B, T1 and T2, respectively), interstitial radiation therapy or a combination of interstitial radiation therapy and external-beam radiation therapy is an alternative to surgical resection of the distal third of the urethra. Patients with T3 anterior urethral lesions or lesions treated by local excision or radiation therapy, which then recur, require anterior exenteration and urinary diversion.
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Stage 0 bladder cancer is defined by the following TNM classifications:
Ta, N0, M0
Tis, N0, M0
Patients with stage 0 bladder tumors can be cured by a variety of treatments,...
If inguinal nodes are palpable, frozen section confirmation of tumor is obtained. If positive for malignancy, ipsilateral node dissection is indicated, as cure is still achievable with limited regional nodal metastases. If no inguinal adenopathy exists, node dissection is not recommended, but careful inguinal palpation is mandatory at 3- to 4-month intervals.[1,2,3]
Standard treatment options:
Open excision or electroresection and fulguration, or laser vaporization-coagulation (Tis, Ta, T1 lesions).
External-beam radiation therapy or interstitial radiation therapy or a combination of both (T1, T2 lesions).
Anterior exenteration with or without preoperative radiation and diversion (T3 lesions/recurrent lesions).
If the malignancy is in the pendulous urethra and is superficial, the potential for cure is high. In the rare case that involves mucosa only (stage 0/Tis, Ta), resection and fulguration is justified as initial therapy. For infiltrating lesions in the fossa navicularis, amputation of the glans penis may be adequate treatment. For lesions involving more proximal portions of the distal urethra, excision of the involved segment of the urethra, preserving the penile corpora, may be feasible for superficial tumors. Infiltrating lesions require penile amputation 2 cm proximal to tumor. Local recurrences after amputation are rare. The role for radiation therapy in the treatment of anterior urethral carcinoma in the male is not well defined. Some anterior urethral cancers have been cured with radiation alone.[4,5]
If inguinal nodes are palpable, ipsilateral node dissection is indicated after frozen section confirmation of tumor, as cure is still achievable with limited regional nodal metastases. If no inguinal adenopathy exists, node dissection is not recommended, but careful inguinal palpation is mandatory at 3- to 4-month intervals.[6,7,8]
Standard treatment options:
Open excision or electroresection and fulguration, or laser vaporization-coagulation.
Amputation of penis (T1, T2, T3 lesions).
Radiation (T1, T2, T3 lesions, if amputation is refused).
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with anterior urethral cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.