Optimal Management of the Elderly Patient with Muscle-Invasive Bladder Cancer

With the growing elderly demographic and the peak incidence of bladder cancer being approximately 70 years old, an increasing number of elderly patients will develop invasive bladder cancer. Several studies suggest that a survival gap exists between elderly patients with invasive bladder cancer and younger cohorts. Radical cystectomy is the standard of care that provides good cancer-specific survival, but few elderly patients are referred for cystectomy. This is likely, at least in part, due to concern with the morbidity associated with the operation. Cisplatin is the most effective chemotherapeutic agent used to treat invasive bladder cancer but some patients cannot receive it due to toxicity. There are few promising alternatives to cisplatin at this time. This review discusses opportunities for improved care, recent therapeutic advances, and future directions to improve the outcome for elderly patients with invasive bladder cancer.