Background: Early radical cystectomy (eRC) can be performed for high or very high risk non-muscle-invasive bladder cancer (NMIBC). Whether immediate eRC is beneficial is still unclear. The objective of this study was to compare outcomes between immediate eRC, delayed eRC, and radical cystectomy (RC) at the diagnosis of muscle-invasive bladder cancer (MIBC).

Methods: The single-center cohort consisting of patients with RC between 2008 and 2020 was divided into 4 populations: patients who received immediate eRC within 3 months of diagnosis of NMIBC (IEC), patients who received eRC at recurrence of NMIBC (REC), patients who underwent RC after primary diagnosis of MIBC (primMIBC), and patients with the initial diagnosis of NMIBC who received RC after progression to MIBC (progMIBC).

Results: Among the 463 patients included, 39 had IEC, 58 had REC, 314 had primMIBC, and 53 had progMIBC. No statistically significant differences for OS, CSS, and RFS between the two groups receiving eRC were found. Patients with pT1 tumors (p = 0.003) and tumor size ≥3 cm (p = 0.012) were more likely to receive immediate RC.

Conclusions: Immediate and delayed eRC show comparable survival outcomes. The present study emphasizes the need for accurate risk stratification of patients with NMIBC to identify the most advantageous therapy for individual patients.