During the 2021 Belgian Multidisciplinary meeting on Urological Cancers (BMUC) three presentations were given on the subject of bladder preservation in muscle invasive bladder cancer (MIBC). The first presentation by Dr. Nora Sundahl, from the department of radiation oncology, University of Gent, Belgium, addressed the question whether it is best to use radio-chemotherapy, radio-immunotherapy or a combination of all three in patients with muscle invasive bladder cancer (MIBC). Dr. Nieves Martinez-Chanza, from the Medical Oncology department at Jules Bordet Institute, Brussels, Belgium, aimed to answer the question whether neo-adjuvant immunotherapy is already good enough as a treatment option. Lastly Prof. James Catto, professor in Urological Surgery at the University of Sheffield and Urological Surgeon at Sheffield Teaching Hospital discussed four common clinical assumptions around radical cystectomy (RC) and the role of RC in current practice. Although there is some overlap in the discussed topics we will honour the presenters interpretations of the subject by discussing them separately.