Peter Black, MD, FACS, FRCSC, Khosrowshahi Family Chair and Professor in the Department of Urologic Sciences at the University of British Columbia (UBC) in Vancouver, discusses the merits of radiationbased, bladdersparing therapies for muscleinvasive bladder cancer (MIBC). Dr. Black advises practitioners to discuss trimodal (TMT) as an option for patients with MIBC, consider neoadjuvant chemotherapy in patients planning to undergo TMT, consider alternative chemotherapy in cisplatinineligible patients, and remember the importance of shared decisionmaking.