Bladder cancer in the elderly: A retrospective analysis of bladder cancer in individuals older than 85 years

Introduction: Current life expectancy in the United Kingdom is 79.2 years in men and 82.9 years in women. Average age at diagnosis of bladder cancer is 73 years, but incidence continues to rise with age. Elderly patients represent a unique cohort of patients; they often have multiple medical co-morbidities, and may have different wishes and treatment aims as opposed to younger patients. We describe our current bladder cancer practice in patients older than 85 years. Methods: A retrospective review was conducted of patients older than 85 years, first diagnosed with bladder cancer between December 2012 and June 2016. Results: A total of 102 patients were analysed from our database. Mean age at diagnosis was 88.34 years. Staging at diagnosis was: 75 non-muscle-invasive bladder cancer (NMIBC) (17 low, 13 intermediate, 45 high risk), 23 muscle-invasive bladder cancer (MIBC), and four metastatic disease. Of patients with NMIBC, 29/75 patients had a recurrence, 4/75 were upstaged, and 9/75 progressed to MIBC. Twenty-nine of 75 of the NMIBC patients declined treatment or ongoing surveillance. Overall, 53% (53/102) have died of any cause, with a mean of 2.0 years since diagnosis, 31 of bladder cancer. In NMIBC patients, 38.7% (29/102) have died of any cause since diagnosis, at a mean interval of 1.8 years following diagnosis. Conclusion: In our cohort of bladder cancer patients older than 85 years, there is a high all-cause mortality rate within a relatively short time period following diagnosis. These data should aid well-informed discussions with our elderly bladder cancer patients and their relatives when considering treatment and surveillance options. Level of evidence: Not applicable for this single centre audit.