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Non-muscle-invasive bladder cancer (NMIBC) is managed initially with transurethral resection of a bladder tumor (TURBT), followed by a risk stratified approach to adjuvant intravesical therapy (IVe), and is associated with an overall survival of 90%. However, cure rates remain lower for muscle invasive bladder cancer (MIBC) owing to a variety of factors. NMIBC and MIBC groupings are heterogeneous and have unique pathological and molecular characteristics. Indeed, The Cancer Genome Atlas project identified genetic drivers and luminal and basal molecular subtypes of MIBC with distinct treatment responses. For NMIBC, IVe immunotherapy (primarily BCG) is the gold standard treatment for high grade and high risk NMIBC to reduce or prevent both recurrence and progression after initial TURBT; novel trials incorporate immune checkpoint inhibitors. IVe gene therapy and combination IVe chemotherapy have recently been completed, with promising results. For localized MIBC, essential goals are improving care and reducing morbidity following cystectomy or bladder preserving strategies. In metastatic disease, advances in understanding of the genomic landscape and tumor microenvironment have led to the implementation of immune checkpoint inhibitors, targeted treatments, and antibody-drug conjugates. Defining better selection criteria to identify the patients most likely to benefit from a specific treatment is an urgent need.<\/jats:p>","DOI":"10.1136\/bmj-2023-076743","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T06:55:12Z","timestamp":1707720912000},"page":"e076743","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":486,"title":["Advances in diagnosis and treatment of bladder cancer"],"prefix":"10.1136","volume":"384","clinical-trial-number":[{"clinical-trial-number":"nct03049410","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03924895","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03609216","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04223856","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03547973","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04527991","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02450331","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04660344","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02177695","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Antonio","family":"Lopez-Beltran","sequence":"first","affiliation":[{"name":"Department of Morphological Sciences, Unit of Anatomic Pathology, University of Cordoba Medical School, Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S","family":"Cookson","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Oklahoma Health Sciences Center and the Stephenson Cancer Center, Oklahoma City, OK, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan J","family":"Guercio","sequence":"additional","affiliation":[{"name":"Department of Medicine, James P. 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