The ability to accurately and efficiently predict systemic therapies that provide the optimal benefit-to-harm ratio for an individual patient before initiation of treatment is a `holy grail` of precision medicine. Over the past several decades, several approaches attempting to achieve this vision for patients with bladder and other cancers have emerged, ranging from the use of genetic and genomic data derived from an individual patient`s tumor to harvesting an individual patient`s tumor for in vitro or in vivo assays.