Srikala Sridhar, MD, MSc, FRCPC, Princess Margaret Hospital, Toronto, ON, Canada, discusses how recent advances have led to bladder-sparing trimodality therapy (TMT) to become an accepted alternative to cystectomy for selected muscle invasive bladder cancer patients who are unfit for cystectomy. This interview took place at the 2020 Genitourinary Cancers Symposium, held in San Francisco, CA.