Cancer bladder represents the fourth most common cancer in men and ninth most common cancer in women. It is the second most prevalent cancer in men 60 years of age or older in United States. Radical cystectomy is the most widely used treatment for invasive bladder cancer. Radical cystectomy and urinary diversion has long-term effects on urinary, gastrointestinal and sexual function, and changes the body image of patients who use incontinent urinary diversions. Five-year specific and overall survival rates are 68% and 40 to 60%, and that is probably dependent upon the existence of micrometastases at the time of diagnosis. Clinical trials in the adjuvant setting require large numbers of patients to detect a survival advantage. It has been difficult to demonstrate a survival benefit from adjuvant chemotherapy. Neo-adjuvant cisplatin-based combination chemotherapy resulted in a significant 14% reduction in the risk of death, which translated into a 5% absolute improvement in five-year OS (from 45 to 50%). In appropriately selected patients, bladder preserving treatment with transurethral resection, radiation therapy and concurrent chemotherapy offers a probability of long term cure and overall survival at 5-years is comparable to cystectomy-based approaches (49 to 63% at 5 years) in patients of similar clinical stage and age. Five-year survival with bladder preservation is 40 to 45%. In addition, these selective bladder-preserving approaches result in approximately 80% of the long-term survivors maintaining a normal functioning bladder.