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World J Urol. 2016 Jan;34(1):3-11. doi: 10.1007/s00345-015-1708-z. Epub 2015 Oct 23.

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

Author information

1
Department of Radiation Oncology, University of Tennessee Health Science Center, 1265 Union Ave. Thomas Basement, Memphis, TN, 38104, USA. nvanderw@westclinic.com.
2
University of Tennessee West Cancer Center, 100 N. Humphrey's Blvd., Memphis, TN, 38120, USA. nvanderw@westclinic.com.
3
University of Tennessee West Cancer Center, 100 N. Humphrey's Blvd., Memphis, TN, 38120, USA.
4
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.
5
Division of Hematology/Oncology, Department of Medicine, Mount Sinai School of Medicine, 1470 Madison Ave, 3rd Floor, New York, NY, 10029, USA.
6
Division of Urologic Oncology, Department of Urology, University of North Carolina at Chapel Hill, 2105 Physicians Office Building, Chapel Hill, NC, 27599, USA.

Abstract

PURPOSE:

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.

CONCLUSION:

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.

KEYWORDS:

Antineoplastic agents; Cystectomy; Geriatric assessment; Radiotherapy; Urinary bladder neoplasms

PMID:
26497825
DOI:
10.1007/s00345-015-1708-z
[Indexed for MEDLINE]

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