63 The Global Society of Rare Genitourinary Tumours has endorsed a recent study that has shed light on the intricate treatment options for urethral cancer, a rare but aggressive disease that affects both men and women. The study underscores the importance of a personalised, multimodal treatment approach, combining surgery, radiotherapy, and chemotherapy to improve patient outcomes, particularly for advanced stages of the disease. The findings were published in the journal BJU International. Urethral cancer is an uncommon malignancy, representing less than 1% of all cancers worldwide. Despite its rarity, it presents significant treatment challenges due to its aggressive nature and the complexities of the urethral anatomy. The prognosis for patients with urethral cancer varies widely depending on several factors, including the tumour’s location, the patient’s sex, and the stage of the disease at diagnosis. The study reviewed data from 92 studies, encompassing over 25,000 patients, to evaluate the effectiveness of different treatment modalities for urethral cancer. The findings revealed that survival rates differ significantly based on the extent of the disease and the treatment approach used. Surgical intervention remains a primary treatment option for urethral cancer, particularly in its early stages. However, the study found that surgery alone offers limited benefits for patients with advanced disease. Patients’ sex and the location of the tumor had a significant impact on their five-year overall survival (OS) rates, which ranged from 10% to 68%. Notably, men with proximal urethral tumours who underwent radical resection had a five-year OS rate as low as 10%, highlighting the need for more effective treatment strategies for these patients. In contrast, women with distal urethral tumours who underwent organ-preserving surgery exhibited better outcomes, with some studies reporting no local recurrences at five years. However, the study also noted that the complexity of female urethral anatomy often necessitates more extensive surgical procedures, which can lead to significant morbidity. Radiotherapy (RT) alone has shown mixed results in the treatment of urethral cancer. The study found that RT can achieve a five-year OS rate of around 40%, but its effectiveness is heavily dependent on the stage of the disease and the tumour’s histological subtype. Combined with surgery, RT has been shown to improve local control and reduce recurrence rates, particularly in cases where surgical margins are positive or the disease is more advanced. However, the use of RT is not without risks. Patients undergoing RT for urethral cancer may experience significant complications, including urethral strictures, fistulae, and radiation-induced cystitis. These complications underscore the importance of careful patient selection and the potential need for a combined treatment approach to minimise these risks. The study’s most significant finding is the superiority of multimodal therapy (MMT) over single-modality treatments. MMT, which combines surgery, chemotherapy, and radiotherapy, has been shown to enhance survival outcomes and reduce recurrence rates, particularly in patients with advanced disease. The study highlighted that neoadjuvant chemotherapy (administered before surgery) offers the most consistent survival benefits, particularly for urothelial subtypes of urethral cancer. Trimodal therapy, which includes surgery, chemotherapy, and RT, was found to be particularly effective for patients with locally advanced or high-grade tumours. The study reported that this approach significantly improved both recurrence-free survival and overall survival compared to monotherapy. However, the benefits of MMT were not uniform across all histological subtypes, emphasising the need for tailored treatment strategies based on the specific characteristics of each patient’s tumour.