- The International Society of Geriatric Oncology (SIOG) task force has released recommendations for management in older patients.
- Nonmuscle invasive bladder cancer:
- Treat with standard therapy according to accepted national/international guidelines.
- Avoid anticholinergics to manage the adverse effects of intravesical therapy where possible; use with caution if needed.
- Muscle invasive bladder cancer:
- Cross-sectional imaging should be performed in all patients for staging and identifying bone disease and to optimize the best supportive care regardless of age and fitness.
- If radical cystectomy is decided on, refer patient to an experienced center.
- Prehabilitation for surgery includes enhancing nutrition and fitness and treatment of anemia to avoid unduly delay in surgery (strong).
- Consider radiotherapy or transurethral resection of a bladder tumor alone when the patient refuses or is unfit for standard treatment (strong).
- Metastatic bladder cancer:
- Discuss prognosis and goals of care with patients and caregivers; consideration of appropriate palliation should begin at the time of diagnosis.
- First-line should be standard systemic therapy, but this will depend primarily on fitness for cisplatin and on prognostic factors.
- Consider carboplatin for cisplatin-unfit and immunotherapy for PD-L1-positive patients.
- Consider standard second-line immunotherapy in platinum-pretreated patients.
- Consider palliative radiotherapy for intractable gross hematuria and control of pain.