Full Guidelines
Reproduced from the official EAU 2025 publication.
Recommendations
Recommendation for staging and grading
| Recommendation | Strength rating |
|---|---|
| Use the 2017 Tumour, Node, Metastasis (TNM) classification and 2022 World Health Organisation grading system for pathological staging and grading of primary urethral carcinoma. | Strong |
Recommendations for diagnostic evaluation and staging
| Recommendation | Strength rating |
|---|---|
| Use urethrocystoscopy with biopsy and urinary cytology to diagnose urethral carcinoma. | Strong |
| Assess the presence of distant metastases by computed tomography of the thorax and abdomen/pelvis. | Strong |
| Use pelvic magnetic resonance imaging to assess the local extent of urethral tumour and regional lymph node enlargement. | Strong |
Recommendations for the treatment of primary urethral carcinoma in males
| Recommendation | Strength rating |
|---|---|
| Offer distal urethrectomy as an alternative to penile amputation in localised distal urethral tumours, if negative surgical margins can be achieved intra-operatively. | Weak |
| Ensure complete circumferential assessment of the proximal urethral margin if penile-preserving surgery is intended. | Strong |
Recommendations
| Recommendation | Strength rating |
|---|---|
| Offer urethra-sparing surgery, as an alternative to primary urethrectomy, to females with distal urethral tumours, if negative surgical margins can be achieved intra-operatively. | Weak |
| Offer local radiotherapy, as an alternative to urethral surgery, to females with localised urethral tumours, but discuss local toxicity. | Weak |
Recommendations for multimodal treatment in advanced urethral carcinoma in both males and females
| Recommendation | Strength rating |
|---|---|
| Refer patients with advanced urethral carcinoma to academic centres. | Strong |
| Discuss treatment of patients with locally- advanced urethral carcinoma within a multidisciplinary team of urologists, radiation-oncologists, and oncologists. | Strong |
| In locally-advanced urethral carcinoma, use cisplatin-based chemotherapeutic regimens with curative intent prior to surgery. | Weak |
| In locally-advanced squamous cell carcinoma (SCC) of the urethra, offer the combination of curative radiotherapy (RT) with radiosensitising chemotherapy for definitive treatment and genital preservation. | Weak |
| Offer salvage surgery or RT to patients with urethral recurrence after primary treatment. | Weak |
| Offer inguinal lymph node (LN) dissection to patients with limited LN-positive urethral SCC. | Weak |
Recommendations for the treatment of urothelial carcinoma of the prostate
| Recommendation | Strength rating |
|---|---|
| Offer a urethra-sparing approach with transurethral resection (TUR) and bacillus- Calmette Guérin (BCG) to patients with non-invasive urethral carcinoma or carcinoma in situ of the prostatic urethra and prostatic ducts. | Strong |
| In patients not responding to BCG, or in patients with extensive ductal or stromal involvement, perform a cystoprostatectomy with extended pelvic lymphadenectomy. | Weak |
Classification & Evidence Tables
| T - Primary Tumour |
|---|
| TX Primary tumour cannot be assessed |
| T0 No evidence of primary tumour |
| Urethra (male and female) |
| Ta Non-invasive papillary, polypoid, or verrucous carcinoma |
| Tis Carcinoma in situ |
| T1 Tumour invades subepithelial connective tissue |
| T2 Tumour invades any of the following: corpus spongiosum, prostate, periurethral muscle |
| T3 Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck (extraprostatic extension) |
| T4 Tumour invades other adjacent organs (invasion of the bladder) |
| Urothelial (transitional cell) carcinoma of the prostate |
| Tis pu Carcinoma in situ, involvement of prostatic urethra |
| Tis pd Carcinoma in situ, involvement of prostatic ducts |
| T1 Tumour invades subepithelial connective tissue (for tumours involving prostatic urethra only) |
| T2 Tumour invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle |
| T3 Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension) |
| T4 Tumour invades other adjacent organs (invasion of the bladder or rectum) |
|---|
| N - Regional Lymph Nodes |
| NX Regional lymph nodes cannot be assessed |
| N0 No regional lymph node metastasis |
| N1 Metastasis in a single lymph node |
| N2 Metastasis in multiple lymph nodes |
| M - Distant Metastasis |
| M0 No distant metastasis |
| M1 Distant metastasis |
| dna 4T-3T 2N-1N yparehtomehc evtiadilosnoc ***yregrus -oidarome **ypareht evticudnI• ro hC• |
|---|
| dna yparehtomehc 4T-3T 0N tnavujdaoeN• yregrus -oidaromehC• **ypareht dna yregruS• tnavujda yparehtoidar ro ro |
| *ymotcerhteru gniraps-arhterU• ymotcerhterU• yparehtoidaR• latsiD 2T-aT *yregrus ELAM latsiD• ELAMEF ro ro |
|---|
| lamixorP -cerhterU• **** * )etelpmoc 2T ymot latirap( ro |
| lamixorP 1T-aT -cerhterU• * latirap( )etelpmoc ymot ro |
| 2T ctiatsorP lamixorP 2T-aT -lacidaR• -sorpotsyc ymotcetat -cerhteru dna -edahpmyl ymotcen dna ymot **** -/+ |
| ***** ctiatsorP 1T-siT-aT taepeR• RUT GCB + |