WEBVTT 1 00:00:00.080 --> 00:00:02.242 This podcast is created by Coelis. 2 00:00:03.163 --> 00:00:03.303 Now, 3 00:00:03.703 --> 00:00:06.365 the use of focal therapy is not yet common, 4 00:00:06.566 --> 00:00:11.930 but a lot of doctors and patients are very keen to embark on focal therapy. 5 00:00:20.838 --> 00:00:21.278 Welcome, 6 00:00:21.318 --> 00:00:23.620 aficionados of all things prostate, 7 00:00:23.720 --> 00:00:26.042 related to another episode of Prostatalk. 8 00:00:26.483 --> 00:00:27.003 I'm your host, 9 00:00:27.203 --> 00:00:27.524 Thomas. 10 00:00:28.024 --> 00:00:33.586 and today we are delving into the nitty-gritty world of prostate biopsies and focal therapies. 11 00:00:34.386 --> 00:00:37.227 Joining us is none other than the estimated Dr. 12 00:00:37.307 --> 00:00:37.787 Peter Chiu, 13 00:00:38.267 --> 00:00:47.489 a trailblazing pioneer on focal therapy in Asia and driving force behind the evolution of urological practices for prostate care. 14 00:00:48.370 --> 00:00:52.191 With his innovative approaches and unwavering dedication, 15 00:00:52.851 --> 00:00:53.151 Dr. 16 00:00:53.211 --> 00:00:57.412 Peter Chiu is worshipping the landscape of prostate treatment across the world. 17 00:00:58.044 --> 00:00:58.324 Now, 18 00:00:58.524 --> 00:01:02.527 when it comes to targeting in the diagnosis and treatment of prostate cancer, 19 00:01:03.007 --> 00:01:03.287 Dr. 20 00:01:03.387 --> 00:01:05.068 Peter Chu is a true marksman, 21 00:01:05.688 --> 00:01:06.529 and he will tell us, 22 00:01:06.769 --> 00:01:10.351 hitting the bull's-eye is not just for harkering tournaments, 23 00:01:10.511 --> 00:01:14.954 it is also essential for improving the everyday lives of the patients. 24 00:01:16.354 --> 00:01:16.494 So, 25 00:01:16.995 --> 00:01:17.715 let's aim high, 26 00:01:17.775 --> 00:01:18.496 but not too high, 27 00:01:18.496 --> 00:01:20.076 we are talking about prostates, 28 00:01:20.237 --> 00:01:25.560 and learn how precise targeting is key to hitting the mark in prostate care with Dr. 29 00:01:25.660 --> 00:01:26.100 Peter Chu. 30 00:01:29.464 --> 00:01:29.664 Hi, 31 00:01:29.744 --> 00:01:29.964 Dr. 32 00:01:30.024 --> 00:01:30.164 Chu. 33 00:01:30.344 --> 00:01:31.745 We are really pleased to welcome you. 34 00:01:31.925 --> 00:01:36.447 So today we are currently live from the 2024 AUA annual meeting in San Antonio, 35 00:01:36.647 --> 00:01:38.408 Texas for an amazing edition. 36 00:01:38.668 --> 00:01:39.248 How are you today? 37 00:01:39.809 --> 00:01:40.269 So thank you, 38 00:01:40.289 --> 00:01:40.629 Thomas. 39 00:01:41.129 --> 00:01:45.451 I'm doing very well and I'm very happy to be coming back to the AUA again. 40 00:01:45.931 --> 00:01:46.692 Before to begin, 41 00:01:47.052 --> 00:01:49.293 could you please introduce yourself to our listeners? 42 00:01:50.033 --> 00:01:50.233 Well, 43 00:01:50.353 --> 00:01:50.914 I'm Peter, 44 00:01:51.094 --> 00:01:52.414 Peter Chu from Hong Kong, 45 00:01:53.275 --> 00:01:55.856 and I work in the Chinese University of Hong Kong. 46 00:01:56.416 --> 00:02:08.007 And my research and practice focus is mainly on prostate cancer and mainly on image-guided prostate biopsies to novel treatments like focal treatments, 47 00:02:08.207 --> 00:02:09.528 and I also do robotic surgery. 48 00:02:10.409 --> 00:02:12.271 So in order to prepare this interview, 49 00:02:12.711 --> 00:02:14.132 I have made my little research, 50 00:02:14.453 --> 00:02:21.299 and I have seen that your studies focus on prostate cancer with a particular emphasis on exploring novel treatment options. 51 00:02:21.639 --> 00:02:22.120 Am I right? 52 00:02:22.932 --> 00:02:23.192 Yes, 53 00:02:23.933 --> 00:02:33.541 there are lots of new treatments coming up and my interest in recent years would be on focal therapy for prostate cancer. 54 00:02:33.981 --> 00:02:41.187 And that includes my trial cases in microwave ablation and also high-intensity focus ultrasound and some cryotherapy too. 55 00:02:41.747 --> 00:02:48.373 I've had the opportunity to participate in many congresses and conferences across Europe and few in the US. 56 00:02:48.853 --> 00:02:49.494 Unfortunately, 57 00:02:49.574 --> 00:02:52.036 I haven't yet had the chance to attend any in Asia. 58 00:02:52.536 --> 00:02:53.176 As a result, 59 00:02:53.256 --> 00:02:57.998 my understanding of the situation regarding focal therapy in Asia is a little bit limited. 60 00:02:58.478 --> 00:02:58.599 So, 61 00:02:59.099 --> 00:02:59.359 Dr. 62 00:02:59.419 --> 00:02:59.559 Chu, 63 00:02:59.739 --> 00:03:02.820 could you provide insight into the current situation there, 64 00:03:03.240 --> 00:03:05.841 including any guidelines of emerging trends, 65 00:03:05.881 --> 00:03:06.222 please? 66 00:03:06.682 --> 00:03:08.463 We do not have very unified 67 00:03:09.023 --> 00:03:10.183 Asian guidelines, 68 00:03:10.623 --> 00:03:16.766 but the emerging trend is that minimally invasive treatment is getting more and more popular. 69 00:03:17.386 --> 00:03:17.526 Now, 70 00:03:17.926 --> 00:03:21.708 the use of focal therapy for prostate cancer in Asia is not yet. 71 00:03:22.228 --> 00:03:22.588 common, 72 00:03:23.288 --> 00:03:32.932 but a lot of doctors and patients are very keen to embark on focal therapy because focal therapy gives the patient much less morbidity, 73 00:03:33.373 --> 00:03:34.393 but at the same time, 74 00:03:35.273 --> 00:03:38.455 a lot of patients can be treated with the prostate cancer. 75 00:03:38.955 --> 00:03:40.736 So in some countries like Japan, 76 00:03:40.976 --> 00:03:42.756 some focal therapies is approved, 77 00:03:43.076 --> 00:03:44.317 but in most other countries, 78 00:03:44.357 --> 00:03:47.078 there's actually no formal approval. 79 00:03:47.618 --> 00:03:50.920 And a lot of these focal therapies are done under trial settings. 80 00:03:51.440 --> 00:03:51.560 So 81 00:03:51.980 --> 00:03:54.262 I would say there's a lot of interest, 82 00:03:54.562 --> 00:03:55.903 but it is not yet very common. 83 00:03:56.363 --> 00:03:57.003 Interesting. 84 00:03:57.584 --> 00:03:59.525 Let's go back to your daily practice now. 85 00:03:59.925 --> 00:04:04.669 Are you performing transpirineal prostate biopsy or transrectal biopsies and why? 86 00:04:05.109 --> 00:04:07.791 In my hospital and in my personal practice, 87 00:04:08.391 --> 00:04:13.154 I have been doing transpirineal prostate biopsy since 2019. 88 00:04:13.414 --> 00:04:14.455 So since five years ago, 89 00:04:14.895 --> 00:04:17.077 I have not done one transrectal biopsy. 90 00:04:17.697 --> 00:04:18.798 And there are a few reasons. 91 00:04:19.158 --> 00:04:21.500 One is obviously less infection. 92 00:04:22.100 --> 00:04:23.261 with a transperineal biopsy. 93 00:04:23.941 --> 00:04:24.361 Secondly, 94 00:04:24.802 --> 00:04:38.609 as we are doing more focal therapy and we need to plan for focal therapy and transperineal biopsy and with the targeted and systematic biopsies gives us an excellent mapping on transperineal route, 95 00:04:39.350 --> 00:04:41.571 much better than transrectal in my opinion. 96 00:04:42.352 --> 00:04:48.375 So it would actually make us easier to choose suitable cases to do focal therapy. 97 00:04:49.035 --> 00:04:49.696 According to you, 98 00:04:50.236 --> 00:04:57.605 What are the main advices you can provide to a physician who wants to switch from transrectal to transparent prostate biopsies? 99 00:04:58.049 --> 00:05:04.873 I think this is a major change from transrectal to transperineal as we did more than five years ago. 100 00:05:06.054 --> 00:05:07.734 But this is not something difficult. 101 00:05:08.295 --> 00:05:09.696 So you need some to learn. 102 00:05:10.036 --> 00:05:11.136 There is some learning curve, 103 00:05:11.397 --> 00:05:11.637 you know, 104 00:05:11.697 --> 00:05:12.837 in transperineal biopsy, 105 00:05:12.977 --> 00:05:17.860 both in a freehand manner and also in MRI ultrasound fusion platforms. 106 00:05:19.021 --> 00:05:19.441 In a way, 107 00:05:19.941 --> 00:05:21.202 the softwares are similar. 108 00:05:21.722 --> 00:05:23.323 The way you do it is slightly different. 109 00:05:23.603 --> 00:05:26.325 And also you need to determine whether in your setting, 110 00:05:26.585 --> 00:05:31.248 you do it under local anesthesia or under general or monitor anesthetic care. 111 00:05:31.788 --> 00:05:35.490 So these are all the considerations that you need to have. 112 00:05:36.150 --> 00:05:39.812 And also that you need to have slightly different equipments, 113 00:05:40.132 --> 00:05:44.595 particularly the ultrasound probe in doing a transperineal biopsy. 114 00:05:44.955 --> 00:05:45.755 But overall, 115 00:05:45.975 --> 00:05:49.237 I think it is a very nice experience. 116 00:05:49.377 --> 00:05:53.159 And I don't think it's that difficult to change to a transperineal biopsy. 117 00:05:53.700 --> 00:05:55.641 And how the equipment and... 118 00:05:56.361 --> 00:05:57.882 especially the ultrasound probe, 119 00:05:57.902 --> 00:06:00.824 it's important for transperineal biopsies. 120 00:06:01.545 --> 00:06:02.605 So for transrectal, 121 00:06:02.785 --> 00:06:05.087 it is usually an N-firing probe. 122 00:06:05.928 --> 00:06:09.490 To use the same probe for transperineal would be quite challenging. 123 00:06:09.970 --> 00:06:14.554 So a side-firing probe would make your life much easier. 124 00:06:15.014 --> 00:06:17.035 And all of the transperineal 125 00:06:17.656 --> 00:06:19.557 MRI ultrasound fusion platform, 126 00:06:19.937 --> 00:06:21.318 including the coalescent one, 127 00:06:21.338 --> 00:06:23.740 would be a side-firing ultrasound probe. 128 00:06:24.320 --> 00:06:25.081 I have no doubt that... 129 00:06:25.181 --> 00:06:26.762 this information will be helpful. 130 00:06:27.423 --> 00:06:33.428 From what I understand focal therapy is typically performed via the transpirineal route correct? 131 00:06:34.149 --> 00:06:40.635 This aspect could serve as a compelling argument for doctors who wish to provide the patients with multi treatment options. 132 00:06:41.015 --> 00:06:42.136 Wouldn't you agree? 133 00:06:42.796 --> 00:06:51.324 Yes so with all the needle based ablations not only in microwave but cryotherapy or even 134 00:06:51.744 --> 00:06:52.205 IRE 135 00:06:52.841 --> 00:06:55.343 All of them were done on the transperineal setting, 136 00:06:55.804 --> 00:06:56.664 except for HIFU, 137 00:06:56.824 --> 00:07:02.209 which it is actually a transrectal transmission of ultrasound energy to the prostate. 138 00:07:02.809 --> 00:07:07.353 But most of them would be done with the transperineal route. 139 00:07:07.533 --> 00:07:19.203 And that is why I mentioned that doing a transperineal biopsy is sometimes similar to the way we do transperineal route of focal therapy, 140 00:07:20.004 --> 00:07:21.025 particularly in... 141 00:07:21.449 --> 00:07:22.990 microwave or cryotherapy, 142 00:07:23.550 --> 00:07:29.174 it's actually very similar to how you do a fusion guided transperineal biopsy. 143 00:07:29.974 --> 00:07:32.576 So you mentioned IFU and microarrays, 144 00:07:32.836 --> 00:07:35.057 what kind of treatments are you performing now? 145 00:07:35.718 --> 00:07:40.721 Different focal energies are suitable for different tumor locations. 146 00:07:41.161 --> 00:07:41.942 So for example, 147 00:07:42.342 --> 00:07:45.124 for very posterior lesions next to the rectum, 148 00:07:45.444 --> 00:07:47.185 HIFU would be a good option. 149 00:07:47.741 --> 00:07:50.523 Whereas for tumors that are further away, 150 00:07:50.784 --> 00:07:51.544 like anterior, 151 00:07:51.604 --> 00:07:53.166 particularly antero-lateral, 152 00:07:53.566 --> 00:07:59.331 cryotherapy or any needle-based ablations like microwave or IRE would be more suitable. 153 00:07:59.991 --> 00:08:09.499 For tumors that is next to the prostate urethra or anterior to the prostate urethra are those which are very challenging for cryotherapy. 154 00:08:10.199 --> 00:08:12.361 And in my personal experience, 155 00:08:12.822 --> 00:08:16.645 microwave ablations are particularly good in that locations. 156 00:08:17.129 --> 00:08:17.970 So in a way, 157 00:08:18.110 --> 00:08:20.872 microwave ablation can cater for most locations, 158 00:08:20.972 --> 00:08:26.276 except for the small region of the tumours that is just anterior or next to the rectum. 159 00:08:26.896 --> 00:08:28.677 So about targeted microwave ablation, 160 00:08:29.278 --> 00:08:32.941 could you explain to us what does it consist concretely? 161 00:08:33.401 --> 00:08:33.581 Right, 162 00:08:33.621 --> 00:08:37.104 so we're talking about targeted and microwave ablation. 163 00:08:37.184 --> 00:08:38.024 So these are two things. 164 00:08:38.565 --> 00:08:39.786 First thing is the targeted. 165 00:08:40.246 --> 00:08:40.686 Targeted, 166 00:08:40.826 --> 00:08:41.367 we use 167 00:08:42.147 --> 00:08:44.289 MRI ultrasound fusion technology. 168 00:08:44.897 --> 00:08:46.758 on the organ-based tracking mechanism, 169 00:08:47.418 --> 00:08:50.280 just like what we do in fusion biopsy. 170 00:08:50.760 --> 00:08:51.341 And the second, 171 00:08:51.541 --> 00:08:51.881 obviously, 172 00:08:52.221 --> 00:08:53.402 is the microwave ablation. 173 00:08:54.002 --> 00:08:59.165 We use a single microwave needle inserted transparently into the prostate, 174 00:08:59.705 --> 00:09:01.446 and we do it one by one, 175 00:09:02.407 --> 00:09:05.388 usually with the guidance of the mini-grid, 176 00:09:05.869 --> 00:09:10.391 which is attached to the side-firing transrectal ultrasound probe, 177 00:09:10.811 --> 00:09:13.733 exactly the same as we do fusion biopsy. 178 00:09:14.401 --> 00:09:30.213 So these are the components of the microwave ablation and each microwave ablation lasts for around five minutes and usually for one lesion we need about between three to five ablations to cover the tumor and margin. 179 00:09:31.113 --> 00:09:39.620 So each ablation five minutes and overall the ablation time are usually within 25 minutes for each case. 180 00:09:40.080 --> 00:09:41.081 So it's quite a... 181 00:09:41.401 --> 00:09:44.746 fast to treat this kind of lesion with microwave ablation. 182 00:09:44.907 --> 00:09:45.207 In fact, 183 00:09:45.247 --> 00:09:45.648 you're right, 184 00:09:45.828 --> 00:09:48.913 because compared with HIFU or cryotherapy, 185 00:09:49.594 --> 00:09:52.138 microwave ablation is a much quicker treatment. 186 00:09:52.894 --> 00:09:56.417 probably less than half of the time that you need for other treatments. 187 00:09:56.477 --> 00:09:59.599 So this is another advantage of doing microwave ablation. 188 00:10:00.340 --> 00:10:00.580 Great. 189 00:10:00.780 --> 00:10:03.382 This is why you decided to offer it to your patients? 190 00:10:04.183 --> 00:10:04.423 Yes, 191 00:10:04.563 --> 00:10:07.446 I think because for microwave ablation, 192 00:10:07.666 --> 00:10:11.089 I think the direct comparison which is more commonly done, 193 00:10:11.329 --> 00:10:11.949 the alternative, 194 00:10:11.949 --> 00:10:12.890 would be cryotherapy. 195 00:10:13.731 --> 00:10:14.531 For cryotherapy, 196 00:10:15.292 --> 00:10:17.814 it is actually a well-proven focal energy, 197 00:10:18.815 --> 00:10:21.397 but there are also challenges when we apply it. 198 00:10:22.198 --> 00:10:22.538 First, 199 00:10:22.718 --> 00:10:38.405 we cannot apply it near the urethra because the urethral warmer will stop the cryo from killing tumor cells around the prostate urethra and the warmer and for the anterior central midline tumors it is also quite challenging for the cryo on 200 00:10:38.405 --> 00:10:51.050 the other hand cryotherapy requires the gas which is sometimes a problem because it is less convenient to prepare for the gas and also sometimes the gas isn't in is inadequate for one case 201 00:10:51.706 --> 00:10:54.988 or maybe it is a bit too much for one case or two cases. 202 00:10:55.329 --> 00:10:57.150 So this is another challenge. 203 00:10:57.870 --> 00:10:58.371 And thirdly, 204 00:10:58.591 --> 00:11:00.052 for the cryotherapy, 205 00:11:00.132 --> 00:11:03.074 because there is a risk of harming the urethra. 206 00:11:03.834 --> 00:11:05.015 So for routine, 207 00:11:05.075 --> 00:11:07.337 we put in the urethra warmer via cystoscopy, 208 00:11:07.837 --> 00:11:10.979 and this is another step which makes the treatment time longer. 209 00:11:11.600 --> 00:11:12.420 So in a way, 210 00:11:12.580 --> 00:11:18.544 I think tachycardia microwave ablation is as good as cryotherapy in killing prostate cancer cells, 211 00:11:18.925 --> 00:11:20.766 but it is much more convenient. 212 00:11:21.118 --> 00:11:21.518 quicker, 213 00:11:21.978 --> 00:11:24.279 much reproducible and to me 214 00:11:24.860 --> 00:11:28.821 I think it is a very convenient and nice way of treating prostate cancer. 215 00:11:29.321 --> 00:11:33.983 And do you have any feedbacks from your patient or could you see a specific impact? 216 00:11:34.784 --> 00:11:44.368 For almost all of my patients they are actually discharged from the hospital around six hours after the operation. 217 00:11:45.428 --> 00:11:49.250 I typically put in a catheter to put in for a few days and they 218 00:11:49.594 --> 00:12:05.425 actually come back a few days later or within a week to take off the catheter and most of them would you know pass urine quite well so for the recovery wise most patients actually feel very good and they do not have you know major complications even 219 00:12:05.445 --> 00:12:18.574 in the first week besides the discomfort of the follies catheter otherwise the patient just feel very very good a little bit of urinary frequency in the first one to two weeks maybe very minor hematuria in a few cases but 220 00:12:19.274 --> 00:12:21.615 overall no major complications so far. 221 00:12:22.996 --> 00:12:34.140 How do you determine which treatment options to offer a patient and do patients have the freedom to choose one option over another based on their preferences or their research? 222 00:12:35.000 --> 00:12:42.564 I think for focal therapy the choice of the energy heavily relies on first the experience of the user, 223 00:12:42.904 --> 00:12:43.644 the availability, 224 00:12:44.084 --> 00:12:48.286 the cost and also last but of course on the least but a tumor location. 225 00:12:49.146 --> 00:12:53.709 So in some hospitals where only one energy is available, 226 00:12:54.330 --> 00:12:59.234 then the doctor or the patient wouldn't have a choice for an alternative. 227 00:13:00.034 --> 00:13:01.075 But in my hospital, 228 00:13:01.495 --> 00:13:05.018 I'm very fortunate that I have three different energies that the patient can choose from. 229 00:13:05.558 --> 00:13:06.219 And therefore, 230 00:13:06.599 --> 00:13:11.403 I can actually choose according to the patient's need and the tumor location. 231 00:13:12.003 --> 00:13:15.806 So I can actually select the most suitable treatment option for them. 232 00:13:16.314 --> 00:13:22.479 It seems like you are now leading a trial in Asia for the use of targeted microwave ablation for prostate cancer, 233 00:13:22.559 --> 00:13:22.799 right? 234 00:13:23.260 --> 00:13:24.621 What are the objectives? 235 00:13:25.341 --> 00:13:25.622 Yes, 236 00:13:26.142 --> 00:13:27.003 it is very exciting. 237 00:13:27.723 --> 00:13:31.006 I've completed 30 cases of targeted microwave ablation, 238 00:13:31.066 --> 00:13:31.426 TMA, 239 00:13:32.087 --> 00:13:32.267 for 240 00:13:33.048 --> 00:13:35.850 30 patients in the past few years. 241 00:13:36.651 --> 00:13:40.254 And now we're embarking on not a single center, 242 00:13:40.394 --> 00:13:45.578 but now a multi-center trial on targeted microwave ablation involving... 243 00:13:45.818 --> 00:13:48.901 a few Asian countries and regions like Hong Kong, 244 00:13:49.221 --> 00:13:49.681 Malaysia, 245 00:13:50.062 --> 00:13:50.682 Philippines, 246 00:13:51.142 --> 00:13:53.224 and a couple of more centers we'll be coming up to. 247 00:13:53.825 --> 00:13:56.507 So we hope to do a bigger trial. 248 00:13:57.047 --> 00:13:58.729 We can't wait to follow the results. 249 00:13:59.169 --> 00:14:00.630 Before we end this episode, 250 00:14:00.991 --> 00:14:04.514 what would you say to convince physicians to perform focal therapy? 251 00:14:05.314 --> 00:14:05.594 To me, 252 00:14:06.455 --> 00:14:08.917 a different treatment option for prostate cancer, 253 00:14:08.997 --> 00:14:10.338 for localized prostate cancer, 254 00:14:10.438 --> 00:14:11.459 they each have its role. 255 00:14:12.100 --> 00:14:12.700 So for me, 256 00:14:12.920 --> 00:14:14.562 I also do robotic prostatectomy. 257 00:14:14.922 --> 00:14:16.703 So in my counseling of the patients, 258 00:14:17.564 --> 00:14:18.184 prostatectomy, 259 00:14:18.785 --> 00:14:19.445 radiotherapy, 260 00:14:19.746 --> 00:14:20.446 and focal therapy, 261 00:14:21.027 --> 00:14:24.569 I will actually talk to them like one by one with the pros and cons, 262 00:14:24.629 --> 00:14:26.511 explain each of them in detail. 263 00:14:27.091 --> 00:14:29.293 So I would not push them into focal therapy. 264 00:14:30.393 --> 00:14:33.376 Some of them actually come to me because they want to do focal therapy, 265 00:14:34.216 --> 00:14:35.617 but for suitable cases, 266 00:14:35.957 --> 00:14:37.098 I would arrange for them. 267 00:14:37.559 --> 00:14:41.081 But some of the cases which are actually not very suitable for focal therapy, 268 00:14:41.281 --> 00:14:42.102 I would actually 269 00:14:42.342 --> 00:14:44.505 advise them to do radical treatment instead. 270 00:14:45.607 --> 00:14:47.730 Whereas some patients who come for robotic surgery, 271 00:14:48.291 --> 00:14:49.252 I would actually talk to them, 272 00:14:49.833 --> 00:14:49.953 oh, 273 00:14:49.993 --> 00:14:51.676 you may be suitable for focal therapy. 274 00:14:52.197 --> 00:14:52.978 So we talk about 275 00:14:53.385 --> 00:15:10.917 the advantages and disadvantages of vocal therapy and let them you know choose for themselves so i think you know to have the information of every single treatment option is important for the patient perfect thank you again so dr fitzschuh for this precise input and for your time and 276 00:15:11.278 --> 00:15:21.385 see you downstairs on the exhibition area bye-bye thank you very much thomas huge thanks to our dedicated listeners if you enjoyed the podcast 277 00:15:21.585 --> 00:15:24.207 make sure to subscribe for more captivating content. 278 00:15:24.787 --> 00:15:26.688 Your support means the world. 279 00:15:28.389 --> 00:15:30.030 If you found this informative, 280 00:15:30.130 --> 00:15:31.210 a quick favor please, 281 00:15:31.531 --> 00:15:32.831 drop up a 5-star review. 282 00:15:33.272 --> 00:15:36.754 Your feedback helps us grow and deliver quality insight. 283 00:15:37.654 --> 00:15:39.275 Have topics you'd love us to cover? 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