Bladder Preservation for Muscle-Invasive Bladder Cancer is an Option for Some Patients

For decades, radical cystectomy — the complete surgical removal of the bladder — has been considered the gold standard for treating muscle-invasive bladder 

cancer (MIBC). But for many patients, a life without a bladder can have profound and permanent impacts on quality of life. Fortunately, for carefully selected individuals, there’s another pathforward: bladder preservation therapy.

This evidence-based treatment approach is becoming an increasingly recognized and accepted option for some patients with MIBC, offering outcomes comparable to bladder removal while preserving bladder function. At Moffitt Cancer Center, our multidisciplinary bladder cancer clinic is helping lead this shift by offering expert evaluations, advanced technologies and personalized care plans aimed at helping patients keep their bladder when possible. 

Historically, bladder cancer surgery for MIBC has involved radical cystectomy, which not only removes the bladder but may also include surrounding organs and tissues, depending on the case. Patients must then undergo urinary diversion procedures, which permanently change how urine exits the body. While often effective, this approach carries surgical risks and lifelong quality-of-life implications.

Bladder Preservation Therapy: A New Standard for Some

Bladder preservation therapy — also called bladder-sparing or trimodal therapy — is a bladder cancer treatment strategy that integrates three key steps:

• Surgical resection of as much tumor as possible via Transurethral Resection of Bladder Tumor (TURBT)
• Radiation therapy, often delivered over four to seven weeks
• Low-dose chemotherapy to enhance the effect of radiation

This combination is designed to maximize cancer control while maintaining bladder function. While not suitable for every patient, multiple studies suggest that survival outcomes for properly selected individuals are comparable to those who undergo radical cystectomy.

Who Qualifies for Bladder Preservation?

Not every patient with advanced bladder cancer is a candidate for bladder preservation therapy. Selection is critical. Patients must meet strict criteria, including the ability to undergo complete TURBT, no evidence of extensive lymph node involvement, and good overall health. At Moffitt, our experts perform a thorough evaluation including:

• Cystoscopy to assess tumor size and location
• Imaging with MRI or CT to understand disease spread
• Consultation with a multidisciplinary team that includes urologic oncologists, radiation oncologists, medical oncologists, radiologists and pathologists

Although radical cystectomy has been proven to be curative in many patients with muscle invasive bladder cancer, careful selection can help many to successfully avoid this life-altering surgery.

Roger Li, MD

What Are the Benefits of Bladder Preservation?

For eligible patients, bladder preservation therapy offers several meaningful advantages:

• Organ Preservation – Maintains bladder and urinary function
• Comparable Cancer Control – Offers outcomes similar to cystectomy in select patients
• Fewer Surgical Risks – Avoids the complications of major surgery
• Quality of Life – No need for permanent urinary diversion

This approach delivers precision radiation that targets the tumor while minimizing damage to surrounding tissue. Innovations like MRI-guided radiation therapy and adaptive radiation planning ensure high precision, adju

sting in real-time for bladder filling and movement.

What Happens After Treatment?

Bladder preservation requires ongoing surveillance to ensure long-term success. Moffitt’s follow-up plan might include:

• Cystoscopy and imaging every three months for the first two years
• Twice-yearly check-ins thereafter

This schedule helps detect any recurrence early, when it is most treatable. Patients who commit to this monitoring routine can expect outcomes comparable to surgery, with the added benefit of maintaining their bladder.

Why Choose Moffitt for Bladder Cancer Treatment?

As a high-volume cancer center, Moffitt treats more than 3,000 patients annually in our urologic oncology program. Our expertise and resources allow us to offer a full spectrum of bladder cancer treatment options — from partial cystectomy to radical surgery, chemotherapy for bladder cancer, and advanced bladder preservation therapy.

Moffitt stands out with our use of cutting-edge technology, like the MR Linac, to deliver highly precise bladder cancer treatment. Our expert team uses advanced tools such as adaptive radiation and ctDNA testing to monitor your health closely, detect any early signs of recurrence, and adjust your care in real time. Before treatment begins, we complete a thorough evaluation of your bladder and continue personalized monitoring throughout your journey to help reduce side effects and improve outcomes.

We are also investing in the future of bladder cancer care through research and innovation. Moffitt is using artificial intelligence and machine learning to develop smarter treatment protocols based on real-world patient data. This work is supported by state and federal grants and may lead to national treatment guideline changes in the future.

Bladder Cancer Outcomes

The primary aim of cancer treatment is to attain the best possible outcome with minimal side effects, ensuring the highest quality of life for the patient. On average, Moffitt's bladder cancer treatment survival rates exceed 2.5 times the national average.

Our Outcomes

Your First Treatment Choice Matters

Whether you’re newly diagnosed or exploring treatment alternatives, where you receive your first treatment can shape your outcome. At Moffitt, we offer comprehensive evaluation, leading-edge therapies, and a collaborative team dedicated to preserving your health and your quality of life.

If you or a loved one has been diagnosed with muscle-invasive bladder cancer, find out if bladder preservation therapy might be an option. We’re here to help you understand all your choices and make the one that’s right for you.