Age is now widely accepted as the greatest single risk factor for developing cancer, and cancer is considered primarily as a disease of the elderly. Furthermore, a characteristic of aging is the progressive deterioration of immune function known as immunosenescence. In addition to the increased risk of occurrence of cancer among older patients, they are more predisposed to poor outcomes after definitive treatment. Therapies, outcomes and mortality are often influenced by age and elderly must have a specific and a multidisciplinary approach. It is obvious to consider that one should not consider "age" as the only risk factor, but the condition that this determines to the organism, like the presence of co-morbidities and the consequent poor response to treatment. Cancer occurs frequently in association of one or more other chronic diseases, that affect the efficacy of various treatment interventions. Because of the potential morbidity associated with surgery, the use of mini-invasive techniques have expanded considerably. Aging should not be viewed as a difficulty to definitive therapeutic option. For these reason, it should be correct to value the physiologic capabilities of each organ system and all co-morbidities in the elderly, in order to face possible risks of treatment or improbable benefits. This review takes a look to the tumor biology and to the morbidity of cancer treatment in elderly patients affected by genito-urological cancer like prostate, bladder and renal cancer.