This editorial suggests those claiming modern peri- and neoadjuvant therapy for muscle-invasive bladder cancer elevates bladder preservation from “promising alternative” to “radical cystectomy replacement” need to slow their roll. Recognizing propensity-matched datasets show comparable cancer-specific survival between trimodality therapy and radical cystectomy in selected patients, no phase 3 trial to date has demonstrated noninferior survival. Real-world flaws remain: heterogeneity in TURBT quality, radiotherapy and systemic therapy regimens, complete clinical response definitions and follow-up intensity. Not to mention delayed salvage radical cystectomy after trimodality therapy is decidedly not a free lunch. So while the era of disciplined, biomarker-informed, guideline-standardized bladder-intact cure is rapidly maturing, we’re not there yet. | Crupi, Eur Urol 2025
