Objective To assess trends and factors driving aggressive surgery for patients >75 years diagnosed with prostate cancer (PCa), bladder cancer (BCa), and renal cell carcinoma (RCC). Methods We identified all patients >75 years diagnosed with PCa, BCa, and RCC from the Surveillance, Epidemiology and End Results-Medicare registry during 1992-2009. We analyzed the comorbidity and trends in radical cystectomy (RC), nephrectomy, and radical prostatectomy (RP) for these cohorts. Predictive factors for receiving aggressive surgery were assessed using logistic regression analysis. Results We identified cohorts of 85,073 PCa, 44,801 BCa, and 10,737 RCC patients. Among the BCa patients, 5.75% underwent RC and 78.2% had a Charlson comorbidity score (CCS) of ≤1. The trend of RC did not change significantly. There was a significant change in receipt of RP (P = .01). There were 85.8% of PCa patients who had a CCS ≤1 and 2.67% underwent RP. Approximately 65.2% of RCC patients had nephrectomy whereas 76.2% had CCS of ≤1. There was a decline in receipt of nephrectomies (P < .0001). Younger age, high stage or grade disease, and lower comorbidity were associated with higher odds of receiving RC, RP, and nephrectomy. Conclusion In addition to stage and grade, age remains an important factor influencing the decision to undergo curative surgical therapy for PCa, BCa, and RCC patients >75 years. Comorbidity is also predictive, but to a lesser extent.