Sorry that you need to join our club!!
First, to my knowledge, P21 gene presence is not a diagnostic test for bladder cancer. You need to know what the pathology report determined....what type of bladder cancer is is? is it low grade or high grade? has it penetrated the lining/muscle? What is your urologist actually recommending? Is the chemo supposed to be prior to bladder removal? None of these questions are answered by "P21" You should get, and keep, a copy of the path report.
Once you have found the answers you will be better able to decide what to do. If you don't get the answers to these questions, perhaps a second opinion from a urologist at a place that sees LOTS of bladder cancer cases would be a good idea.
AND, yes...if there is a consensus that treatment that is not available locally is necessary...or for a competent second opinion, you would need to go out of town.
Hope you can clarify your situation.
Sara Anne