Radical cystectomy is the gold standard treatment in localized muscle-invasive bladder
cancer according to today’s guidelines. However, in many cases, surgery is not possible
due to the patient’s general condition, or the patient refuses bladder removal. In
such cases, as well as in some selected patients suitable for surgery, trimodal organ
preservation therapy is an alternative, which provides the patient with similar survival,
local tumor control, so that 80% of patients retain their bladder. In some cases,
due to complications or a muscle-invasive local recurrence in the bladder, the bladder
may not be retained. At this point, a salvage cystectomy can still save the patient’s
quality of life and life. Adequate patient selection is a prerequisite for effective
trimodal therapy. We summarize the components of organ-preserving treatment, including
radiation therapy, its state-of-the-art technology, results and side effects. The
results and toxicity of trimodal treatment are compared with those of radical cystectomy.
