The most common treatments for muscle-invasive bladder cancer are radical cystectomy and radiation therapy. There is no strong evidence from randomized controlled trials to determine whether surgery or radiation therapy is more effective. There is strong evidence that both therapies are more effective when combined with chemotherapy. The treatments with the highest levels of evidence supporting their effectiveness are radical cystectomy preceded by multiagent cisplatin-based chemotherapy and radiation therapy with concomitant chemotherapy.

Because bladder cancer commonly recurs with distant metastases, studies have evaluated giving systemic immunotherapy or chemotherapy before or after cystectomy as a means of improving outcomes.

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Radical cystectomy →Neoadjuvant chemoimmunotherapy followed by radical cystectomy followed by adjuvant immunotherapy →Neoadjuvant combination chemotherapy followed by radical cystectomy →Radical cystectomy followed by adjuvant chemotherapy or immunotherapy →EBRT with or without concomitant chemotherapy →Segmental cystectomy (in selected patients) →TUR with fulguration (in selected patients) →

Preserved source evidence · Not medical advice