Current Clinical Trials

Approximately 10% of patients having cystectomy for bladder cancer can be expected to have or to later develop clinical neoplasm of the urethra distal to the urogenital diaphragm. An autopsy series of patients having had cystectomy for bladder cancer documented histologic evidence of urethral neoplasm in 20% of the patients. A review from the Royal Marsden Hospital showed that those patients having cystectomy for multiple and superficial bladder lesions have an especially high incidence (34%) of urethral neoplasia.

The benefits of urethrectomy at the time of cystectomy need to be weighed against the morbidity factors, which include added operating time, hemorrhage, and the potential for perineal hernia. However, tumors found incidentally on pathologic examination are much more likely to be superficial or in situ in contrast to those that present with clinical symptoms at a later date when the likelihood of invasion within the corporal bodies is high. The former lesions are often curable, and the latter are only rarely so. Indications for urethrectomy in continuity with cystoprostatectomy are:

• Visible tumor in the urethra.
• Positive swab cytology of the urethra.
• Positive margins of the membranous urethra on frozen section taken at the time of cystoprostatectomy.
• Multiple in situ bladder tumors that extend onto the bladder neck and proximal prostatic urethra.

If the urethra is not removed at the time of cystectomy, optimal follow-up includes periodic cytologic evaluation of saline urethral washings.[1-4]

Standard treatment options:

1. In continuity cystourethrectomy.
2. Monitor urethral cytology and delayed urethrectomy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with urethral cancer associated with invasive bladder cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References

1. Schellhammer PF, Whitmore WF Jr: Transitional cell carcinoma of the urethra in men having cystectomy for bladder cancer. J Urol 115 (1): 56-60, 1976.  [PUBMED Abstract]
   
   
2. Wolinska WH, Melamed MR, Schellhammer PF, et al.: Urethral cytology following cystectomy for bladder carcinoma. Am J Surg Pathol 1 (3): 225-34, 1977.  [PUBMED Abstract]
   
   
3. Gowing NFC: Urethral carcinoma associated with cancer of the bladder. Br J Urol 32(4): 428-438, 1960. 
   
   
4. Hendry WF, Gowing NF, Wallace DM: Surgical treatment of urethral tumours associated with bladder cancer. Proc R Soc Med 67 (4): 304-7, 1974.  [PUBMED Abstract]
   
   

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