Evolving Concepts in the Evaluation and Management of Bladder Cancer in Elderly Men
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Purpose of Review
In this article, the contemporary knowledge regarding specific issues related to the care of older bladder cancer patients is reviewed. The status of radical cystectomy, bladder-sparing strategies, checkpoint inhibition, prostate-sparing surgery, and BCG distribution pertaining to older adults are discussed.
The use of minimally invasive approaches for radical cystectomy in patients with invasive bladder cancer is on the rise, including those patients with advanced age. Enhanced recovery pathways are improving time-to-recovery for patients undergoing radical cystectomy which may be especially important in the elderly and frail. Trimodal bladder-sparing strategies are emerging options for patients who are unfit for radical cystectomy. Immunotherapies offer promising options for patients with advanced or treatment-refractory disease. Prostate-sparing surgery does not currently hold a place in the contemporary management of bladder cancer for those patients who are surgical candidates. Older adults may be at risk of disparity in the distribution of scarce BCG resources during times of manufacturing shortage.
Older adults, as compared with those younger, face special challenges in their bladder cancer care. There is a clinical imperative that practitioners involved in the evaluation and management of older bladder cancer patients be knowledgeable of the unique issues that stand between them and cancer-free survival.
KeywordsBladder cancer Elderly Radical cystectomy Immunotherapy Quality of life
University of Oklahoma Health Sciences Center, Department of Urology
Compliance with Ethical Standards
Conflict of Interest
Dr. Cookson, Dr. Patel, and Dr. Parker each declare no conflict of interest.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
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