EURURO Vol. 73 No. 1

51 148

Platinum Priority – Editorial
Referring to the article published on pp. 40–50 of this issue
Bladder Cancer in the Elderly
Marko Babjuk
Department of Urology, Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
Bladder cancer is one of the most common tumours and a
significant cause of tumour-related death worldwide. In
this issue of European Urology, Fonteyne and coauthors
present an analysis of curative treatments for muscle-
invasive bladder cancer (MIBC) in elderly patients. Through
their systematic review of the literature, the authors clearly
demonstrate decreases in cancer-specific and overall
survival and an increase in perioperative mortality after
radical cystectomy with age. In other words, patients aged
> 70 yr or > 80 yr are at greater risk of postoperative
complications and of death from bladder cancer.
To provide adequate and effective management for
elderly patients with MIBC, we need to concentrate on some
important points and questions.
1. How significant is the problem for the health
care system?
The aging of the population is a phenomenon apparent in all
developed countries. The percentage of elderly people is
dramatically increasing. For example, in the EU in 2016,
13.5% (nearly 69million people) of the population was older
than 70 yr and 5.4% (more than 27 million people) was older
than 80 yr .
The incidence of bladder cancer is increasing with age.
According to the cancer registry of the Czech Republic, 55%
of bladder cancer cases detected were in individuals aged
> 70 yr and 23% in those aged > 80 yr. Moreover, the
proportion of more advanced stages is higher among older
than among younger patients. To demonstrate the real load
for a health care system, in the Czech Republic (population
10 million) 470 patients aged > 70 yr and 220 aged > 80 yr
had stage T2–4 bladder cancer newly detected in 2014
.
2. How significant is the problem for our patients?
MIBC is a life-threatening disease. Median survival among
patients with unresectable or metastatic bladder urothelial
carcinoma treated with systemic chemotherapy was
reported as 14.8 mo, with 17% surviving for 5 yr By
contrast, the average life expectancy of EU citizens was
15.9 yr at age 70 yr and 9.2 yr at age 80 yr in 2015. These data
strongly support the use of curative treatments in elderly
patients with tumours that are still potentially curable. In
spite of this, the adoption of radical surgery is underused.
According to data from the Surveillance, Epidemiology, and
End Results database, only 21% of elderly patients (>65 yr)
with MIBC underwent radical cystectomy even though
overall survival was better among cystectomy cases
. Similarly, the US National Cancer Data Base demonstrat-
ed that the indication for radical cystectomy dramatically
decreased with age, and the same tendency can be observed
in Europe (see ref. and ref. [49] from ref. ).
3. What is the optimal performance of radical
cystectomy in elderly patients?
Radical cystectomy with urinary diversion is considered the
standard treatment for patients with nonmetastatic MIBC. It
must be underlined that in the elderly population, optimal
results can only be expected if the usual principles of
oncologic surgery, including thorough pelvic lymphadenec-
tomy, are maintained
Radical cystectomy is a complex surgery with a high risk
of postoperative morbidity and mortality, as clearly
demonstrated by Fonteyne et al . Significant numbers
of serious complications, particularly gastroinestinal, are
associated with urinary diversion. Careful selection of the
ava ilable at
journal homepage:
DOI of original article: .
* Department of Urology, FN Motol, V U´ valu 84, 15006 Prague 5, Czech Republic. Tel. +420 224434801.
E-mail address: .
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.