Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Bladder cancer in the elderly: clinical outcomes, basic mechanisms, and future research direction

Nature Reviews Urology volume 6, pages 135–144 (2009)Cite this article

Abstract

The association between aging and cancer is well exemplified by bladder cancer: with advancing age, the risk of developing bladder cancer increases, and patients' clinical presentation and outcomes worsen. Care for elderly patients with bladder cancer requires specific knowledge of many key geriatric clinical issues in order to determine optimal treatment plans. While numerous studies have tried to address the role of urologic intervention for elderly patients with bladder cancer, many studies fail to incorporate a component of true functional assessment. Evaluation tools that incorporate comorbidities, disabilities and functional status will need to be developed, as chronological age is a poor predictor of treatment outcomes. Additionally, further research is necessary to better understand the basic mechanisms that predispose elderly patients to develop this costly and life-threatening disease. This Review examines the current literature evaluating the clinical and mechanistic interactions between aging and bladder cancer, and suggests the formulation of a research agenda to address the issues raised.

Key Points

  • The annual number of bladder cancer cases in the US is increasing, with the elderly representing the largest group at risk

  • While age seems to adversely affect treatment outcomes for patients with all stages of bladder cancer, the optimum management of geriatric patients remains unclear

  • The majority of the data for treatment outcomes in elderly patients come from retrospective data analyses that are limited by selection biases and lack of a true assessment of physiologic reserves in the elderly

  • Current research into the etiology of bladder cancer in the elderly indicates a potential role for epigenetic events that accumulate over time, as opposed to repeated genetic damage

  • Future research agendas should be established to study the biology and physiology of aging as it relates to the development and progression of bladder cancer in the elderly, from the perspective of both basic mechanistic and clinical outcomes trials

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: The number of new bladder cancer cases by year in the US (based on data from the American Cancer Society Cancer Facts & Figures 2002–2008).5
Figure 2: The probability of developing invasive bladder cancer by age group (based on data from the American Cancer Society Facts & Figures 2008).5

Similar content being viewed by others

References

  1. Edwards BK et al. (2002) Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on US cancer burden. Cancer 94: 2766–2792

    Article  Google Scholar 

  2. Serrano M and Blasco MA (2007) Cancer and ageing: convergent and divergent mechanisms. Nat Rev Mol Cell Biol 8: 715–722

    Article  CAS  Google Scholar 

  3. Lichtman SM et al. (2007) Geriatric oncology: a field coming of age. J Clin Oncol 25: 1821–1823

    Article  Google Scholar 

  4. Lynch CF and Cohen MB (1995) Urinary system. Cancer 75: 316–329

    Article  CAS  Google Scholar 

  5. American Cancer Society (online 2008) Cancer Facts & Figures 2008 [http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf] (accessed 21 January 2009)

  6. Schultzel M et al. (2008) Late age (85 years or older) peak incidence of bladder cancer. J Urol 179: 1302–1305

    Article  Google Scholar 

  7. Prout GR Jr et al. (2005) Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer 104: 1638–1647

    Article  Google Scholar 

  8. Konety BR and Joslyn SA (2003) Factors influencing aggressive therapy for bladder cancer: an analysis of data from the SEER program. J Urol 170: 1765–1771

    Article  Google Scholar 

  9. Briggs NC et al. (1992) Age as a predictor of an aggressive clinical course for superficial bladder cancer in men. Cancer 69: 1445–1451

    Article  CAS  Google Scholar 

  10. Ries LA et al. (online 31 December 2008) SEER Cancer Statistics Review, 1975–2005 [http://seer.cancer.gov/csr/1975_2005/] (accessed 21 January 2009)

  11. Cooksley CD et al. (2008) Clinical model of cost of bladder cancer in the elderly. Urology 71: 519–525

    Article  Google Scholar 

  12. Joudi FN et al. (2006) The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy. J Urol 175: 1634–1639

    Article  Google Scholar 

  13. Herr HW (2007) Age and outcome of superficial bladder cancer treated with bacille Calmette–Guérin therapy. Urology 70: 65–68

    Article  Google Scholar 

  14. Rodin MB and Mohile SG (2008) Assessing decisional capacity in the elderly. Semin Oncol 35: 625–632

    Article  Google Scholar 

  15. Wood DP Jr et al. (1987) Radical cystectomy for carcinoma of the bladder in the elderly patient. J Urol 138: 46–48

    Article  Google Scholar 

  16. Skinner EC et al. (1984) Radical cystectomy in the elderly patient. J Urol 131: 1065–1068

    Article  CAS  Google Scholar 

  17. Ogawa A et al. (1985) Treatment of bladder carcinoma in patients more than 80 years old. J Urol 134: 889–891

    Article  CAS  Google Scholar 

  18. Chamie K et al. (2008) Cystectomy in the elderly: does the survival benefit in younger patients translate to the octogenarians? BJU Int 102: 284–290

    Article  Google Scholar 

  19. Nielsen ME et al. (2007) Advanced age is associated with poorer bladder cancer-specific survival in patients treated with radical cystectomy. Eur Urol 51: 699–706

    Article  Google Scholar 

  20. Figueroa AJ et al. (1998) Radical cystectomy for elderly patients with bladder carcinoma: an updated experience with 404 patients. Cancer 83: 141–147

    Article  CAS  Google Scholar 

  21. Fried LP et al. (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56: M146–M156

    Article  CAS  Google Scholar 

  22. Soulié M et al. (2002) A multicenter study of the morbidity of radical cystectomy in select elderly patients with bladder cancer. J Urol 167: 1325–1328

    Article  Google Scholar 

  23. Gamé X et al. (2001) Radical cystectomy in patients older than 75 years: assessment of morbidity and mortality. Eur Urol 39: 525–529

    Article  Google Scholar 

  24. Zebic N et al. (2005) Radical cystectomy in patients aged ≥75 years: an updated review of patients treated with curative and palliative intent. BJU Int 95: 1211–1214

    Article  Google Scholar 

  25. Koppie TM et al. (2008) Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer 112: 2384–2392

    Article  Google Scholar 

  26. Stroumbakis N et al. (1997) Radical cystectomy in the octogenarian. J Urol 158: 2113–2117

    Article  CAS  Google Scholar 

  27. Weizer AZ et al. (2007) Performance status is a predictor of overall survival of elderly patients with muscle invasive bladder cancer. J Urol 177: 1287–1293

    Article  Google Scholar 

  28. Feng Z et al. (2007) Declining p53 function in the aging process: a possible mechanism for the increased tumor incidence in older populations. Proc Natl Acad Sci USA 104: 16633–16638

    Article  CAS  Google Scholar 

  29. Stuart GR et al. (2000) Mutation frequency and specificity with age in liver, bladder and brain of lacI transgenic mice. Genetics 154: 1291–1300

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Maruyama R et al. (2001) Aberrant promoter methylation profile of bladder cancer and its relationship to clinicopathological features. Cancer Res 61: 8659–8663

    CAS  PubMed  Google Scholar 

  31. Marsit CJ et al. (2006) Carcinogen exposure and gene promoter hypermethylation in bladder cancer. Carcinogenesis 27: 112–116

    Article  CAS  Google Scholar 

  32. Jones PA et al. (1998) DNA methylation in bladder cancer. Eur Urol 33 (Suppl 4): 7–8

    Article  Google Scholar 

  33. Marsit CJ et al. (2007) Promoter hypermethylation is associated with current smoking, age, gender and survival in bladder cancer. Carcinogenesis 28: 1745–1751

    Article  CAS  Google Scholar 

  34. Habuchi T et al. (2001) Hypermethylation at 9q32–33 tumour suppressor region is age-related in normal urothelium and an early and frequent alteration in bladder cancer. Oncogene 20: 531–537

    Article  CAS  Google Scholar 

  35. Bornman DM et al. (2001) Methylation of the E-cadherin gene in bladder neoplasia and in normal urothelial epithelium from elderly individuals. Am J Pathol 159: 831–835

    Article  CAS  Google Scholar 

  36. Gu J et al. (2005) Roles of tumor suppressor and telomere maintenance genes in cancer and aging—an epidemiological study. Carcinogenesis 26: 1741–1747

    Article  CAS  Google Scholar 

  37. Rodin MB and Mohile SG (2007) A practical approach to geriatric assessment in oncology. J Clin Oncol 25: 1936–1944

    Article  Google Scholar 

  38. Walston J et al. (2006) Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 54: 991–1001

    Article  Google Scholar 

  39. Monfardini S and Basso U (2007) Oncological causes of frailty in older cancer patients. Eur J Cancer 43: 1230–1231

    Article  Google Scholar 

  40. Michaud DS (2007) Chronic inflammation and bladder cancer. Urol Oncol 25: 260–268

    Article  CAS  Google Scholar 

  41. Taylor JA et al. (2006) Null mutation in macrophage migration inhibitory factor prevents muscle cell loss and fibrosis in partial bladder outlet obstruction. Am J Physiol Renal Physiol 291: F1343–F1353

    Article  CAS  Google Scholar 

  42. Taylor JA III and Kuchel GA (2006) Detrusor underactivity: clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc 54: 1920–1932

    Article  Google Scholar 

  43. Leng SX et al. (2007) Inflammation and frailty in older women. J Am Geriatr Soc 55: 864–871

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by grants from the American Cancer Society MRSG-08-270-01-CCE (JAT), the National Institutes of Health R01-AG028657 (GAK, JAT), a Dennis W Jahnigen Career Development Award from the American Geriatrics Society (JAT) and the Travelers Chair in Geriatrics and Gerontology (GAK).Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

Author information

Authors and Affiliations

  1. JA Taylor III is an Assistant Professor of Surgery at the Division of Urology, and GA Kuchel is a Professor of Medicine and Director at the University of Connecticut Center On Aging, University of Connecticut Health Center, Farmington, CT, USA.,

    John A Taylor III & George A Kuchel

Authors
  1. John A Taylor III
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George A Kuchel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John A Taylor III.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taylor, J., Kuchel, G. Bladder cancer in the elderly: clinical outcomes, basic mechanisms, and future research direction. Nat Rev Urol 6, 135–144 (2009). https://doi.org/10.1038/ncpuro1315

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro1315

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing