Trends in urology: Arpeet Shah, MD, on challenges and opportunities in 2025

In this interview, Arpeet Shah, MD, considers some of the advancements and challenges that the field of urology will face in the coming year. Shah is a urologist at Associated Urological Specialists, which is a part of Solaris Health. In clinical practice, Shah does a combination of general urology as well as urological oncology.

This transcript was AI generated and edited by human editors for clarity.

Arpeet Shah, MD

What are some of the biggest trends that you see shaping urologic research and care in 2025?

One of the biggest trends shaping urological research, as well as care in 2025, [will be] a shift toward precision-based care, where we're tailoring diagnosis and treatment to the individual patient. One example of this is in prostate cancer detection, where we see tools like IsoPSA or other adjunctive tests, which have emerged as game-changers in the diagnostic process. IsoPSA, for example, is a blood test that goes beyond traditional PSA [prostate-specific antigen] testing and detects structural changes in the PSA that are linked to cancer. This allows us to better distinguish benign conditions from clinically significant prostate cancers, thus reduc[ing] the need for unnecessary biopsies and [allowing us to] focus interventions for patients who need them the most.

If you look at things beyond prostate cancer, there are precision-based approaches for bladder cancer and kidney cancer. All of these are improving our ability to detect diseases earlier and develop treatment plans that minimize overtreatment and [adverse] effects.

What do you see as some of the most significant challenges facing urology in the coming year?

The work force challenges in urology are multifaceted and mirror broader trends in health care, but there are unique aspects to our field of urology. There are concerns with the growing demand of urological care in terms of an aging population. We have increasing prevalence of prostate cancer, kidney stones, and BPH [benign prostatic hyperplasia], and we're seeing a significant mismatch between the number of practicing urologists and the patient population. This is leading to longer wait times and limits access to timely care, particularly in rural and underserved areas.

This problem only gets worse when you look at recruitment and retention. Urology is a very in-demand specialty. A recent study [found that] it’s one of the most demanding specialties in medicine, with potentially 8 jobs available per applicant. Being able to recruit urologists is a real challenge for practices. This also gets worse when you look at the retirement of urologists. The average age of a practicing urologist is in the upper 50s. We're not training enough urologists to fill the gaps that are coming with the increased retirements. As a result, we have many practices exploring different ways to optimize team-based care, [such as] leveraging APPs [advanced practice providers] to help meet patient and practice needs.

How do you predict advancements in diagnostic imaging technologies will affect urology?

We've already seen quite significant advancements in diagnostic imaging, but I think they will continue to revolutionize how we diagnose patients faster, more precisely, and less invasively. For example, we already use multiparametric MRI, and it's pretty widespread. But if you include the addition of AI driven imaging analysis to improve our ability to detect cancers earlier and with greater accuracy, it's a really interesting concept.

We’ve focused a lot on oncology, but there's many non-invasive urinary pressure flow [devices] such as UroCuff, which are allowing us to objectively determine the significance of patients' BPH diagnosis and allow us to be less invasive compared with traditional urodynamics testing. There are a lot of new diagnostic testing coming out that will help us care for our patients better.

What role do you see biomarkers playing in improving early detection of urologic conditions such as prostate cancer or kidney cancer?

Biomarkers are a game-changer in the early detection of urological conditions like prostate cancer and kidney cancer.

For example, in prostate cancer, biomarkers like IsoPSA or 4K scores, or urinary biomarkers like ExoDX or Select MDX are helping us better stratify patients based on their risks. This allows us to reduce unnecessary biopsies and focus on identifying clinically significant cancers.

In kidney cancer, there are emerging blood-based and urine-based biomarkers, which are showing some promise to detect tumors at earlier stages, even sometimes before they're visible on imaging. These advancements mean we're moving towards a more personalized approach in screening and surveillance.

How are targeted therapies and immunotherapies expected to evolve for bladder and kidney cancer?

There are several novel therapies and immunotherapies that are related to more advanced forms of bladder and kidney cancer, and these are transforming the way we treat these conditions. For example, in bladder cancer, we're seeing significant advancements in antibody drug conjugates and checkpoint inhibitors, which are providing more effective options for patients with advanced or metastatic disease. We're seeing similar novel therapies in kidney cancers. Looking forward, I think the focus is on improving response rates and durability of these treatments and figuring out what combination of treatments and in what order we should deliver all these new therapies that are coming to market.

What role do you see AI playing in urology over the next few years?

AI is hitting all parts of health care delivery. It’s going to have an impact on how we approach diagnosis, treatment planning, and other forms of patient care. If you look at one of the more immediate ways that AI will have an impact, there are AI-powered imaging tools that help improve the accuracy of diagnostic imaging conditions like prostate cancer, kidney stones, or urothelial carcinoma. These systems can analyze imaging data faster and more precisely than ever, as well as identify subtle abnormalities that might be missed by the human eye. This ultimately helps us diagnose disease earlier and with greater confidence.

Beyond imaging, AI is enhancing clinical decision-making. We have machine learning algorithms that can help analyze large data sets to predict patient outcomes, stratify risk, and even suggest personalized treatment pathways. For example, in prostate cancer management, AI can integrate data from biomarkers, genomic testing, and imaging studies to guide toward a more targeted intervention.

We're also seeing AI become more integrated in robotic surgery as well as predictive analytics. For example, PROCEPT Aquablation is now utilizing AI to determine treatment planning. We're going to see AI touch all forms of technology to make surgery more precise and safer, outcomes more predictable, and care more efficient.

If you look at AI in terms of workflow, it can help with clinical documentation and integrating with live patient encounters, allowing the physician to spend more time with the patient rather than on all of the administrative tasks. There's going to be a lot of advancements that AI brings to health care, but it's crucial that we ensure these advancements are implemented thoughtfully, with an emphasis on improving patient outcomes and maintaining the clinician-patient relationship at the center of all of it.

How do you see some of the minimally invasive procedures evolving in BPH in 2025? Are there any new treatments on the horizon that you're looking forward to seeing?

We're in the golden age of BPH therapy. There are many therapies, surgical procedures, and MISTs [minimally invasive surgical therapies] that are in line. What's more remarkable from a global level is that all of these new technologies for BPH—whether you're talking about Aquablation or FloStent or Rezūm or PAE [prostatic artery embolization]—are bringing awareness to the issue and getting patients and providers off the bench, getting them to be more proactive in treating BPH earlier in the disease state before there's a real compromise to bladder health. Even more than the techniques and technologies that are coming down the pipeline, I'm most excited about the more widespread use of objective diagnostic testing to tell us how severe of an issue BPH is to the health of a patient. We know things like IPSS [International Prostate Symptom Score], although important, are extremely subjective and do not tell us the whole story. The use of objective testing in urology, specifically in bladder and prostate health, allow the provider and the patient to make a better decision.

I say this to everybody, but the analogy to cardiology is really important. You don't go to a cardiologist and have them give you a survey on how your heart is feeling. They determine your cardiac care based on objective testing, whether it's an echocardiogram, a stress test, or something else. Urologists need to move away from just survey-based questionnaires to more objective measurements of bladder and prostate health to determine what needs to be done.