The treatment of T1 G3 bladder cancer is still an issue surrounded by much conflict. TUR of the bladder tumor as single treatment is considered not valid to be successful. TUR associated with intravescical chemotherapy or, even better, local immunotherapy may be the treatment of first choice in monocentric cancer, while radical cystectomy is, at the moment, the treatment of first choice in pluricentric or Cis associated T1 G3 bladder cancer. Since 1980, 25 patients with transitional T1 G3 bladder cancer have been observed in our department. Thirteen patients had a pluricentric disease while the remaining 12 cases had a monocentric bladder cancer. 92% of the patients (12/13) with a monocentric lesion and treated with TUR and local chemotherapy (Doxorubicin or BCG) are disease free after an average follow up of 34 Months (range 12-60 months). While 100% patients with a pluricentric cancer and treated with cystectomy are disease free after an average follow-up of 37 months (range 12-122 months); the 4 remaining cases with a pluricentric bladder lesion who refused cystectomy experienced a relapse of the disease after a follow-up of 19 months (range 9-27 months) and, despite surgery, they died within 12 months.