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June 27, 2017. With a lack of randomized trials using modern surgical or radiation techniques for the treatment of muscle-invasive bladder cancer, controversy remains surrounding the optimal treatment. But now we have this meta-analysis published in Red Journal earlier this year which...does little to end the controversy. Close to 10K patients across 8 studies were collectively analyzed to assess outcomes in patients receiving radical cystectomy (RC) vs bladder preservation with TURBT + chemoradiation. There were no differences at 5 or 10 years in terms of overall survival, disease-specific survival (DSS), or progression-free survival. Early (i.e., perioperative) major complication rate was higher with RC, and minor complication rates were similar with either RC or bladder preservation. But with DSS at 10 years approaching 60-70% with either modality, patient preference may be the tie-breaker we’ve all been waiting for.