Therapeutic Approaches to Invasive Bladder Cancer in the Elderly Patient

Invasive transitional cell carcinoma (TCC) of the bladder is a potentially life-threatening problem. Radical cystectomy and full-dose radiation therapy have been the standard approaches to controlling local disease and, in some cases, may be curative. However, 60% or more of treated patients die of metastatic disease. Newer approaches using active chemotherapeutic drug combinations, both before and after primary local therapy, may downstage local tumors but have not yet been demonstrated to increase the overall survival rate. Choice of combined modality therapy should take into consideration the primary tumor stage, potential treatment-related toxicities and morbidities, the patient's functional status, present and past medical problems, and treatment preference, but not age alone.