Treatment of muscle invasive bladder cancer in the elderly: navigating the trade-offs of risk and benefit

Despite the fact that bladder cancer patients have the highest median age of any type of cancer, older patients with muscle invasion are often under-treated.

In this review, we report the most up to date literature on the patterns of care and treatment of older patients with muscle invasive bladder cancer.

Data on under-treatment, geriatric principles, cystectomy, perioperative chemotherapy, and bladder preservation for older patients are presented and analyzed.

Chronologic age should not exclude patients from curative-intent therapy. Functional age as determined by geriatric assessments and multidisciplinary evaluation can help clinicians decide on the best course of treatment for individual patients. Cystectomy, perioperative chemotherapy, and curative-intent bladder preservation are reasonable options in healthy older adults. Observation should be limited to patients with extremely poor performance status and very limited life expectancy.

World journal of urology. 2015 Oct 23 [Epub ahead of print]

Noam A VanderWalde, Michelle T Chi, Arti Hurria, Matthew D Galsky, Matthew E Nielsen

Department of Radiation Oncology, University of Tennessee Health Science Center, 1265 Union Ave. Thomas Basement, Memphis, TN, 38104, USA.  University of Tennessee West Cancer Center, 100 N. Humphrey's Blvd. , Memphis, TN, 38120, USA. , Cancer and Aging Program, Division of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte RD, Duarte, CA, 91010, USA. , Division of Hematology/Oncology, Department of Medicine, Mount Sinai School of Medicine, 1470 Madison Ave, 3rd Floor, New York, NY, 10029, USA. , Division of Urologic Oncology, Department of Urology, University of North Carolina at Chapel Hill, 2105 Physicians Office Building, Chapel Hill, NC, 27599, USA.