Bladder cancer is a potentially curable malignancy but for those patients who present with or develop muscle-invasive disease, there is a high risk of metastases and cancer-related death. The treatment of patients with muscle-invasive bladder cancer uses a multimodal approach, including radical cystectomy with pelvic lymph node dissection and perioperative chemotherapy. Neoadjuvant cisplatin combination chemotherapy has a modest survival benefit, with those patients achieving a complete pathological response after chemotherapy having the best outcome. Adjuvant chemotherapy, although less well substantiated, is a reasonable option for patients with extravesical disease or lymph node involvement after cystectomy. Perioperative chemotherapy is substantially underused despite the level-1 evidence showing a survival benefit. Ongoing research will focus on individualized patient care, with biomarkers to predict a pathological complete response and the development of novel targeted therapies.