Bladder cancer in older adults

Abstract

Bladder cancer (BC) is a disease of the elderly. Considering the increasing aging of the population, BC will become a more important public health challenge to manage in a very close future. However, the current treatment of BC in the elderly remains controversial. The purpose of this article is to review the previous literature to summarize and gather the current knowledge in order to describe the management and treatment of BC in the elderly, in all its aspects. Original articles in English as well as reviews and editorials were selected based on their clinical relevance. The definition of elderly can differ as it is based on varying chronological ages. However, it is commonly found in most BC literature reviews that the elderly may be affected more severely than the younger people. Even if the management of non-muscle-invasive BC (NMIBC) does not strongly differ from younger patients, the impact of adjuvant intravesical immunotherapy might be inferior. Patients with muscle-invasive BC (MIBC) may benefit from a multidisciplinary geriatric evaluation. Radical cystectomy (RC) remains the curative treatment to BC, and elderly patients should not be withheld a potentially lifesaving intervention only based on chronological age. Bladder-sparing techniques may be a potential replacing treatment approach for unsuitable patients to a major surgical approach. Geriatric assessment could help identify the frail elderly and customize their perioperative care. In conclusion the treatment of BC in the elderly has to be patient-centered and focused on biological age and functional reserves. Age per se should not be the key driver.