We describe the case of a 50-year-old male presented intermittent macrohematuria and was diagnosed with bladder urothelial carcinoma...The tumor mutation burden (TMB) was 19.10 Mutants/Mb and the microsatellite state was stable (MSS). Furthermore, inactivating mutation in the RB1 gene was detected...The immunohistochemistry showed that the combined positive score (CPS) of the PD-L1 expression level was <1...The patient received a novel regimen of neoadjuvant chemotherapy plus pembrolizumab and subsequent chemoradiotherapy that successfully preserved his bladder with no immunotherapy-related adverse events.