BACKGROUND We evaluated the prognostic significance of pT0 stage on organ-confined transitional cell carcinoma of the bladder following radical cystectomy. METHODS We retrospectively reviewed the medical records of consecutive patients who underwent radical cystectomy for organ-confined transitional cell carcinoma of the bladder between 1986 and 2004. Patients who were treated with neoadjuvant or adjuvant therapy were excluded. A total of 197 patients were enrolled in this study. We investigated the impact of pathologic T stage on disease-specific survival. RESULTS Overall disease-specific survival rate was 84.1% after 5 years. Five-year disease-specific survival rates according to pathologic stage were 88.7% in pT0, 92.2% in pTis-1 and 65.4% in pT2 disease. Overall disease-specific survival rate with pTis-1 or pT0 tumors was significantly higher than with pT2 tumors (p = 0.001, pT2 vs. pT0; p < 0.001, pT2 vs. pTis-1), but there was no difference in disease-specific survival between pTis-1 and pT0 tumors (p > 0.05). In the muscle-invasive tumor group, pT0 tumors had a more favorable prognosis than pT2 tumors (p = 0.042), but there was no difference in prognosis between pT0 and pTis-1 tumors. CONCLUSIONS Pathologic stage T0 cystectomy can be considered a curative therapy in most cases, including pT0cT2 tumors, but there is a substantial risk of tumor recurrence.