Need to determine best management options

Sorry to hear about the diagnosis.

Did the doctor(s) who diagnosed him provide any recommendations, or identify what stage the cancer is, or how aggressive it is? How is his overall physical health?

I'm not a doctor (and have zero medical training). I've learned a few things from three recent family cancers, but am in no way qualified to suggest the "best" management options, but can offer some thoughts and questions you might address with your husband's medical team.

My 84-year old father-in-law has pretty advanced dementia, heart issues, and was diagnosed several months ago with urothelial adenocarcinoma, which usually starts in the bladder but affected one of his kidneys first instead. He had separate surgeries to remove a kidney and put a stent in his heart.

We had been warned that general anesthesia can make dementia worse, and that does seem to have been the case with my FIL, so major surgery * * * might not * * * be a good option.

Outside of surgery, the treatment options might include radiation or a systemic therapy (chemotherapy or immunotherapy), but there are still a lot of unknown variables. None of them strike me as "easy" for the average 91-year old, unless he is otherwise active and in good health. The immunotherapies that were advertised as "easier than traditional chemo" were still pretty tough on my 85-year old father (mesothelioma) as well as my FIL.

My first concern for your husband would be urinary issues in general, and palliative management of them. If he has any issues (blockages, etc) emptying his bladder, he runs the risk of urinary tract infections (UTI) , as well as significant discomfort. A urinary catheter is no fun, and can also increase the risk of UTIs. In elderly patients, especially those with dementia, UTIs can also cause hallucinations or disorientation.

If there is prostate enlargement, that may also complicate bladder emptying. Drugs like finasteride and Flowmax may help. According to Wikipedia https://en.wikipedia.org/wiki/Prostatic_stent there are temporary ("The Spanner") and permanent ("Urolume") prostatic stents that can be inserted without general anesthesia.

I have zero knowledge of either, but are something you could ask the medical team about.

The progression (if treated or untreated) is far beyond any experience or knowledge I have.

You should definitely be asking the original oncologist for advice/referrals on palliative care, because I imagine it will be a part of his future (management of treatment side effects and/or disease progression).

Wishing you both the very best.

--mm

Thank you for your thoughtful reply.