What is your approach to solitary node positive bladder cancer (e.g. N1) in a patient who is otherwise a candidate for either bladder preservation or radical cystectomy?  

This is a very intriguing question, with limited prospective data to guide us.  I will frame my response on a patient with clinical node positive (based on imaging) bladder cancer and a candidate for bladder preservation or cystectomy.  This patient is deemed metastatic yet there may be a...