Future of BPH management lies in precision, personalization, and technology

The treatment landscape for benign prostatic hyperplasia (BPH) has undergone a rapid transformation over the past few years. With the advent of minimally invasive surgical therapies (MISTs) as well as artificial intelligence (AI), urologists are increasingly able to personalize treatment plans based on prostate anatomy and patient preferences.

AI holds particular promise in shaping how BPH is diagnosed, evaluated, and managed. Its applications extend across multiple domains, from improving diagnosis and treatment selection to guiding surgical planning and supporting patient education. Looking ahead, additional technologic advancements such as targeted drug therapies and robotics may continue to guide individualized management strategies.

In a recent interview with Urology Times®, Martin B. Richman, MD, MBA, FACS, outlined some of the advancements forthcoming in the space, with a notable emphasis on the importance of a precision-guided, patient-focused approach to care. Richman specifically notes that the field has moved away from a “trial-and-error” approach to BPH management, and instead embraced a paradigm of tailored treatment strategies.

Richman is a board-certified urologist at Advanced Urology Institute in Florida.

Urology Times: The BPH treatment landscape has grown to include novel investigational devices such as the Butterfly device, ProVee System, and FloStent System. How do these newer minimally invasive devices compare to established options in terms of efficacy, safety, and patient recovery time?

Richman: Each of these novel devices involves a method of stenting the prostatic urethra. Although feasibility studies show promising results with reductions in [International Prostate Symptom Score] IPSS and improved uroflow, I do have some concerns about long-term durability, as well as the risk of future problems from the exposed stent and the risk of encrustation. All of these devices also claim to be easily removable; however, the longer it has been indwelling, the more I am concerned about increasing difficulty with removal. I think longer-term studies on both efficacy and safety are necessary before these devices become acceptable options for BPH.

Urology Times: AI has been explored for BPH diagnosis, treatment selection, and surgical optimization. Where do you see the most promising applications?

Richman: Although BPH is a very common condition, each prostate is somewhat unique in anatomy and obstructive function. Therefore, tailoring the treatment to the individual patient is important. I think AI can be an important tool in this decision-making process. AI could assist in real-time imaging analysis or automated IPSS tracking. I also foresee AI being useful for patient education prior to and after various treatments for BPH with the caveat that the AI product needs to be validated for accuracy.

Urology Times: What are some of the barriers—technical, regulatory, or clinical—to incorporating AI tools into routine BPH management?

Richman: Incorporating AI tools into the routine management of BPH holds significant promise, particularly for improving diagnosis, treatment selection, patient monitoring, and workflow efficiency. However, several barriers must be overcome for successful integration into clinical practice. These include technical, regulatory, and clinical obstacles. FDA approval would likely be required for AI-based diagnostic tools. There may also be resistance to acceptance of this technology from both urologists and patients.

Most importantly, I am concerned about the accuracy of the data that is used by AI. AI utilizes information from the Internet, some of which is terribly inaccurate. It is important to validate the data that AI uses to create treatment protocols and patient education.

Urology Times: Beyond device development, what diagnostic or imaging advances are making a difference in how you evaluate BPH?

Richman: In addition to device development and refinement, there are several diagnostic and imaging advances that are significantly enhancing the evaluation and management of BPH.Noninvasive pressure-flow studies such as Urocuff combined with ultrasound for both prostate volumetric analysis and bladder wall thickness can determine not only the size of an enlarged prostate but also the adverse effect it is having on detrusor function and bladder compliance and elasticity. Three-dimensional transrectal ultrasound imaging (3D-TRUS) enhances anatomic evaluation of the prostate including the degree of intravesical protrusion and multiplanar evaluation of the transition zone. Prostate MRI, primarily used for the evaluation of prostate cancer, also provides accurate prostate volumetric measurement and transition zone anatomy and sizing. Lastly, the increased use of BPH nomograms, care pathways, and assessment questionnaires helps to stratify the severity of the condition, the need for treatment, and the best pathways to follow in the management of each individual patient’s situation.

Urology Times: Looking ahead, what innovations—whether in drug therapy, device technology, or diagnostics—do you think will have the biggest impact over the next 5 years?

Richman: The next 5 years in BPH management will likely be shaped by personalized, less invasive, and data-driven innovations across drug therapy, device technology, and diagnostics. Some emerging trends that stand out as potential game-changers include targeted drug therapies and localized drug delivery models, refinements in thermal ablation and tissue reduction with various forms of energy, including more precise water vapor devices, refined hydro-jet and laser devices as well as additional incorporation of robotic-assisted devices to aid in surgical precision and reduce collateral damage to sexual and voiding function.

Urology Times: Is there anything else that you’d like to add?

Richman: BPH management is moving away from “trial-and-error” approach toward a more precision-guided, patient-centric paradigm. The integration of AI, smarter devices, minimally invasive therapies, and personalized medicine will likely reduce overtreatment, improve quality of life, and expand access to the aging male population.