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


METHODS
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.


CONCLUSIONS
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.
Department of Radiation Oncology, University of Tennessee Health Science Center, 1265 Union Ave. Thomas Basement, Memphis, TN, 38104, USA. nvanderw@westclinic.com.|University of Tennessee West Cancer Center, 100 N. Humphrey's Blvd., Memphis, TN, 38120, USA. nvanderw@westclinic.com.
Noam A
NA
VanderWalde
University of Tennessee West Cancer Center, 100 N. Humphrey's Blvd., Memphis, TN, 38120, USA.
Michelle T
MT
Chi
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.
Arti
A
Hurria
Division of Hematology/Oncology, Department of Medicine, Mount Sinai School of Medicine, 1470 Madison Ave, 3rd Floor, New York, NY, 10029, USA.
Matthew D
MD
Galsky
Division of Urologic Oncology, Department of Urology, University of North Carolina at Chapel Hill, 2105 Physicians Office Building, Chapel Hill, NC, 27599, USA.
Matthew E
ME
Nielsen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy*; D015653:Cystectomy / Q000379:methods*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D009130:Muscle, Smooth / Q000473:pathology*; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents
Antineoplastic agents; Cystectomy; Geriatric assessment; Radiotherapy; Urinary bladder neoplasms