The treatment of muscle-invasive bladder cancer in geriatric patients

Bladder cancer is an age-related cancer and because of aging population, an increase of patients with muscle-invasive bladder cancer (MIBC) seems inevitable. Decisions regarding the treatment of geriatric patients with MIBC are complex and require a multidisciplinary approach.

In addition to a specific urological oncology evaluation, a general geriatric evaluation is of great importance for all geriatric patients with MIBC. Standard of care in appropriate geriatric MIBC patients is radical cystectomy with urinary diversion and neoadjuvant platinum-based combination chemotherapy. There is evidence that adjuvant chemotherapy after surgery brings a benefit, but these data are less clear. An alternative to radical cystectomy, especially in elderly patients with concomitant disease, can be trimodal therapy, whereas the equality of this approach remains to be proven.

Treatment decisions should not be based on the patient's chronological age alone, but rather on overall performance status, quality of life considerations, social performance, and patient preferences. On this account, patients should not be denied a potentially life-saving intervention just because they are elderly. The hope of personalized medicine and targeted therapy with less side-effects and complications may soon become a reality.