Objective: Approaches for curative treatment of muscle-invasive bladder cancer include radical cystectomy after neoadjuvant chemotherapy and chemoradiotherapy. We compared the results of these treatment modalities in our clinic. Material and Methods: A total of 43 patients with muscle-invasive bladder cancer, who underwent front-line cystectomy or received neoadjuvant chemoradiotherapy between 2010 and 2018, were compared retrospectively. Results: Twenty patients received definitive chemoradiotherapy, and 23 patients underwent surgery (cystectomy) after neoadjuvant treatment. The median age was 68 years, and 86% of the patients were male. The median age was higher in the chemoradiotherapy group, and the number of patients with an ECOG performance score above 2 was significantly higher in this group. In patients who underwent surgery after neoadjuvant treatment, median disease-free survival was 17.1 months (CI: 6.1-27.9) and overall survival (OS) was 22.2 months (CI: 10.3-34.1), whereas disease-free survival was 12.5 months (CI: 9.7-15.3) (p=0.93). The OS was 12.7 months (CI:1.0-33.9) (p=0.74) in the group receiving definitive chemoradiotherapy. Survival was significantly longer (p=0.03) in patients who were treated with radical cystectomy, and pathological downstaging (T1 tumor and below) was achieved. In addition, the male gender, smoking above 40 pack-years, and alcohol remarkably reduced the OS. Conclusion: The OS and disease-free survival were similar between patients in the chemoradiotherapy and surgery groups. In contrast, patients with ECOG performance score below 2 and pathological downstaging after neoadjuvant chemotherapy had prolonged survival.