Approach to initial therapy for muscle-invasive bladder cancer

ECOG: Eastern Cooperative Oncology Group; TURBT: transurethral resection of bladder tumor; NYHA: New York Heart Association; RT: radiation therapy.
* Tumor stage is assessed using cystoscopy, biopsy, systemic imaging, and other testing as clinically indicated. Refer to UpToDate content on diagnosis and staging of bladder cancer.
¶ Various treatment options are available for metastatic disease such as platinum-based chemotherapy, immunotherapy, targeted therapy, and antibody-drug conjugates. For further details, refer to UpToDate content on treatment of metastatic urothelial carcinoma of the bladder.
Δ Refer to UpToDate content on bladder preservation treatment options for muscle-invasive urothelial bladder cancer.
◊ For select patients with high-risk disease after radical cystectomy, adjuvant therapy (eg, chemotherapy, immunotherapy, radiation) is an option. Refer to UpToDate content on adjuvant therapy for muscle-invasive urothelial carcinoma bladder.
§ Refer to UpToDate content on management of bladder cancer in older adults.