The curability of bladder cancer is directly related to the pathologic stage of the primary tumor. If extravesical extension or lymph-node metastases are present, the risk of metastatic progression is significant. Adjuvant chemotherapy has been proposed for these patients in an attempt to reduce the probability of relapse and to improve survival. Although improved survival with cisplatin-based adjuvant chemotherapy is suggested in some studies, the actual benefit of the treatment after radical cystectomy for patients with muscle-invasive bladder cancer is still controversial due to the absence of sufficiently powered prospective randomized clinical trials. Ongoing and future trials should further define the role of adjuvant chemotherapy in bladder cancer treatment.