In light of recent updates on neoadjuvant enfortumab vedotin plus pembrolizumab for muscle-invasive bladder cancer showing benefit, how should a trimodality bladder-preservation strategy be contextualized?   

Do patients who are otherwise suitable for bladder preservation risk forfeiting access to highly effective preoperative systemic therapy, and does a bladder-sparing approach remain a reasonable option in an era of more effective neoadjuvant treatment with EV/pembrolizumab?