(UroToday.com) Neoadjuvant chemotherapy (NAC) is the standard of care for muscle-invasive bladder cancer. However, upper tract urothelial carcinoma (UTUC) is not the same as bladder cancer, with a higher rate of invasive disease. The survival of high grade and high stage disease UTUC remains poor (Figure 1), and downstaging in urothelial cancer is highly predictive of improved survival1.