Of 297 patients with bladder cancer treated between 1975 and 1981, 90 (30 per cent) had histologic documentation of muscle invasion, 82 of whom (91 per cent) had invasion into the muscle at the time of presentation. Of these 82 patients 51 (62 per cent) had tumor localized to the bladder after clinical staging. Of 36 patients undergoing radical cystectomy 9 (25 per cent) had microscopic pelvic lymph node involvement. Nine patients underwent urinary diversion alone and 31 presented with perivesical or pelvic nodal tumor extension, or distant metastases. Only 8 of the 90 patients (9 per cent) had prior superficial bladder cancer. The mean survival for patients with stage B to C disease at diagnosis was 23 months and for those with stage D tumor it was 11 months. This experience indicates that the majority of patients with advanced bladder cancer are not identified at a stage when definitive therapy offers an excellent prognosis. More resources must be devoted to earlier detection.