Management of muscle-invasive bladder cancer in the elderly

Curr Opin Urol. 2015 Sep;25(5):459-67. doi: 10.1097/MOU.0000000000000190.


Purpose of review: 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.

Recent findings: 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.

Summary: 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.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Aged
  • Chemotherapy, Adjuvant
  • Cystectomy* / adverse effects
  • Humans
  • Neoadjuvant Therapy* / adverse effects
  • Neoplasm Invasiveness
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome
  • Urinary Bladder Neoplasms / drug therapy*
  • Urinary Bladder Neoplasms / mortality
  • Urinary Bladder Neoplasms / pathology