Emerging evidence is redefining bladder preservation strategies in muscle-invasive bladder cancer, with circulating tumor DNA (ctDNA) offering a novel approach to response-adapted care. Joining Dr. Charles Turck to review findings from the phase II RETAIN trials, which highlight how ctDNA clearance correlates with improved metastasis-free survival and informs risk stratification, is Dr. Pooja Ghatalia. She also examines the strengths and limitations of ctDNA, including its prognostic value for systemic recurrence and its inability to reliably detect localized disease. Dr. Ghatalia is an Associate Professor in the Department of Hematology and Oncology at Fox Chase Cancer Center at Temple University Hospital in Philadelphia, and she presented this research at the 2026 ASCO Genitourinary Cancers Symposium.