Bladder sparing treatment is an alternative to radical cystectomy (RC) in non-metastatic muscle invasive bladder cancer (MIBC), especially in patients willing to preserve their bladder or unfit for cystectomy. No randomized controlled trials (RCT) compared between both treatment options. This study aim to perform a randomized, controlled trial comparing between bladder sparing treatment (BST) and RC in management of non-metastatic MIBC. The present study was a RCT including patients with MIBC (T2,3/N0,1/M0) presented to Clinical Oncology & Nuclear Medicine and Urology Center during the period from April 2018 to June 2020. Patients were randomized into 2 groups: group (A) included 25 patients who underwent maximal transurethral resection of bladder tumor followed by concurrent chemoradiotherapy, while group (B) included 24 patients who received 3 cycles of chemotherapy followed by RC. In group (A): 68% had complete response, 4% had progression of the disease, 8% had partial response and 20% had stable disease. While in group (B): 20.9% achieved pCR, 33.3% achieved pPR, 33.3% had pSD, and 12.5 % developed PD. Mean PFS and OS were (28.9and 29.2 month) and (30.4 and 29.2 months) in group A & B respectively. PFS and OS were higher in BST group but without statistically significant difference (P= 0.71& 0.96 respectively). Both treatment options were well tolerable without major toxicities. BST is an emerging procedure with tolerable toxicities and similar oncologic outcomes to RC for patients with MIBC.RCTs & long-term follow up are warranted to define best candidates, regimen for BST and RC.

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