Background: As the prevalence of bladder cancer increases amongst the elderly, nearly 1 in 3 muscle invasive bladder cancer (MIBC) cases are in patients aged >80 years (Taylor JA, III, Kuchel GA. Nat Clin Pract Urol 2009; 6(3):135-1440). However, radical cystectomy remains as the gold standard treatment for MIBC (Yafi FA, Kassouf W. Can Urol Assoc J 2009; 3(5):409-412). In this study we examined treatment patterns and outcomes patients aged >80 years from a prospective study of bladder cancer. Methods: The Bladder Cancer Prognosis Programme (BCPP) is a 5 year prospective cohort study (2006-2011) with 1191 patients confirmed as having newly-diagnosed bladder cancer. Recruitment took place at 9 urological centres within the West Midlands region, UK. From this cohort we identified 67 patients aged >/=80 years with newly diagnosed MIBC. Study records include overall and disease specific survival, time to disease recurrence and radiotherapy (RT) treatment. Simple descriptive statistics were used to describe the outcomes. Results: This cohort consisted of 46 male and 21 female patients with a median age of 83 (IQR=81, 87; range=80, 94). Only 4 (6%) patients underwent cystectomy and 36 (53%) underwent RT. Median survival data is summarised in the table below. Conclusions: Despite guidelines, practising urologists in the West Midlands region do not offer cystectomy to the vast majority of MIBC patients aged >80 years. Furthermore, in this patient cohort, OS was shorter than BCSS by 10 months, suggesting that quality of life after diagnosis will be far more important than cure rates due to deaths from other causes. Of particular note is that the group receiving RT had longer OS and BCSS than the rest of the cohort. This indicates that RT could be a far more appropriate standard of care in the elderly than surgery, which is clearly of limited applicability in this growing demographic. Clinical trial information: 06/MRE04/65.