There is no difference between the surgery or radiotherapy treatment among patients over 65 years compared to those under 65 in localized melanoma. In metastatic melanoma the use of ipilimumab, BRAF inhibitors or dacarbazine also had the same results [19].

Urogenital Cancers

The main urogenital cancer is urothelial carcinoma. It appears frequently in the bladder after 65 years compared to the urethra, ureter or renal pelvis. The 5-year survival decreases progressively with the age being 84 % in patients with 65-69 years and 60 % in those with more than 85 years [40,41].

For kidney cancer surgical resection is commonly indicated in the treatment of localized malignancy, but this surgery can be followed by renal insufficiency in patients over 75 years [42,43]. Target treatment with sunitinib, sorafenib or temsirolimus, and everolimus in patients over 70 years has a higher risk of neutropenia, anemia and asthenia. Infections were also more common in older patients using everolimus. Interferon must not be used in older patients due to high toxicity [44-46].

Bladder cancer in 2014 was the 5th most incident (74,000 cases estimated) in USA and had the highest median age among all cancer types (73 years old). Muscle invasive bladder cancer (MIBC) is present in 25-30 % of all bladder cancer diagnoses and requires a more aggressive approach [47]. Older patients are often undertreated as in 40,000 patients with muscular invasive bladder cancer (MIBC), cystectomy varied between 55 % in those younger than 70 years of age to 21 % in those older than 79. In addition, in those non-receiving surgery patients (>79 years) only 30 % received chemotherapy and/or radiotherapy [48]. Recent adjusted analyses comparing older patients receiving radiation or cystectomy found no difference in overall survival or cancer-specific survival [49, 50]. Neoadjuvant chemotherapy based on methotrexate, vinblastine, doxorubicin, and cisplatin was shown by Grossman et al. to improve 5-year overall survival and became standard of care [51].

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