In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, speaks with Tullika Garg, MD, MPH, FACS, a urologic oncologist at Geisinger Medical Center in Danville, Pennsylvania, about the nuances of caring for older adults with genitourinary malignancies. Garg—who has authored the American Urological Association Core Curriculum chapter on geriatric oncology—shares her passion for improving outcomes in a population that represents the majority of new cancer diagnoses yet remains underrepresented in clinical trials. Garg emphasizes the need to move beyond chronological age, using tools such as the Cancer and Aging Resilience Evaluation and the Cancer and Aging Research Group chemotherapy toxicity calculator to assess physiologic fitness. She encourages urologists to employ frameworks like the 3-talk model of shared decision-making—team talk, option talk, and decision talk—to align treatment plans with patient goals and values. Even simple questions such as, “What’s a typical day like for you?” or “What are you looking forward to?” can uncover key insights about function and priorities. The discussion spans practical approaches to frailty screening, prehabilitation, and nutritional optimization, as well as strategies for discussing palliative options when surgery or chemotherapy may not be feasible. Garg also reviews perioperative considerations—minimizing delirium, avoiding anticholinergics and opioids, and the importance of early mobility and home health support. She and Goodstein explore cancer-specific issues, from immunotherapy use in older patients to balancing risks of androgen deprivation therapy in prostate cancer. Garg closes with a call for trainees to recognize and challenge ageism in clinical practice, urging clinicians to treat each older adult as an individual—not by number, but by capacity and life goals. Chapters 0:52 How Dr Garg became interested in geriatric oncology 10:02 Assessing geriatric patients 14:36 Patient resources for improving fitness 21:54 Exercise vs nutrition 29:55 Immune checkpoint inhibitors 35:50 Drugs to avoid in older patients 40:58 Robotic vs open surgery 49:00 Being mindful of ageism

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