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This phase III trial studies how well chemotherapy and radiation therapy work with or without atezolizumab in treating patients with localized muscle invasive bladder cancer. Radiation therapy uses high energy rays to kill tumor cells and shrink tumors. Chemotherapy drugs, such as gemcitabine, cisplatin, fluorouracil and mitomycin-C, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy with radiation therapy may kill more tumor cells. Immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving atezolizumab with radiation therapy and chemotherapy may work better in treating patients with localized muscle invasive bladder cancer compared to radiation therapy and chemotherapy without atezolizumab.

This study compares therapy within the bladder (intravesical therapy) and surgery as treatment options for patients with bladder cancer. Bladder cancer is the fifth most common cancer in the United States, but not enough research is available to help patients decide between the two most common treatments: medical therapies or bladder removal. The purpose of this study is to compare how the two treatments affect patient clinical outcomes and patient and caregiver experiences. This study may help researchers improve the decision-making process about bladder cancer treatments for patients and their caregivers.