FIG. 24:  This Figure shows the consensus recommendations of the combined American Urologic Association(AUA), American Society of Clinical Oncology (ASCO), American Society for Radiation Oncology (ASTRO), and Society of Urologic Oncology (SUO) metastatic muscle-invasive bladder cancer guideline issued in 2017.^[11]  They advocate using a multidisciplinary approach for clinicians to offer cisplatin-based neoadjuvant chemotherapy, and again, this is a strong recommendation.  

According to this guideline recommendation, patients ineligible for cisplatin-based neoadjuvant chemotherapy should proceed to definitive locoregional therapy. This recommendation is not based on many data; it is rather an expert opinion.  Further, it recommends that clinicians should perform radical cystectomy as soon as possible following a patient's completion of and recovery from neoadjuvant chemotherapy,  again, based on expert opinion. Overall, these guidelines are very similar to the EAU guidelines.^[10]