Organ preservation tri-modality therapy for locally advanced bladder cancer involves transurethral resection of the bladder tumor followed by radiotherapy with a radiosensitizer. The radiosensitizer could be hypoxia-modifying therapy or chemotherapy.1 Both approaches achieve similar survival benefits, but a predictive biomarker would enable a personalized and optimized choice.1 Our group develops hypoxia-associated, tumor type-specific gene expression signatures. The signatures are prognostic in multiple cohorts and predict benefits from having hypoxia-modifying therapy with radiotherapy.