The perils of using registry data to compare the survival and cost of radical cystectomy and trimodality therapy in bladder cancer

Radical Cystectomy and trimodality therapy with maximal transurethral resection of bladder tumor followed by concurrent chemoradiotherapy are standard curative treatment options for patients with muscle-invasive bladder cancer (MIBC). There are no robust randomized data available to determine the comparative effectiveness between these treatment modalities. Both treatment approaches are supported by National Comprehensive Cancer Network (NCCN) and American Urological Association guidelines (1,2). However, fundamental differences in the two therapeutic approaches and associated risks create a divergent choice for clinicians and patients, which can introduce some complexity in decision making.