The importance of local tumor staging in the assessment and treatment of bladder cancer cannot be overstated. While neoadjuvant chemotherapy (NAC) followed by radical cystectomy and urine diversion remains the gold standard for muscle-invasive bladder cancer treatment, bladder-sparing regimens comprising systemic chemotherapy and pelvic radiation are still an option for some patients. Furthermore, identifying individuals with a full response to NAC prior to cystectomy may eliminate the need for radical cystectomy, although proper post-therapy staging might be difficult to perform. Beyond conventional imaging and cystoscopic biopsies, modern imaging modalities may give extra value in local tumor staging. For a review, researchers summarized the efficacy of several imaging modalities to appropriately stage bladder cancer patients in both pre-and post-chemotherapy scenarios.

Multiparametric magnetic resonance imaging (mp-MRI) has been studied in the assessment of bladder cancer in recent studies. Its new addition into bladder cancer staging is mostly being evaluated in treatment-naive patients; however, other sequences are being investigated to see how accurate they are if chemotherapy and potentially radiation are introduced. Several recent investigations that included cystoscopy and biopsy have shown to be less reliable than expected.

Imaging has traditionally played a minor role in directing therapy in localized bladder cancer, but with the introduction of better sequences and methods, imaging is set to play a larger part in cancer decision-making. Improved imaging can help doctors better choose patients for bladder-sparing therapies while still achieving optimal oncologic results, making this paradigm more accepted in the urologic oncology community.