Geriatric Assessment and Inflammaging Biomarkers in Older Patients with Urological Cancers: Evidence and a Conceptual Framework

Background: and Objectives: Prostate, bladder and kidney cancers are frequently diagnosed in older adults, in whom chronological age and performance status poorly reflect functional reserve. Geriatric assessment (GA) identifies clinical vulnerability, whereas the contribution of blood biomarkers of chronic low-grade inflammation (“inflammaging”) to risk stratification remains unclear. This narrative review summarizes the evidence on geriatric screening and assessment in older patients with urological cancers and on frailty-associated blood biomarkers, and asks whether these add information beyond GA. Materials and Methods: A structured, non-systematic search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library (2010–2026) prioritized guidelines, meta-analyses and clinical studies. Results: In cohorts of mixed tumor types, the Geriatric-8 (G8) detected impairments on GA with about 82–85% sensitivity and 63–65% specificity, and an abnormal score was associated with shorter survival and more postoperative complications, including in urological cohorts. Frailty is independently associated with adverse outcomes after radical cystectomy and in renal cell carcinoma, and androgen deprivation is associated with loss of lean mass. C-reactive protein and interleukin-6 are the biomarkers most consistently associated with frailty in cross-sectional studies, but longitudinal confirmation is limited; evidence for haptoglobin and transferrin is sparse. All markers with adequate data, including the neutrophil-to-lymphocyte ratio, albumin, fibrinogen and growth differentiation factor-15, also relate to tumor stage or prognosis and are therefore non-specific. Most biomarker–frailty data come from populations without urological cancer. In a study of older patients with mixed cancer types, routine laboratory markers provided modest additional prognostic information beyond clinical variables and GA. Conclusions: The evidence reviewed does not establish an inflammaging biomarker panel sufficiently validated to guide treatment intensity in older patients with urological cancers. We outline a conceptual framework in which biomarkers form an exploratory layer added to G8 screening and GA, and identify the validation steps required before clinical use.