Radiotherapy for Primary Urethral Carcinoma (PUC): An Illustrative and Narrative Review

Primary urethral carcinoma (PUC) is a rare malignancy with a complex and site-specific management paradigm. While surgery remains the mainstay for many cases, advances in modern radiotherapy have facilitated organ preservation without compromising oncologic outcomes. This narrative review outlines the clinicopathological features, diagnostic evaluation, and evolving role of radiotherapy in the management of PUC. An illustrative case of a young male with high-grade urothelial carcinoma of the bulbar urethra managed successfully with definitive external beam radiotherapy is presented. We explore the rationale, technique, and outcomes associated with radiotherapy, including external beam and brachytherapy modalities, across disease stages. For locally advanced cases, chemoradiotherapy offers an organ-sparing alternative to mutilating surgery, with promising control rates and acceptable toxicity. This article aims to collate current evidence, highlight gaps, and support the integration of personalised, multidisciplinary care in this rare disease context.