Local recurrence of invasive bladder cancer after radical cystectomy has an aggressive natural history with a poor prognosis. Most patients with this difficult clinical problem have either objective or subclinical metastatic disease. Accordingly, patients should be treated with a multimodality approach that includes systemic treatment (chemotherapy) as well as aggressive local treatments, such as surgery and radiation therapy. Although the prognosis is generally poor, long-term disease-free survival is achievable in a few patients with a multimodality treatment approach