You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.

Table 1. The Percentage of Patients Diagnosed With ≤T1 or ≥T2 Bladder Cancer on the Basis of Age[7,8]  

Table 2. Clinical Summary of Selected Studies Evaluating the Role of Aging in Bladder Cancer Outcomes  

Box 1. Assessment Tools and the Meaning of Scores  

Table 3. Summary of the Basic Science Studies Assessing the Mechanistic Interactions Between Bladder Cancer and Aging  


Bladder Cancer in the Elderly: Clinical Outcomes, Basic Mechanisms, and Future Research Direction

  • Authors: John A. Taylor, III, MD ; George A. Kuchel, MD, FRCP, AGSF
Start Activity

Target Audience and Goal Statement

This activity is intended for primary care physicians, urologists, oncologists, radiation oncologists, and other physicians who care for patients with bladder cancer.

The goal of this activity is to describe the interaction between age and bladder cancer as well as treatment outcomes of bladder cancer among older adults.

Upon completion of this activity, participants will be able to:

  1. Describe the epidemiology of bladder cancer
  2. Identify the outcomes of treatment of bladder cancer among older adults
  3. Specify valuable predictors of poor treatment outcomes among elderly patients with bladder cancer
  4. Describe possible genetic mechanisms explaining the interaction between bladder cancer and age


As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • John A. Taylor, III, MD

    Assistant Professor of Surgery, Division of Urology, University of Connecticut Health Center, Farmington, Connecticut


    Disclosure: John A. Taylor III, MD, has disclosed no relevant financial relationships.

  • George A. Kuchel, MD, FRCP, AGSF

    Professor of Medicine; Director, University of Connecticut Center on Aging, University of Connecticut Health Center, Farmington, Connecticut


    Disclosure: George A. Kuchel, MD, FRCP, AGSF, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P. Vega, MD, FAAFP

    Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine


    Disclosure: Charles P. Vega, MD, FAAFP, has disclosed that he has served as an advisor or consultant to Novartis, Inc.

Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Nature Publishing Group.

    Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.


Bladder Cancer in the Elderly: Clinical Outcomes, Basic Mechanisms, and Future Research Direction

Authors: John A. Taylor, III, MD ; George A. Kuchel, MD, FRCP, AGSFFaculty and Disclosures


Summary and Introduction


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.


Cancer is a disease that occurs more frequently in later life, and the proportion of cancers that occur in the elderly is increasing relative to younger age groups. By 2030, over 70% of all cancers are expected to occur in people aged over 65 years.[1] Proposed mechanisms for the increased incidence of cancer in the aging population include an accumulation of genetic and cellular damage, prolonged exposure to carcinogens, and fundamental changes in the host environment. Cancer and aging are intimately linked at the most basic level: convergent mechanisms protect against both aging and cancer (e.g. antioxidant defenses), while the pathways regulating cellular proliferation typically exert divergent or opposing effects; specifically, protecting from cancer but promoting aging.[2] The presence of age-related physiological changes in elderly patients, plus common comorbid conditions, presents clinicians with challenges that require specific knowledge of geriatric oncology.[3]

Bladder cancer illustrates well the association between cancer and aging, and occurs most commonly in the elderly: the median age at diagnosis is 69 years for men and 71 years for women.[4] Bladder cancer is also the fourth and eighth most common malignancy in men and women, respectively, and the number of diagnosed cases is increasing annually in the US (Figure 1).[5] In 2008, a Californian tumor registry study showed that the incidence of bladder cancer peaks at the age of 85 years, with a rate of increase roughly 10-fold higher than that seen in younger age groups.[6] Advanced age may be associated with worse outcome, but stage and grade at diagnosis remain key determinants of prognosis. Advanced age seems to increase the risk of higher-stage cancer (Table 1), and also of high-grade disease if the cancer is found to be superficial.[7–9] High-grade or muscle-invasive tumors are much more likely to progress and metastasize than low-grade, low-stage cancers, and the 5-year survival rates in patients with high-grade or muscle-invasive tumors are as low as 6%.[10] The overall probability of developing invasive disease increases with age, rising from 0.01–0.02% before age 40 years, to 1.2–3.7% for those aged over 70 years (Figure 2).[5]

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.


TThe probability of developing invasive bladder cancer by age group (based on data from the American Cancer Society Facts & Figures 2008).[5]

The management of high-grade disease in the elderly is costly and challenging. The current standard of care for superficial high-grade or recurrent low-grade disease remains intravesical immunotherapy with bacillus Calmette–Guérin (BCG). Cystectomy with reconstructive surgery is the current standard of care for invasive or recurrent superficial disease. Chemotherapy and radiation therapy can be used in conjunction with cystectomy, as either bladder-sparing therapy or as palliative treatment. The annual costs of caring for patients with muscle-invasive bladder cancer can exceed $35 million.[11]

The goal of this article is to review the current literature addressing both the clinical and mechanistic interactions between bladder cancer and aging, while also encouraging future progress in these fields through the formulation of a research agenda.