Evolving Concepts in the Evaluation and Management of Bladder Cancer in Elderly Men

  • Daniel C. Parker
  • Sanjay G. Patel
  • Michael S. CooksonEmail author
Geriatric Urology (T Griebling, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Geriatric Urology


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.

Recent Findings

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.


Bladder cancer Elderly Radical cystectomy Immunotherapy Quality of life 


Funding Information

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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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Daniel C. Parker
    • 1
  • Sanjay G. Patel
    • 1
  • Michael S. Cookson
    • 1
    Email author
  1. 1.Department of UrologyThe University of Oklahoma Health Sciences Center & The Stephenson Cancer CenterOklahoma CityUSA

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