Cancer in the Elderly: What is Different?

ObjectivesThe aging population will have a dramatic impact on urologic practice. Therefore it is becoming increasingly necessary to understand the impact of aging on both the diagnosis and treatment of urological cancers in elderly and fragile people.MethodsThe data of the recent series in the international literature have been analyzed.ResultsEvaluation of functional status plays a unique role in the assessment of older cancer patients. Currently available data indicate that well-selected elderly patients, even those 75 years old or older do not have a significantly higher risk of morbidity or mortality from major surgery for urologic malignancies than do younger patients. There is an emerging need to develop a means for urologists and oncologists to characterize the “functional age” of older cancer patients in order to tailor treatment decisions and stratify outcomes based on factors other than chronological age and to develop interventions to optimize urological cancer treatment.ConclusionsElderly patients have traditionally been viewed as poor candidates for urologic surgery. However, a review of renal, prostate and bladder cancer literature supports what most urologists know intuitively: properly selected elderly patients are safe to operate on and can potentially gain survival benefits from surgery.