Urothelial carcinoma (UC) is the second most common malignancy of the genitourinary system and the sixth most common cancer in the United States. The incidence is four times greater in males. Disease incidence has declined in recent years; however, death rates have remained stable (American Cancer Society 2015; SEER Cancer Statistics Factsheets: Bladder Cancer n.d.). Patients are often diagnosed with non-muscle invasive UC, yet one third of patients present with locally advanced or invasive disease. For early disease, overall survival (OS) rates range between 50% and 60% if treated with neoadjuvant chemotherapy and cystectomy. Unfortunately, 5-year survival rates remain poor, and 85% of patients will die at 2 years if not treated (NCCN 2021; American Urological Association n.d.; Steinberg et al. 2000).