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Michael S. Cookson, MD, MMHC, Professor and Chairman of the Department of Urology at the University of Oklahoma Health Sciences Center, summarizes the updated AUA/SUO/ASTRO guideline for the treatment of muscle-invasive bladder cancer (MIBC), a particularly deadly and difficult-to-treat disease. He explains the purpose and methodology of the guideline, summarizes its contents, and makes a note of recent and ongoing research in the areas of chemotherapy, extended pelvic lymphadenectomy, and bladder preservation that may change the guidelines in the future.