Matthew Mossanen, MD, assistant professor of surgery at Harvard Medical School, Boston, MA, leads a roundtable discussion of upper tract urothelial cell carcinoma with Guru Sonpavde, MD, Dana-Farber Cancer Institute, Boston, MA; Steven L Chang, MD, MS, assistant professor of surgery at Harvard Medical School; Michelle S. Hirsch, MD, PhD, associate professor at Harvard Medical School; and Mark A. Preston, MD, PhD, assistant professor of urology at Harvard Medical School. The roundtable discussion centers on a 49-year-old male patient with upper tract urothelial cell carcinoma who underwent robotic cystoprostatectomy, received gemcitabine/cisplatin, and then underwent urethrectomy. Challenges and considerations for unresponsive disease, use of adjuvant therapy, and use of radiation are covered.