Higher pathologic stage and prostatic urethral involvement are associated with an increased risk for urethral recurrence among patients undergoing radical cystectomy (RC), investigators reported at the virtual 2021 Genitourinary Cancers Symposium.
Abhinav Khanna, MD, MPH, and colleagues at Mayo Clinic in Rochester, Minnesota, identified 144 (4.9%) patients with urethral recurrence from their RC registry of 2930 patients. Prostatic urethral involvement and higher pT-stage at RC were significantly associated with approximately 5.8-fold and 3.6-fold increased odds of urethral recurrence, respectively, the investigators reported. Conversely, receipt of continent urinary diversion was significantly associated with 66% decreased odds.
Half of patients were diagnosed with urethral recurrence based on symptoms, whereas the other half were asymptomatic and diagnosed during scheduled surveillance. A total of 72.2% of patients with urethral recurrence underwent urethrectomy. Pathology results showed that patients with symptomatic recurrence were significantly more likely to have pT2 or higher stage disease on urethrectomy than patients with asymptomatic recurrence (13.1% vs 3.1%), Dr Khanna’s team reported.
At a median 2.6 years after urethral recurrence, 68 of the 144 patients died of urothelial carcinoma. Patients with urethral recurrence had a significant 93% and 34% increased risk of cancer-specific and all-cause mortality, respectively, than patients without urethral recurrence. Asymptomatic patients with urethral recurrence detected by cytology, however, enjoyed significantly longer median overall and cancer-specific survival, according to Kaplan-Meier analyses.
“Asymptomatic detection of urethral recurrence was associated with lower pathologic stage at urethrectomy as well as longer cancer-specific and overall survival, supporting urethral surveillance after radical cystectomy,” said co-investigator Stephen A. Boorjian, MD, FACS, told Renal & Urology News. “We recommend yearly assessment of the urethra with cytology for surveillance. This can be done as a urethral washing in patients who have had a prior cutaneous urinary diversion or as a voided urine cytology in patients with an orthotopic neobladder reconstruction.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Khanna A, Zganjar A, Shah P, et al. Urethral recurrence following radical cystectomy: risk factors and outcomes. Poster presented at the virtual2021 Genitourinary Cancers Symposium; February 11 to 13. Abstract 416.