Hello @kevinpm. Your history sounds like my husband's only his started with a highly aggressive muscle invasive cancer. He was a BCG failure and was receiving care at Mayo Rochester. He had also had chemo initially following first surgery. His next trial was Keytruda, which had some side effects and still more new spots showed up in bladder over 4 months. By this time he had been back and forth with many cystoscopies and TURBTS and wanted to go for a cure. He had a radical cystectomy and prostatectomy 3 years ago and despite many postoperative complications and needing to self cath 3-4 times daily , he is cancer free and happy with the outcome. There are a couple of newer treatment regimens available now which were not then which he certainly would have tried prior to surgery. I know others have gone for years with less aggressive cancers and regular monitoring and TURBTS. They are working at saving the bladder more each year with newly approved treatments. Are you more satisfied with your medical team at Mayo?