Hi,
That is a very valid question to ask, as philosophies may differ when there is sign of spread. It seems to me that a PET scan would be a very good test at this point to see if the suspicious spots are active cancer or not. If your current doctor doesn't have access to a PET, maybe you should find a doctor who does. You need as exact a diagnosis as possible.
If there is lymph node metastasis, some surgeons will operate, remove many nodes and attempt an actual cure, while other doctors will not operate or even close people up when they see that lymph nodes are cancerous. Thus, it's an extremely important detail to clarify.
I'm not exactly sure this path report is saying that there is no muscle involved, it may well be, but that is not the most important issue as any spread would make it moot and treatments would be geared to the metastatic- meaning chemotherapy and not surgery.
Some doctors will then operate if there is a total response to chemo, some will not and that also depends on the extent of the spread at diagnosis.
Pathology should be checked out by an expert in uro-pathology. Your husband's case is very complicated. Focal lymphovascular invasion means the bladder tumor is aggressive, and glandular elements means it's of mixed cell type, probably adenocarcinoma along with transitional cell, also making it more complicated and worth it to engage an expert.
I know that Dr. Kamat from MDAnderson is a wonderful person, as well as an authority on rare bladder tumors. If you could get a consult for a second opinion I would recommend him, as well as the path dept at MDAnderson. If finances are a problem with MDAnderson, maybe just a second opinion on the pathology report from them could be an option and treatment given locally or at Southwestern...
Please keep in touch.
Wendy