The treatment of advanced urological cancers has evolved tremendously over the last decade. As the incidence of these cancers is increasing with age, uro-oncologists are increasingly faced with the challenge of choosing optimal therapeutic strategies for elderly patients. Comorbidities interfering with cancer treatment can be identified by geriatric assessment tools that should be applied in elderly cancer patients before starting therapy. Using these tools competing risks of morbidity and mortality can be evaluated. We provide a review on evidence based treatments in elderly prostate, bladder and renal cell carcinoma patients.