Joshua J. Meeks, MD, PhD, discusses his work exploring the complex genomic landscape of muscle-invasive bladder cancer (MIBC). He talks about his recent review published in Nature Reviews Urology examining the concept of genomic heterogeneity as a predictor of treatment outcomes for MIBC. Ultimately, he hopes to use genomic information to develop novel systemic and intravesical therapies that would preserve the bladder and quality of life without shortening survival in MIBC patients.