Tobert CM, et al. - Researchers recognized 847 Iowans in Surveillance, Epidemiology, and End Results-Medicare from 1992 to 2009 with high-grade nonmuscle invasive bladder cancer (NMIBC) who survived 2 years and were not treated with cystectomy or radiation during this period in order to identify factors correlated with NMIBC American Urological Association (AUA) guideline compliance in a rural state, to assess compliance rates over time, and to evaluate the influence of subject and provider rurality on delivery of NMIBC care. Overall compliance with AUA guidelines was low and did not particularly get better over the study period. Only care at an academic medical center and tumor stage raised the odds of compliance in the multivariable model. In comparison to subjects living farther, subjects living closer to their urologists underwent more cystoscopies, however, distance did not influence compliance with other measures. Compliance was not related to cancer-specific survival. Hence, compliance with post-Transurethral Resection of Bladder Tumor NMIBC treatment guidelines has improved, however, it persisted to be suboptimal in a rural state, and was highly correlated with treatment at an academic cancer center for reasons that could not be fully described with these data.