Bladder preservation in muscle-invasive bladder cancer (MIBC) may be entering a new era. For years, the standard of care for appropriate candidates with MIBC has been trimodal therapy (TMT): maximal transurethral resection and chemoradiation, followed by surveillance for clinical complete responders and salvage cystectomy for local recurrence. About half of the patients are alive and still have their bladder at 5 years, and the results haven’t improved much over time.