Recent Advances and Future Directions in Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer

Bladder preservation therapy has emerged as an essential alternative to radical cystectomy for muscle-invasive bladder cancer, particularly in elderly or frail patients. Trimodal therapy, combining maximal transurethral resection of bladder tumors, chemotherapy, and radiotherapy, has shown comparable oncological outcomes to radical cystectomy in selected cases. Recent advances in radiotherapy techniques and systemic therapies, including immune checkpoint inhibitors, have expanded the role of bladder-preserving strategies in the management of bladder cancer. Clinical trials investigating various combinations of radiotherapy, chemotherapy, and immune checkpoint inhibitors have redefined the treatment landscape. Observational studies have reported survival outcomes comparable to those of radical cystectomy, along with improved quality-adjusted life years. Emerging therapeutic strategies offer additional potential for improving outcomes. Bladder preservation therapy continues to evolve, with future approaches aimed at enhancing survival while preserving the quality of life.