Jena and colleagues noted that it is odd that so many apparently fit patients (77% with Eastern Cooperative Oncology Group performance status of 0) would choose trimodality therapy in an era when most urologists in North America tended to recommend radical cystectomy for muscle-invasive bladder cancer.1 Massachusetts General Hospital and Princess Margaret Cancer Centre (with Toronto General Hospital) have collectively operated multidisciplinary bladder cancer clinics for decades, which allowed patients the opportunity to discuss and choose between treatment options, when they are deemed candidates for either radical cystectomy or trimodality therapy. ...29% represents the percentage of patients with muscle-invasive bladder cancer operated on by radical cystectomy (among the total radical cystectomies performed at the contributing institutions) who presented with the inclusion criteria of our study. ...research is needed to inform the full range of eligibility for trimodality therapy.