John Gore, MD, on bladder preservation in muscle–invasive bladder cancer

While the majority of patients with muscle–invasive bladder cancer (MIBC) who receive systemic therapy will also undergo a radical cystectomy, there may be a role for a systemic therapy-only approach in select patients, according to John L. Gore, MD, MS.

In an interview with Urology Times®, Gore recapped his session at the 2025 American Urological Association (AUA) Annual Meeting in Las Vegas, Nevada, titled, “Controversies in Urology: Muscle-Invasive Bladder Cancer (MIBC), Bladder Preservation.” The main goal of his talk, he said, was to assess whether some patients with MIBC may be able to receive systemic therapy alone, thus preserving their bladders.

He explained, “We reviewed some recently released data that showed that it is a small numerator, but for this small numerator that have a really robust response—what we would call a clinical complete response to these treatments—whether it's chemotherapy or chemotherapy plus immunotherapy, there is a pretty good chance they can have durable disease-free survival and keep their bladder.”

Gore is the vice chair of research and a professor of urology at the University of Washington, Fred Hutchinson Cancer Center in Seattle.

Gore continued, “In this well-selected patient population, it is possible to treat with systemic therapy alone. If you take the denominator of patients with muscle-invasive bladder cancer, the majority still are probably headed for systemic therapy and a radical cystectomy. But in these more selected patients, you can either give systemic therapy combined with radiation therapy, or in some, systemic therapy alone, which is really exciting for patients.”