(UroToday.com) The 2021 Ramon Guiteras Lecture at the 2021 American Urologic Association (AUA) annual meeting was provided by Dr. Eila Skinner who provided her perspective on three decades of bladder cancer treatment and advances. Dr. Skinner started by highlighting what bladder cancer was like in 1990, noting that there was an understanding of the basic epidemiology and biology, the importance of stage and grade, and the role of smoking in the etiology. Importantly, in 1994, the role of p53 mutation in invasive bladder cancer was first recognized.1 During the ’90s, all non-muscle invasive bladder cancer was deemed “superficial” bladder cancer, which included a wide range of tumor biology. BCG was the only commonly used intravesical treatment in the United States, however, post-TUR single-dose chemotherapy was becoming routine in Europe, but not widely adopted in the United States. Additionally, early work from the University of Southern California (where Dr. Skinner worked for many years) showed that G3T1 disease was associated with a high rate of upstaging at subsequent cystectomy with behavior similar to clinical stage T2 disease.