title: Challenging treatment decision-making in older urologic cancer patients.
abstract: OBJECTIVE
  Cancer is the leading cause of death among patients aged 65 years and older. In this population, the cancer diagnosis is often made at a more advanced stage and worse prognosis than in younger patients. Specific mortality in older patients is superior to that reported in their younger counterparts. Moreover, the impact of curative treatment that has proven benefit in overall population may be not well studied in the sub-group of older patients. Thus, the management of cancer in the elderly is a major public health concern in most Western countries.
  
  
  RESULTS
  In this review, we summarize this challenging treatment decision-making in older urologic patients with prostate, kidney or bladder cancer. The estimation of life expectancy remains a difficult task. Chronological age should not be considered as the main decisive factor anymore when considering aggressive cancer treatment. Comorbidities increase the complexity of cancer management and affect survival. Multidisciplinary evaluation and comprehensive geriatrics assessment using specific scales are critical to improve the treatment decision-making and to minimize both overtreatment of low-risk disease and undertreatment of high-risk disease. When an aggressive and potential quality-of-life-threatening treatment is scheduled after this comprehensive geriatrics assessment, personalized patient care must be early predefined by the geriatric team.
  
  
  CONCLUSIONS
  In the elderly, an enhanced support including specific geriatric assessment and management optimizes the treatment course, including preoperative optimization, prevents treatment-related complications and loss of autonomy using or not geriatrics clinic or rehabilitation units, and limits the length of hospital stay and costs.
authors.affiliation: Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris 7 University, Paris, France, g.ploussard@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Gilles
authors.initials: G
authors.lastname: Albrand
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.forename: Hervé
authors.initials: H
authors.lastname: Lang
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.forename: Pierre
authors.initials: P
authors.lastname: Mongiat-Artus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000628:therapy*; D002295:Carcinoma, Transitional Cell / Q000628:therapy*; D003657:Decision Making; D019468:Disease Management; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007680:Kidney Neoplasms / Q000628:therapy*; D008297:Male; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D001749:Urinary Bladder Neoplasms / Q000628:therapy*