The treatment landscape of bladder cancer has changed rapidly over the past several years. The 2019 version of the NCCN Guidelines has integrated changes to tumor staging that reflect an updated understanding of the natural history of the disease and will affect how patients are treated. Further, 5 PD-1/PD-L1 immune checkpoint inhibitors (ICIs) are approved for the treatment of bladder cancer. The FDA has limited use of ICIs as monotherapy in the first-line treatment of metastatic and advanced disease for patients who are platinum-ineligible or are cisplatin-ineligible with high PD-L1 expression and are candidates for ICIs. Ongoing predictive biomarker development and validation are needed in bladder cancer; the development of better biomarkers will be key in patient selections for therapy going forward.