What is the prognosis of metastatic urothelial carcinoma at 64?

Question

Hello doctor,

I am 64 and was diagnosed with metastatic urothelial carcinoma eight months ago after finding blood in my urine. The cancer started in my bladder but has now spread to lymph nodes and bones, which makes it stage 4. I had my bladder removed, and now I have a urostomy bag, which took some getting used to.

The oncologist tried Carboplatin and Gemcitabine chemotherapy, but after four cycles, the cancer kept growing. Now they are suggesting immunotherapy with Pembrolizumab, but I am not sure if it is worth the side effects at my age. The bone metastases are causing a lot of pain, especially in my spine and hips. Taking OxyContin for pain, but it makes me constipated and confused sometimes.

My daughter thinks I should try every treatment available, but I am tired of feeling sick all the time. The metastatic urothelial carcinoma has also caused kidney problems, and my creatinine is now 2.1. I never smoked cigarettes, but worked in a chemical plant for 30 years, which might have caused this cancer. What is the realistic prognosis with immunotherapy, and how long might I have? Also worried about my two daughters getting screened, since this might be genetic.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Stage 4 urothelial carcinoma that has not responded to first-line chemotherapy is challenging, and treatment now focuses more on slowing progression and maintaining quality of life. Immunotherapy (like Pembrolizumab) can work for some people, even after chemotherapy, but it does not help everyone; the benefit rate is roughly 20 to 30 percent in advanced cases, and it may take weeks to see if it is working.

Side effects can range from mild fatigue to serious immune-related issues. At your age and with kidney involvement, the decision depends on whether the potential extra months or symptom relief outweigh the side effects and hospital visits. The pain you have from bone spread can be better managed with a combination of pain medicines, bone-strengthening injections, and possibly localized radiotherapy for painful spots. Regarding your daughters, this type of bladder cancer is usually not hereditary, but regular health checks and avoiding occupational exposures are wise.

The probable causes: Occupational chemical exposure over the years, leading to bladder cancer, which is now metastatic.

Investigations to be done:

Full blood count.
Kidney and liver function before starting immunotherapy.
PET-CT (positron emission tomography - computed tomography) scan to assess spread and treatment response.
Bone scan if pain worsens in new areas.

Differential diagnosis:

Other secondary malignancy (less likely here).
Chronic kidney disease from cancer and treatment.
Bone pain from osteoporosis (overlap possible).

Probable diagnosis: Metastatic urothelial carcinoma and post-cystectomy.

Treatment plan:

Discuss in detail with the oncologist about the realistic benefits vs. side effects of Pembrolizumab.
Optimize pain management, adjust OxyContin dose or add stool softeners to reduce constipation.
Consider palliative radiotherapy for painful bone spots.
Maintain hydration and monitor kidney function.
Palliative care involvement early to focus on comfort, mobility, and symptom relief.

Regarding follow-up: Keep regular follow-up with your oncologist and palliative care team. If you decide to try immunotherapy, update them on any new symptoms (fever, diarrhea, breathing issues, and severe fatigue). For your daughters, they can discuss individual risk with a physician.

Preventive measures:

Avoid further chemical exposures.
Regular hydration.
A balanced diet is necessary to maintain strength.
For daughters, periodic urine tests prompt evaluation of any urinary symptoms, but routine genetic screening is usually not needed unless advised by a specialist.

I hope this information will help you.

Kindly follow up if you have more concerns.

Thank you.