Bladder cancer remains a leading cause of cancer-related deaths worldwide, significantly impacting patient quality of life, morbidity, and healthcare costs. Gross hematuria is often the first symptom, and non-muscle-invasive bladder cancer (NMIBC) is managed initially with transurethral resection of bladder tumor (TURBT) followed by risk-stratified intravesical therapy (Ive), achieving an overall survival rate of 90%. However, cure rates for muscle-invasive bladder cancer (MIBC) are lower due to various factors. NMIBC and MIBC have distinct pathological and molecular characteristics, with the Cancer Genome Atlas project identifying genetic drivers and molecular subtypes of MIBC. For NMIBC, intravesical immunotherapy (primarily BCG) is the gold standard treatment, and novel trials incorporate immune checkpoint inhibitors. Intravesical gene therapy and combination chemotherapy have shown promising results. For localized MIBC, the goal is to improve care and reduce morbidity following cystectomy or bladder preservation strategies. In metastatic disease, advances in understanding the genomic landscape and tumor microenvironment have led to the implementation of immune checkpoint inhibitors, targeted treatments, and antibody-drug conjugates. Defining better selection criteria to identify patients most likely to benefit from specific treatments is crucial. The review discusses new treatment and diagnostic options, including enhanced diagnostic methods, and aims to assist healthcare professionals and scientists in understanding the current management of bladder cancer.Bladder cancer remains a leading cause of cancer-related deaths worldwide, significantly impacting patient quality of life, morbidity, and healthcare costs. Gross hematuria is often the first symptom, and non-muscle-invasive bladder cancer (NMIBC) is managed initially with transurethral resection of bladder tumor (TURBT) followed by risk-stratified intravesical therapy (Ive), achieving an overall survival rate of 90%. However, cure rates for muscle-invasive bladder cancer (MIBC) are lower due to various factors. NMIBC and MIBC have distinct pathological and molecular characteristics, with the Cancer Genome Atlas project identifying genetic drivers and molecular subtypes of MIBC. For NMIBC, intravesical immunotherapy (primarily BCG) is the gold standard treatment, and novel trials incorporate immune checkpoint inhibitors. Intravesical gene therapy and combination chemotherapy have shown promising results. For localized MIBC, the goal is to improve care and reduce morbidity following cystectomy or bladder preservation strategies. In metastatic disease, advances in understanding the genomic landscape and tumor microenvironment have led to the implementation of immune checkpoint inhibitors, targeted treatments, and antibody-drug conjugates. Defining better selection criteria to identify patients most likely to benefit from specific treatments is crucial. The review discusses new treatment and diagnostic options, including enhanced diagnostic methods, and aims to assist healthcare professionals and scientists in understanding the current management of bladder cancer.