Bladder cancer remains a leading cause of cancer death globally, with significant impacts on quality of life, morbidity, and healthcare costs. Non-muscle-invasive bladder cancer (NMIBC) is initially managed with transurethral resection of a bladder tumor (TURBT), followed by risk-stratified adjuvant intravesical therapy (IVe), achieving an overall survival of 90%. However, muscle-invasive bladder cancer (MIBC) has lower cure rates due to various factors. NMIBC and MIBC are heterogeneous, with distinct molecular and pathological features. The Cancer Genome Atlas identified genetic drivers and molecular subtypes of MIBC with different treatment responses. For NMIBC, IVe immunotherapy (primarily BCG) is the gold standard for high-grade and high-risk cases, while novel trials incorporate immune checkpoint inhibitors. IVe gene therapy and combination IVe chemotherapy have shown promising results. For localized MIBC, the goal is to improve care and reduce morbidity after cystectomy or bladder preservation strategies. In metastatic disease, advances in genomic understanding and tumor microenvironment have led to the use of immune checkpoint inhibitors, targeted treatments, and antibody-drug conjugates. Better selection criteria for treatment are urgently needed. NMIBC frequently recurs or progresses, with five-year recurrence and progression rates of 31-78% and 1-45%, respectively. Carcinoma in situ (CIS) can progress at a 50% rate, and untreated CIS can progress to MIBC at 40-80% within five years. High-grade T1 bladder cancer has five-year recurrence, progression, and cancer-specific survival rates of 42%, 21%, and 87%, respectively. Overall survival after cystectomy correlates with pathologic stage, with about 30% of patients experiencing recurrence at 12 months. Five-year survival remains low in patients with distant metastasis. Relevant clinicopathologic factors include tumor number and size, presurgical recurrence rates, T stage, presence of CIS, and histologic grade and nodal status. Platinum-based chemotherapy remains important for metastatic disease, but emerging treatments like antibody-drug conjugates and targeted therapies have shifted management. Immune checkpoint inhibitors are helpful, particularly in patients with high tumor mutation burden (TMB) and PDL1 expression. New targeted treatments related to FGFR3 alterations and nectin-4 and TROP2 expression have been incorporated into clinical practice. This review discusses new treatment and diagnostic options for bladder cancer, including TURBT, cystectomy, bladder preservation strategies, cisplatin-based chemotherapy, systemic immunotherapy, and other targeted treatments. Enhanced diagnostic methods, including narrow band and blue light cystoscopy, urine biomarkers, and imaging, are also revisited. The review aims to assist health professionals and scientists in understanding current management of bladder cancer.Bladder cancer remains a leading cause of cancer death globally, with significant impacts on quality of life, morbidity, and healthcare costs. Non-muscle-invasive bladder cancer (NMIBC) is initially managed with transurethral resection of a bladder tumor (TURBT), followed by risk-stratified adjuvant intravesical therapy (IVe), achieving an overall survival of 90%. However, muscle-invasive bladder cancer (MIBC) has lower cure rates due to various factors. NMIBC and MIBC are heterogeneous, with distinct molecular and pathological features. The Cancer Genome Atlas identified genetic drivers and molecular subtypes of MIBC with different treatment responses. For NMIBC, IVe immunotherapy (primarily BCG) is the gold standard for high-grade and high-risk cases, while novel trials incorporate immune checkpoint inhibitors. IVe gene therapy and combination IVe chemotherapy have shown promising results. For localized MIBC, the goal is to improve care and reduce morbidity after cystectomy or bladder preservation strategies. In metastatic disease, advances in genomic understanding and tumor microenvironment have led to the use of immune checkpoint inhibitors, targeted treatments, and antibody-drug conjugates. Better selection criteria for treatment are urgently needed. NMIBC frequently recurs or progresses, with five-year recurrence and progression rates of 31-78% and 1-45%, respectively. Carcinoma in situ (CIS) can progress at a 50% rate, and untreated CIS can progress to MIBC at 40-80% within five years. High-grade T1 bladder cancer has five-year recurrence, progression, and cancer-specific survival rates of 42%, 21%, and 87%, respectively. Overall survival after cystectomy correlates with pathologic stage, with about 30% of patients experiencing recurrence at 12 months. Five-year survival remains low in patients with distant metastasis. Relevant clinicopathologic factors include tumor number and size, presurgical recurrence rates, T stage, presence of CIS, and histologic grade and nodal status. Platinum-based chemotherapy remains important for metastatic disease, but emerging treatments like antibody-drug conjugates and targeted therapies have shifted management. Immune checkpoint inhibitors are helpful, particularly in patients with high tumor mutation burden (TMB) and PDL1 expression. New targeted treatments related to FGFR3 alterations and nectin-4 and TROP2 expression have been incorporated into clinical practice. This review discusses new treatment and diagnostic options for bladder cancer, including TURBT, cystectomy, bladder preservation strategies, cisplatin-based chemotherapy, systemic immunotherapy, and other targeted treatments. Enhanced diagnostic methods, including narrow band and blue light cystoscopy, urine biomarkers, and imaging, are also revisited. The review aims to assist health professionals and scientists in understanding current management of bladder cancer.