Review Question - QID 106377

Bloody urethral discharge occurring in an older man is urethral carcinoma (UC) until proven otherwise.

Urethral cancer is cancer originating from any segment of the urethra. This cancer is relatively rare, with the most common histologic type being papillary transitional cell carcinoma. The symptom of gross hematuria (visible blood in the urine during micturition) may suggest upper or lower urinary tract sources, while a urethral discharge is most likely not from a bladder or upper urinary source.

Sharp et al. discuss asymptomatic microscopic hematuria, which can be discovered incidentally in routine primary care situations (defined as the presence of three or more red blood cells per high-power field visible in a properly collected urine specimen without evidence of infection). Notably, the most common causes of microscopic hematuria are not malignancy related and include urinary tract infections, benign prostatic hyperplasia, and urinary calculi. They estimate the risk of malignancy to be 5% in patients with asymptomatic microscopic hematuria.

Gakis et al. discuss primary UC. They report pelvic magnetic resonance imaging is the preferred imaging study to determine the local extent of the urethral tumor. Management is determined by location and extent, with a localized anterior UC, noninvasive UC or carcinoma in situ treated with urethra-sparing surgery is an alternative to primary urethrectomy in both sexes, provided negative surgical margins can be achieved. Bacillus Calmette-Guérin (BCG) also has a role in treatment in certain cases.

Illustration A shows a histomicrograph of papillary urothelial carcinoma, the most common type of urethral cancer.

Incorrect Answers:
Answers 1-3: Cancers of the upper urinary tract and bladder present with hematuria not urethral discharge.
Answer 4: Prostate cancer does not commonly present with hematuria.