To understand urethral secondary malignancies among patients treated with brachytherapy (BRT) for primary prostate cancer.
Institutional retrospective review identified 13 patients evaluated from 2003-2014 with urethral cancer and prior history of BRT monotherapy for prostate cancer. All patients were biochemically free of their primary disease and developed histologically distinct RASM from primary tumor via pathologic confirmation. BRT characteristics, patient age, presentation, staging work-up and clinical course were evaluated.
Average times from BRT to presenting symptoms of hematuria, urinary retention, and/or renal failure was 71. Symptom onset to RASM diagnosis interval was 24 months. Mean time from BRT to RASM diagnosis was 95 months. 85% of patients had an undetectable PSA level (<0.2 ng/ml) at last follow-up. Types of RASM included: sarcomatoid carcinoma (6), small cell carcinoma (2), urothelial carcinoma with squamous differentiation (2), squamous cell carcinoma (1), rhabdomyosarcoma (1) and urothelial carcinoma (1). A majority of patients were diagnosed with advanced disease with either distant metastases (54%) or local progression (23%). 10 patients died during this study period with median time to death after RASM diagnosis of 6 months.
RASM localized to the posterior urethra displayed advanced disease and high mortality rates. Refractory lower urinary tract symptoms, hematuria, and prior history of prostate BRT should raise suspicion for urethral RASM. Further studies are warranted to determine patient and disease characteristics that correlate with disease-specific mortality of secondary urethral malignancies.
Urology. 2017 Sep 04 [Epub ahead of print]
Shree Agrawal, John M Lacy, Herman Bagga, Kenneth W Angermeier, Jay Ciezki, Rahul D Tendulkar, Chandana A Reddy, Hadley M Wood
Case Western Reserve University School of Medicine., Cleveland Clinic, Cleveland, OH., Alleghany General Hospital, Pittsburgh, PA.