THE PLACE OF RADICAL CYSTECTOMY IN TREATMENT OF BLADDER CANCER IN THE ELDERLY

Introduction: As the life expectancy increases, population is progressively becoming older. One of the natural results of this is the disproportionate increase in the incidence of bladder cancer seen in the elderly. Significant changes in physiology and comorbidity at older ages may make cancer treatment difficult. Standard treatment of nonmetastatic invasive bladder cancer is radical cystectomy. However, due to the belief that a major surgical intervention is not suitable in elderly patients they are managed by the alternative conservative methods and even only by palliative care. The results of the population-based prospective data collection studies verify the disparity of practice patterns between younger and older patients with bladder cancer and document that effective treatments are avoided in this age group. Yet, there is strong evidence showing that aggressive treatments may improve survival of these patients. Available literature data suggest that ineffective cancer treatment is the main reason for mortality rather than comorbidity. Many studies published recently demonstrate that radical cystectomy is a safe treatment in advanced aged patients. A general good health status and adequate cardiac and pulmonary functions are important for patient selection for cystectomy. However, more objective criteria are needed for appropriate risk categorization. Data of current epidemiological and clinical studies suggest that based on age alone radical cystectomy should not be avoided in patients with invasive bladder cancer.