Muscle-Invasive Bladder Cancer: Patient Selection and Referral

This segment explores the pivotal role of urologists in recognizing and referring patients with muscle-invasive bladder cancer (MIBC), particularly those with T2N0 disease, for timely systemic therapy. Given the high recurrence rate in this group, early involvement of medical oncology is critical to improving outcomes. The discussion emphasizes that urologists should not delay referral until after surgery but instead initiate multidisciplinary evaluation at diagnosis. Early referral enables assessment for neoadjuvant therapy, including immunotherapy options that may improve long-term survival while preserving quality of life.

Experts highlight practical steps to identify and triage appropriate patients efficiently. These include implementing standardized risk assessment protocols, integrating radiologic and pathologic data into decision-making, and maintaining open lines of communication with oncology colleagues. Utilizing multidisciplinary tumor boards and shared electronic systems ensures that no high-risk patient is overlooked. Educational initiatives can also empower urologists to recognize when systemic therapy is indicated even for those who appear surgically operable.

Barriers to referral—such as misconceptions about tolerability, logistical delays, or uncertainty about benefits—can be overcome through collaborative care models and patient education. Tumor boards play an essential role in fostering coordination, ensuring that T2N0 and other high-risk patients are consistently evaluated for systemic therapy. This team-based approach aligns treatment with evolving evidence and reduces the risk of under-treatment, ultimately improving survival outcomes for patients with MIBC.