Treatment for Bladder Cancer in Elderly

Bladder Cancer and Older Adults

Bladder cancer is one of the most common cancers, especially in older adults. The median age for a bladder cancer diagnosis is 73. As the world’s population grows older, the number of people facing bladder cancer will also rise. Experts predict that by the year 2050, the number of people aged 65 and older will increase by 188%, and the number of people aged 85 and older will go up by 351%.

Current Treatments for Bladder Cancer

There are several treatments available for bladder cancer. These can include surgery to remove the tumor or bladder, radiation therapy, chemotherapy, or newer treatments like immunotherapy that help the body’s own defenses fight cancer. Many patients may get a combination of these treatments, depending on how advanced their cancer is and their overall health.

Challenges for Older Patients

Not every older patient is able to receive these treatments. Younger patients are much more likely to undergo surgery or radiation that could cure the disease. Research shows that over half of patients younger than 60 received treatments that might cure them. But for people in their 70s, only about a third got these treatments. For patients over 80, the number drops even more—only about 12% received surgery or radiation.

There are many reasons for this. Older patients are more likely to have other health problems, which can make surgery or chemotherapy riskier. Recovery can also be harder on the body. Doctors and patients often have to balance the possible benefits of treatment with the risks and the patient’s quality of life.

Creating a Bladder Cancer Treatment Plan for Elderly Adults

How doctors make a plan

Doctors look at tests like cystoscopy, scans, and the lab report from any biopsy. This shows how big the tumor is and how deep it goes.

Doctors check other health problems (like heart or lung disease), how well the kidneys work, if the person can do daily tasks, and if they are frail. These things matter because some treatments are hard on the body. Doctors may do a quick geriatric check. This looks at memory, medicines, walking, and nutrition to see how well a person might handle surgery or chemo.

The doctor and patient (and family) talk about goals. Some people want the strongest treatment to try to cure the cancer. Others want to focus on comfort and fewer risks. Urologists, medical oncologists, and radiation doctors often work together to pick the best option for that person’s cancer and health.

When is TURBT a good choice?

A trans urethral resection of bladder tumor (TURBT) means removing the bladder tumor through the urethra with a thin tool. It is often the first step for many bladder tumors. TURBT is usually done when the tumor looks like it is only on the surface of the bladder (non-muscle invasive) or when the doctor needs tissue to see how deep the cancer goes.

Doctors will check these things before TURBT: Is there a visible tumor that can be removed safely? Can the patient have anesthesia safely? (Some people with bad heart or lung disease may be at high risk.) Are blood thinners managed so bleeding risk is low? Will the TURBT give useful information for the next steps?

If the patient is too frail or has other big health problems, doctors may choose less invasive options or watchful waiting instead.

Bladder Cancer Treatment Options for Elderly Adults

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells in the bladder. Doctors often give radiation together with chemotherapy and after a doctor trims away the visible tumor so the treatment can work better and the bladder can be saved. Older adults might choose radiation because it can help treat the cancer without taking out the whole bladder, which can be safer for people who have other health problems or who might not do well after big surgery. People who pick this treatment still need close checkups with cystoscopy and scans to make sure the cancer does not come back. Learn more about saving the bladder with combined treatments on our bladder preservation page.

Bladder removal (radical cystectomy)

A radical cystectomy is surgery to remove the entire bladder, nearby lymph nodes, and sometimes nearby organs. Doctors often recommend it when bladder cancer has spread into the muscle or when other treatments have not worked. For older adults, it can be the best way to control the cancer, but it is a major surgery with higher risks, so doctors carefully check overall health before moving forward.

Chemotherapy

For older adults, chemotherapy can be an important option but may also bring more side effects, since aging bodies often handle strong medicines differently. Doctors look closely at kidney function, overall health, and other illnesses before recommending chemo. In some cases, the treatment may be adjusted or combined with other therapies to balance effectiveness with safety.

Selective Bladder Preservation

For some older adults with muscle-invasive bladder cancer who cannot have major surgery—or who wish to avoid it—there is another option called bladder preservation with combined modality therapy (CMT). This approach uses a mix of treatments, such as surgery to remove the tumor, followed by radiation and chemotherapy, while keeping the bladder intact.

Read Stories of Hope

Highlight stories of people with bladder cancer over age 70 to offer hope and positivity to those reading this page. If possible, include their photos next to their story summaries:

71-year old Monique was diagnosed with bladder cancer in 2006. Read her experience with radical cystectomy and chemotherapy. “Eventually, you realize it’s not the end of the world. Bladder cancer is treatable, especially compared to other cancers.” Read Monique’s story.

At age 69, Joe’s urologist suggested he try chemotherapy instead of BCG treatments because of his inflammatory arthritis. Read more about his treatment journey. Read Joe’s story.

“One of the interventions our doctor offered was chemotherapy — docetaxel, and gemcitabine.” As a caregiver to her husband, Bonnie and Larry’s journey took an unexpected turn in 2021 when what they thought was a routine prostate issue turned out to be bladder cancer. Read about Bonnie and Larry’s story