Bladder cancer is diagnosed in over 2000 patients per annum in Australia.

Radical cystectomy is the standard treatment for organ confined muscle invasive urothelial bladder cancer.  Despite radical cystectomy the recurrence rate and overall survival remain poor.  Overall 5- year survival rates of approximately 50% are described. Recurrence rates and overall survival are stage dependant. There are some data to support the role of neo-adjuvant chemotherapy. Despite the survival benefit with neo-adjuvant chemotherapy, uptake of this strategy remains low. There are more limited data regarding the role of adjuvant therapy post radical cystectomy. There are many limitations and controversies with regard to the optimal management of organ confined muscle invasive bladder cancer.

This paper will discuss the current status of the management of muscle invasive urothelial bladder cancer.  This will focus on the evidence, to date, evaluating the role of neo adjuvant and adjuvant therapy. Controversies and limitations of available data will be discussed.