How to treat urothelial carcinoma in geriatric people?

Question

Hello doctor,

My father is 70 years old and was recently diagnosed with urothelial carcinoma that has spread beyond the bladder. He initially had symptoms like blood in urine and fatigue, and imaging later showed metastasis to nearby lymph nodes. Doctors are discussing systemic treatment options, including chemotherapy or immunotherapy, but we are unsure what to expect from treatment at this stage.

What are the current treatment options for metastatic urothelial carcinoma?
How effective are they in controlling disease progression?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

In metastatic disease, we usually prefer to give systemic therapy and traditionally start with chemotherapy (a common cancer treatment that uses drugs to destroy cancer cells and prevent tumor growth).

But in the case of your father, who is 70 years old, we often prefer immunotherapy (treatment that uses the body's immune system, usually your own, to attack cancer) or targeted therapy and try to avoid chemotherapy because chemotherapy has many difficult side effects that can affect the general condition and restrict physical activity.

Immunotherapy can be taken at home, and its outcomes are usually very good. It can achieve full control of the tumor, reduce metastasis, and improve the general condition, allowing the patient to live for many years with good control.

At this stage, we also focus on bone support, such as monthly Denosumab injections with vitamin D and calcium to reduce bone loss. Any site of metastasis can receive localized radiotherapy to reduce pain. Pain management is very important, and treatment should be given according to the pain scale.

We also emphasize emotional support. The family should stay around him and reassure him that this is not terminal and not the end of life. It is also very important to pay attention to nutrition, food, and fluid intake, and ensure everything is well cleaned.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.