The future practice of urologic oncology in the United States will be influenced by a variety of factors. The national economic crisis has already impacted reimbursement and coverage for clinical care and has had a direct effect on the level of research funding. Unhealthy lifestyles by a significant segment of the American population contributes to a increased risk of most urologic cancers. Compounding these challenges is the aging of the urological workforce and projected significant manpower shortages. These multiple factors must be confronted directly or the future quality of urologic cancer care will be jeopardized.