Researchers find promise for ctDNA-guided immunotherapy for patients with MIBC who underwent radical cystectomy. The panel concludes with a discussion on the complexities of interpreting ctDNA positivity in earlier-stage bladder cancer. The panel considers the adoption of bladder-sparing protocols and the potential of biomarkers to guide risk stratification. The panel debates the management of high-grade T1 bladder cancer with lymphovascular invasion and variant histology. The panel pivots to complex considerations in bladder cancer treatment, weighing the promise of IO in BCG-naïve patients. The panel shares how patient lifestyle, bladder symptoms, and other factors influence intravesical therapy selection. The panel explores the challenges of delivering bladder-sparing therapies like gem/doce and TAR-200 in real-world settings. The panel discusses a wave of bladder cancer therapies, including cretostimogene, gem/doce, and AI-driven biomarkers. Dr. Canes discusses the formation of the WellPrept delivery platform and how it aims to boost patient education. Mohummad Siddiqui, MD, discusses his work with the Commission on Cancer and their development on standards of care. John P. Sfakianos, MD, discusses the history and use of ctDNA in the GU oncology field. At the AUA 2025 Annual Meeting, Dr. Guerrero-Ramos highlights the first results from Cohort 4 of SunRISe-1. Results of the CREST study show that sasanlimab plus BCG improves EFS compared with BCG alone in high-risk NMIBC. Drs. Chang and Joyce consider the role that N-803 now plays within the treatment paradigm for BCG-unresponsive bladder CIS. Drs. Chang, Joyce take a look at QUILT-3.032, including complete responses to N-803 plus BCG in BCG-unresponsive bladder CIS. Dr. Daneshmand discusses some of the designs and results of ADVANCED-2, PIVOT-006, ABLE-22, and more. Dr. Ghoreifi explains how results suggest feasibility with high rates of pathological downstaging and complete response. Dr. Gomella and Ambinder provide a comprehensive overview of the growing and changing treatment landscape for NMIBC. Dr. Samuel Gold shares some perspective on the impact of disease recurrence on HRQoL after radical cystectomy. Dr. John Gore offers interesting data from the CISTO study, favoring radical cystectomy for recurrent high-grade NMIBC.