Urethral adenocarcinoma (UA) is a rare type of urethral cancer with a poor prognosis. We present a case of UA of intestinal subtype in a 57-year-old patient who initially had lower urinary tract symptoms and was subsequently found to have a urethral lesion in a urethral diverticulum on pelvic MRI which was confirmed on biopsy. She had neoadjuvant chemotherapy followed by open anterior pelvic exenteration, complete urethrectomy and ileal conduit urinary diversion. She required adjuvant chemotherapy for local invasion and a metastasis in the uterus but developed progressive metastatic disease and succumbed to the disease 13-months after surgery.

Background: Recent studies have associated total neoadjuvant therapy (TNT) with better treatment adherence, decreased toxicity, improved complete clinical response and anal sphincter preservation rates in patients with locally advanced rectal cancer (LARC). However, real-world experience with TNT in the management of LARC remains limited. Aim: This study aimed to evaluate the efficacy and safety outcomes of TNT for LARC in Western Australia. Methods: Patients with LARC (cT2-4 and/or cN1-2) who underwent induction chemotherapy followed by neoadjuvant chemoradiotherapy or neoadjuvant chemoradiotherapy followed by consolidation chemotherapy, followed by surgery were recruited from two hospitals in Western Australia. Efficacy outcomes assessed included clinical response (complete, partial, no response), and pathologic complete response (pCR) rate, R0 resection rate, and R1 resection rate were evaluated. Those patients who achieved clinical complete response following TNT were given the option of active surveillance. The safety and tolerability of TNT were assessed. Results: 32 patients with LARC were treated with TNT. In total, 17 patients (53%) received chemoradiotherapy followed by consolidation chemotherapy and 15 patients (47%) received induction chemotherapy followed by chemoradiotherapy. Nine (28%) of the patients with LARC treated with TNT had a complete clinical response, twenty-one (66%) patients had a partial clinical response, and two (6%) patients had no response to TNT. Of the 32 patients, 27 (84%) underwent surgery. There was a 100% R0 resection rate. The pCR rate was 15%. pCR, clinical response, and the R0 resection rate were similar between the two TNT regimens. TNT was well tolerated, with the majority of patients (88%) completing the chemotherapy course with grade 1 and 2 adverse effects. Conclusions: In conclusion, TNT emerges as a promising approach for the management of LARC. However, further research is warranted to refine the optimal TNT protocols, determine its long-term outcomes, and identify patient populations who would benefit the most from this innovative therapeutic strategy.

Cancers that develop within six months of the first primary cancer are referred to as synchronous malignancies. These malignancies are difficult to diagnose and treat, with treatment primarily based on case reports. We report here the case of a 51-year-old male with prior history of prostate cancer who presented with haematuria to the general practice. A CT pyelogram showed left bladder wall lesion that was further investigated with cystoscopy and biopsy confirmed as muscle-invasive urothelial carcinoma. Incidentally, two perigastric nodes and hepatic lesions were noted on CT. FDG-PET revealed high-grade uptake in the right lobe of thyroid gland and cervical nodes that was biopsy proven as papillary thyroid carcinoma. Subsequently, gastroscopy and a biopsy of the gastric lesion confirmed a gastric neuroendocrine tumour. The patient underwent chemoradiotherapy, total thyroidectomy, and commenced somatostatin analogue for treatment of urothelial carcinoma, papillary thyroid carcinoma, and neuroendocrine tumour, respectively. The diagnosis and treatment of synchronous malignancies is complex. A multidisciplinary team approach is required to improve treatment outcomes.

BK polyoma virus (BKV) is a known risk factor for the development of urothelial carcinoma. There is currently limited data on the management of BKV-induced urothelial carcinoma (BUC) of the bladder, with available data limited to case reports. It remains debatable whether radical cystectomy (RC) with removal of the native urinary tract or RC alone is the most optimal management for BUC of the bladder. BKV-induced urothelial carcinoma is rare, and its management is challenging in immunocompromised patients such as that of post-transplant patients. This case report provides additional insight into a rare disease, the management of which still lacks established guidelines and remains debatable. We present a unique case of BKV-induced muscle-invasive urothelial carcinoma of the bladder in an immunosuppressed renal transplant patient who underwent open radical cystectomy, anterior pelvic exenteration, bilateral native nephroureterectomy and ileal conduit formation to transplant kidney. The patient remains recurrence-free with preserved graft function 2 years since surgery. An aggressive management approach which involves anterior pelvic exenteration with removal of the native urinary tract may be favoured in young patients with BUC of the bladder with minimal comorbidities. However, treatment should be individualised for each individual patient.

Background Immune checkpoint inhibitors (ICIs) are standard components of metastatic urothelial carcinoma (mUC) treatment, but the association between FGFR3 alteration status and ICI outcomes remains uncertain. Methods The protocol was prospectively registered in PROSPERO (CRD420251114235). PubMed/MEDLINE, Scopus, and Embase were searched from inception through 22 November 2025; reference lists of included studies and relevant reviews were also examined. Eligible studies compared adults with FGFR3-altered versus FGFR3-wild-type mUC treated with PD-1, PD-L1, and/or CTLA-4 inhibitors. Random effects models pooled risk ratios (RRs) for objective response rate (ORR) and disease control rate (DCR), and hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS). Risk of bias was evaluated using RoB 2 and the Newcastle–Ottawa scale as appropriate. Leave-one-out analyses were performed for all endpoints; small-study effects were assessed for OS at the publication level. Results 13 publications met the eligibility criteria, and 12 contributed to at least one quantitative synthesis. The largest endpoint analysis, OS, included 13 cohort-level comparisons from 11 publications and 2042 patients. FGFR3 alterations were associated with lower DCR (RR 0.74, 95% CI 0.57–0.96; I²=12%), but not significantly different ORR (RR 0.82, 95% CI 0.63–1.07; I²=0%). OS (HR 1.25, 95% CI 1.08–1.44; I²=9%) and PFS (HR 1.63, 95% CI 1.23–2.16; I²=35%) were shorter in FGFR3-altered disease. In exploratory second-line-or-later analyses, DCR was lower (RR 0.59, 95% CI 0.41–0.83), whereas ORR remained inconclusive (RR 0.71, 95% CI 0.41–1.20). Leave-one-out analyses preserved the direction and statistical significance of OS and PFS, but the DCR result was sensitive to study omission. Egger regression did not indicate marked funnel-plot asymmetry for OS (p=0.81). Conclusions Amongst patients treated with ICIs, FGFR3 alterations were associated with less Disease Control and shorter time-to-event outcomes, whilst ORR was not significantly different. Because the evidence is predominantly retrospective or derived from exploratory biomarker subgroups and lacks a non-ICI comparator, these findings do not establish a predictive treatment interaction or causal immunotherapy resistance. They should be regarded as hypothesis-generating and support prospective biomarker-stratified validation, including trials evaluating FGFR inhibition with immunotherapy.