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Radical cystectomy remains the most frequently used curative approach. This review highlights a significant shift in the Australian landscape, with neoadjuvant chemotherapy uptake increasing from historic lows to over 60% according to recent registry data. Clinical unsuitability for cisplatin use and other factors, such as geographic disparities in access to multidisciplinary care, continue to be barriers to the more consistent use of perioperative systemic therapy. Emerging data from landmark trials, such as NIAGARA, KEYNOTE\u2010905, and KEYNOTE\u2010B15, are ushering in a new era of perioperative immunotherapy and antibody\u2010drug conjugates, offering hope for more effective and personalized treatment pathways. Bladder\u2010sparing trimodality therapy is recognized as an underutilized option that can provide good quality of life and oncologic outcomes. Integration of precision medicine, including molecular subtyping and ctDNA monitoring, optimization of surgical and other expertise, and establishment of national optimal care pathways will be essential for further improvement of outcomes. Australian clinicians must bridge the gap between the latest evidence and local reimbursement challenges to standardize care, reduce treatment\u2010related morbidity, and improve long\u2010term survivorship for patients with bladder cancer.<\/jats:p>","DOI":"10.1111\/ajco.70207","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:59:17Z","timestamp":1791608357000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Australian Practical Guide on the Management of Muscle\u2010Invasive Bladder Cancer"],"prefix":"10.1111","author":[{"given":"Dickon","family":"Hayne","sequence":"first","affiliation":[{"name":"UWA Medical School University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shomik","family":"Sengupta","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School Monash University  Melbourne Australia"},{"name":"Urology Department Eastern Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison Y.","family":"Zhang","sequence":"additional","affiliation":[{"name":"Macquarie University Hospital Macquarie University  Sydney Australia"},{"name":"Sydney Clinical Trials Centre University of Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niara","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Mater Hospital Brisbane Mater Misericordiae Ltd  Brisbane Australia"},{"name":"Mater Clinical Unit School of Clinical Medicine University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish I.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Urology Westmead Hospital  Sydney Australia"},{"name":"Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Vela","sequence":"additional","affiliation":[{"name":"Department Of Urology Princess Alexandra Hospital  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9066-8244","authenticated-orcid":false,"given":"Ian D.","family":"Davis","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School Monash University  Melbourne Australia"},{"name":"Cancer Services, Eastern Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17030505"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70043"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0201552"},{"key":"e_1_2_14_5_1","volume-title":"Cancer Data in Australia: Overview of Cancer in Australia","author":"Australian Institute of Health and Welfare","year":"2025"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255\u2010014\u20100643\u2010z"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70011"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2005.04.006"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.14440\/bladder.2023.872"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/bco2.70083"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.24.00340"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2408154"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2511674"},{"issue":"4","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1056\/NEJMoa2601486","article-title":"Enfortumab Vedotin and Pembrolizumab in Cisplatin\u2010Eligible Bladder Cancer","volume":"395","author":"Galsky M. 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