For the last two decades, the combined defects of pRb/p53 have been almost synonymous with the muscle-invasive urothelial carcinomas, largely because of the clinical correlation between the two [
68]. About 50% of the invasive urothelial carcinomas harbor p53 mutations and aberrant pRb expression simultaneously and these two alterations are more significantly associated with poor prognosis and patient survival than one alteration alone [
69‐
71]. Despite the close clinical correlation, several technical constraints precluded the experimental verification of whether pRb and p53 deficiency is collaborative in initiating invasive urothelial carcinomas. pRb inactivation in mice in a global manner resulted in embryonic lethality due to severe abnormalities in hematopoietic and neurological systems [
72‐
74]. Although mice globally defective in p53 survived to term, they succumbed to thymic lymphomas and soft tissue sarcomas 3–7 months of age when urothelium appeared completely normal [
14,
47]. The lack of early-onset urothelial tumorigenesis in global p53 knockout mice suggests that p53 deficiency is insufficient to provoke urothelial tumors, although one could argue that the combined deficiency of p53 and pRb may be sufficient. Such a scenario could be supported in part by the compensatory induction of p53 pathway in pRb-deficient cells and by the fact that defects of the two genes co-exist in nearly half of the muscle-invasive bladder cancers in humans [
69‐
71]. With the help of a urothelium-specific knockout system [
75], pRb and p53 were recently ablated either alone or in a combination in the urothelial cells [
48]. Unlike the global p53 knockout where mice died early in life, conditional p53 inactivation permitted analyses of the long-term urothelial effects of p53 deficiency. Nevertheless, with the exception of late-onset, localized urothelial atypia, no urothelial tumors were detected throughout the 30-month observation period [
48]. Therefore, p53 deficiency per se, like that of pRb, is not tumorigenic within the urothelial context. When p53 deficiency was combined with pRb deficiency in the double knockout mice, the former effectively abrogated the cell-cycle arrest and apoptotic responses provoked by the latter. Unexpectedly, however, even the combined deficiency of p53 and pRb only produced late-onset, simple urothelial hyperplasia, and low-grade, superficial papillary tumors in a small fraction (<5%) of the double knockout mice [
48]. No invasive urothelial carcinoma was observed despite long-term observations of several independent cohorts. While incapable of forming full-fledged invasive carcinomas spontaneously, 50% of the p53/pRb-double null mice developed muscle-invasive urothelial carcinomas after exposure to a 0.01% BBN for 10 weeks [
48]. At the same dosage and time frame, none of the single-null mice lacking either p53 or pRb, or the double null mice lacking one p53 and one pRb allele, developed any urothelial tumors. Taken together, these data provide compelling experimental evidence indicating that the combined defects of p53 and pRb are necessary but not sufficient to initiate invasive urothelial carcinomas and suggest that other genetic alterations are required to trigger this urothelial tumor type. Given the fact that conditional inactivation of both p53 and pRb elicits flank tumors in several non-epithelial tissues [
76,
77], the observed effects with these two genes deleted in the urothelial cells provide yet another example of the context-dependency of tumorigenicity not only by oncogenes, but also by tumor suppressor genes.