How I treat bladder cancer in elderly patients

Bladder cancer is a disease of the elderly. There is a disconnect between the efficacy of treatments for patients with advanced disease, and their effectiveness, at least in part related to the advanced age at diagnosis. Standard treatments for patients with locally advanced or metastatic bladder cancer include radical cystectomy and/or cisplatin-based combination chemotherapy. However, there is significant potential for morbidity, and even mortality, with these treatments necessitating tools to risk stratify elderly patients to optimize the safety and benefit of treatments and alternative strategies in situations where the potential risks are likely to outweigh the potential benefits. This review considers the current standard treatments for advanced bladder cancer, approaches to risk stratify elderly patients, and highlights our relatively poor knowledge base regarding the optimal care of elderly patients with this disease.