The data would strongly suggest that, if local control can be established by either radical cystectomy or by transurethral resection, and if no distant disease is existing, that transurethral resection and radical cystectomy provide equivalent survival advantage. Our current dilemma lies in the inability to accurately determine the extent of disease as evidenced by the upstaging error that occurs following radical cystectomy. Thus, the treating physician must decide whether to abandon a therapeutic procedure such as radical cystectomy, which has the potential to cure higher local stage disease than may transurethral resection. It would appear that radical cystectomy as a single therapy remains the treatment of choice.