IS IT JUSTIFIED TO AVOID RADICAL CYSTOPROSTATECTOMY IN ELDERLY PATIENTS WITH INVASIVE TRANSITIONAL CELL-CARCINOMA OF THE BLADDER

Background. Although radical cystectomy is accepted by most urologists as the treatment of choice for invasive carcinoma of the bladder and age alone is not considered a contraindication for radical surgery, ma ny consider radical major operations to be unsuitable for elderly pati ents. Methods. The authors compared the results of radical cystectomy in 42 elderly patients to those in patients 69 years old or younger an d to a group of 21 elderly patients, matched by stage of disease and s everity of medical problems, who received alternative treatment. Resul ts. The overall operative mortality rate was 6.3% (seven patients). Th ree (4.3%) postoperative deaths in the younger group and four (9.5%) d eaths among elderly patients were recorded. The operative morbidity an d mortality did not differ significantly between those two groups (P = 0.1). Among the patients who received alternative therapy, 13 (61.9%) died within the first 6 months, and only 3 survived more than 12 mont hs. Morbidity was encountered in 97% of these patients. Conclusions. T he authors showed that radical cystectomy is a relatively safe procedu re for elderly patients. The elderly patient who is thought to be unsu itable for surgery not only is deprived of his right to definite curat ive therapy but also is exposed to higher morbidity and mortality and worse quality of life than are those who undergo operations. The autho rs conclude that it is unjustified to avoid radical cystectomy in the elderly population on the basis of age alone.