title: Management of muscle-invasive bladder cancer in the elderly.
abstract: OBJECTIVE
  The number of cases of muscle-invasive bladder cancer is increasing along with the age of the population. Management of muscle-invasive bladder cancer in the elderly is complex, requiring a multidisciplinary team approach and a comprehensive assessment of each individual patient.
  
  
  RESULTS
  A geriatric assessment should be used to inform treatment decisions in elderly patients with bladder cancer. There is increasing evidence to support aggressive therapy in appropriate elderly patients, including radical cystectomy and neoadjuvant chemotherapy. Adjuvant chemotherapy also has a role in patients with high-risk disease after cystectomy. A bladder preservation approach with trimodality therapy is a well tolerated and effective alternative to cystectomy in appropriately selected patients.
  
  
  CONCLUSIONS
  Treatment decisions should not be based on chronologic age alone and advanced age should not preclude aggressive or curative therapy. The recent molecular characterization of bladder cancer and several recent immunotherapy trials provide hope of a more targeted approach to treatment of bladder, potentially improving both effectiveness and tolerability of treatment regimens in the elderly.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Rose
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
mesh_terms: D000367:Age Factors; D000368:Aged; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000009:adverse effects; D006801:Humans; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology