Fig. 1

This figure has been adapted from the AUA guidelines for muscle-invasive bladder cancer (MIBC) therapy

Upon diagnosis of non-metastatic, muscle-invasive bladder cancer, the recommended treatment for patients is neoadjuvant chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection (PLND). Surgery alone may be offered to patients who are ineligible for or who decline NAC, with radical cystectomy potentially followed by adjuvant chemotherapy. Trimodal therapy (TMT), as part of a bladder-preserving approach, is another option for select patients. However, if TMT fails, radical cystectomy remains a viable option for salvage therapy

Note:Option for patients with solitary tumors ≤ 5 cm, absence of hydronephrosis, absence of extensive carcinoma in situ (CIS), good bladder function, or those who are unfit for or decline cystectomy

#Note: Cis or MMC/5FU = cisplatin or mitomycin C and 5-fluorouracil