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Aggressive management of elderly patients with muscle-invasive bladder cancer

Nature Clinical Practice Urology volume 3, pages 346–347 (2006)Cite this article

A variety of therapeutic options are available to vital, elderly patients with invasive bladder cancer, including radical cystectomy and treatments that preserve the bladder. Radical cystectomy remains the gold standard for treatment of muscle-invasive bladder cancer, but has traditionally been avoided in elderly patients because this population was thought to be at higher risk of morbidity and mortality. A growing body of evidence, however, indicates that the procedure is safe in elderly patients, and is even feasible in those at high risk. Clark and colleagues reported on 1,054 patients who underwent cystectomy over a 26-year period. Patients were stratified into four age groups. There was no statistical difference in operative mortality between the groups; however, older patients (>70 years) had a higher rate of early complications (P=0.002), whereas younger patients (<70 years) seemed to have higher rates of late complications (P<0.001).1 The authors did demonstrate decreased overall survival, and diminished recurrence-free survival, in the older population, possibly because of a higher stage at presentation and a lower likelihood of receiving adjuvant therapy.2 Chang et al. identified 44 patients >75 years of age, with American Society of Anesthesiologists class 3 or 4 status (patients with severe systemic disturbances that might or might not be life threatening), who had undergone radical cystectomy. There were no perioperative deaths in this high-risk population. The complication rate was approximately 30%, similar to the expected rate in all patients.3

Radical cystectomy could provide a survival benefit over alternative treatments for bladder cancer in the elderly. Hollenbeck et al. used the Surveillance Epidemiology and End Results database to identify 13,796 patients with bladder cancer, 24% of whom were >80 years old. Elderly patients were less likely to be treated with extirpative surgery than their younger counterparts. Nevertheless, after controlling for disease grade and stage, cystectomy (radical or partial) was associated with the greatest risk reduction of death from bladder cancer.4 Cisplatin-based neoadjuvant chemotherapy can be used before radical cystectomy to improve disease-specific survival,5 but its tolerability in elderly patients is unclear, and the comorbidities of systemic treatment could undermine overall therapeutic compliance.

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Authors and Affiliations

  1. Urologic Oncology,

    Alon Z Weizer, James E Montie & Cheryl T Lee

  2. Department of Urology,

    Alon Z Weizer, James E Montie & Cheryl T Lee

  3. University of Michigan, Ann Arbor, MI, USA

    Alon Z Weizer, James E Montie & Cheryl T Lee

Authors
  1. Alon Z Weizer
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  2. James E Montie
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  3. Cheryl T Lee
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Correspondence to Cheryl T Lee.

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Weizer, A., Montie, J. & Lee, C. Aggressive management of elderly patients with muscle-invasive bladder cancer. Nat Rev Urol 3, 346–347 (2006). https://doi.org/10.1038/ncpuro0506

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