Abstract
The optimal treatment of bulky, non-metastatic, and locally advanced muscle-invasive bladder cancer (MIBC) involves a combination of chemotherapy and radical cystectomy. Evidence exists to support the use of neoadjuvant chemotherapy in the treatment of MIBC; however, there are a number of scenarios where this approach is not feasible or may not be practical. The goal of this chapter is to describe our approach to the treatment of MIBC, in particular the timing and use of chemotherapy with radical cystectomy, and to provide a practical guide based on our clinical experience.