Radiation therapy for urologic malignancies in the elderly

Radiotherapy is a commonly employed modality in the treatment of older men with urologic malignancies. The treatment recommendations should not be solely based on age even though optimal therapy for older patients continues to evolve. Radiotherapy is well tolerated by elderly prostate cancer patients and comparisons with other modalities should incorporate validated health-related quality of life measures, which is an important consideration in this age group. Due to lack of quality data, there is a need to optimize decision making process for older prostate cancer patients with more robust evidence-based measures. The new and emerging radiotherapeutic technologies are likely to benefit older patients with improvement in therapeutic ratio resulting from reduced dose delivery to normal tissues. The use of novel techniques, such as intensity modulated radiation therapy, image guidance and proton beam therapy, and their potential benefits for older population are discussed. This article also reviews the role of radiotherapy in older patients with other urologic malignancies, such as testicular tumor, bladder cancer, renal carcinoma, and penile cancer.