We report a patient who presented with superficial bladder tumors 8 years after cardiac transplantation. He was managed conservatively with intra-vesical therapy for 5 years and ultimately underwent a successful radical cystoprostatectomy and urethrectomy 13 years after cardiac transplantation. This illustrates that cardiac transplant patients with superficial tumors may be managed with conservative therapies, but close vigilance is necessary to identify the opportune time for extirpative surgery.