WEBVTT 1 00:00:00.108 --> 00:00:02.250 This podcast is created by Coelis. 2 00:00:03.271 --> 00:00:03.971 The challenge is, 3 00:00:03.991 --> 00:00:04.452 first of all, 4 00:00:04.512 --> 00:00:05.813 to get the right patient, 5 00:00:05.833 --> 00:00:09.075 to make a patient selection as good as possible, 6 00:00:09.656 --> 00:00:11.978 which is one of the main drawbacks in focal therapy, 7 00:00:12.198 --> 00:00:20.565 that we have no option to really classify the patient as a patient with a unifocal clinically significant cancer patient. 8 00:00:20.745 --> 00:00:22.466 Most of them are multifocal, 9 00:00:22.586 --> 00:00:23.927 and the better the imaging is, 10 00:00:23.967 --> 00:00:26.109 the better the fusion device is, 11 00:00:26.570 --> 00:00:29.412 the better we will know if this is a patient for focal therapy or... 12 00:00:29.772 --> 00:00:32.093 not but better for a radical treatment. 13 00:00:39.137 --> 00:00:41.539 Welcome to today's episode of Prostatalk, 14 00:00:41.999 --> 00:00:46.542 where we're diving into a topic that makes some folks scream in their seats. 15 00:00:46.982 --> 00:00:50.924 The latest perspectives on prostate cancer treatment in Europe. 16 00:00:51.885 --> 00:00:56.347 Now we know prostate health isn't always a comfortable conversation, 17 00:00:56.447 --> 00:00:57.288 but trust us, 18 00:00:57.808 --> 00:00:59.449 It's time to face it head on, 19 00:00:59.889 --> 00:01:02.191 or should we say sit down for a while. 20 00:01:02.791 --> 00:01:04.453 Today with Professor Ganser, 21 00:01:04.513 --> 00:01:10.737 we will explore groundbreaking innovations that are making prostate cancer treatments less invasive. 22 00:01:11.557 --> 00:01:20.904 Professor Ganser is a German neurologist with extensive experience in the treatment of prostate cancer and a particular interest in focal therapies. 23 00:01:21.624 --> 00:01:24.346 From advanced therapies to the future of diagnosis, 24 00:01:24.746 --> 00:01:26.888 we've got all the info to help keep... 25 00:01:27.168 --> 00:01:28.749 things flowing smoothly. 26 00:01:29.350 --> 00:01:32.673 So whether you're here to stay informed or just love a good Prostatpoon, 27 00:01:33.093 --> 00:01:34.234 you're in the far right. 28 00:01:36.656 --> 00:01:37.457 Hi DataGanzer, 29 00:01:37.937 --> 00:01:39.899 welcome to our podcast Prostatalk. 30 00:01:40.239 --> 00:01:43.102 We are currently attending the DGU Congress in Germany, 31 00:01:43.102 --> 00:01:43.662 in Leipzig. 32 00:01:44.203 --> 00:01:46.324 How are you today and how is the Congress going? 33 00:01:47.185 --> 00:01:47.465 Morning, 34 00:01:48.046 --> 00:01:50.608 I'm fine today and as every year the 35 00:01:51.649 --> 00:01:53.170 DGU Congress is very interesting, 36 00:01:53.451 --> 00:01:53.911 very busy, 37 00:01:54.171 --> 00:01:54.812 very interesting. 38 00:01:55.512 --> 00:01:56.793 topics running parallel, 39 00:01:57.093 --> 00:01:58.675 so I'm quite happy to be here. 40 00:01:59.455 --> 00:01:59.956 Perfect. 41 00:02:00.476 --> 00:02:01.817 Before starting the interview, 42 00:02:01.977 --> 00:02:04.399 could you please present yourself to our listeners? 43 00:02:05.140 --> 00:02:05.320 Yes, 44 00:02:05.400 --> 00:02:06.821 so my name is Roman Ganser. 45 00:02:06.941 --> 00:02:11.545 I'm a urologist and started my training in 2003, 46 00:02:11.545 --> 00:02:13.106 where I started my training at the 47 00:02:13.467 --> 00:02:15.228 University Hospital in Regensburg, 48 00:02:15.849 --> 00:02:18.571 where I was trained for about 10 years. 49 00:02:19.191 --> 00:02:19.652 There I got... 50 00:02:20.660 --> 00:02:24.282 experience and training in the fields of laparoscopy, 51 00:02:24.542 --> 00:02:26.003 but also in Haifu. 52 00:02:26.703 --> 00:02:27.124 These days, 53 00:02:27.204 --> 00:02:33.367 we performed mainly whole gland Haifu and then later switched on to go to focal therapy. 54 00:02:34.268 --> 00:02:41.932 Then I got the chance to switch to Leipzig in 2013 as the vice chair of Professor Stolzenburg, 55 00:02:42.672 --> 00:02:45.514 where I got the chance to get training in robotic surgery, 56 00:02:45.934 --> 00:02:47.035 mainly prostate cancer, 57 00:02:47.035 --> 00:02:48.656 but also other entities. 58 00:02:49.216 --> 00:02:53.537 And I was able to set up a focal therapy plan or fields, 59 00:02:53.637 --> 00:02:57.898 including prostate fusion biopsy with a Coalesce device. 60 00:02:58.338 --> 00:03:02.920 I was very lucky to conduct a multicenter focal therapy study with Haifu, 61 00:03:03.260 --> 00:03:04.820 where we did hemiablation. 62 00:03:05.700 --> 00:03:07.701 And in 2017, 63 00:03:07.941 --> 00:03:11.542 I was able to set up a completely new department in Bad Tölz, 64 00:03:11.702 --> 00:03:12.982 where I'm working right now, 65 00:03:13.182 --> 00:03:14.083 south of Munich, 66 00:03:14.963 --> 00:03:18.044 very nice region in the Alps. 67 00:03:19.424 --> 00:03:22.086 I was very happy to get all the equipment that 68 00:03:22.487 --> 00:03:23.528 I wished I had. 69 00:03:23.668 --> 00:03:24.669 So a robot, 70 00:03:25.249 --> 00:03:28.452 but also a fusion biopsy device. 71 00:03:28.712 --> 00:03:29.713 And yeah, 72 00:03:29.993 --> 00:03:31.515 for a percentage of patients, 73 00:03:31.575 --> 00:03:33.136 we are offering focal therapy there. 74 00:03:34.057 --> 00:03:38.441 Sounds fascinating how many topics like robotic surgery, 75 00:03:38.861 --> 00:03:39.522 focal therapy. 76 00:03:40.062 --> 00:03:41.784 Thanks for this nice presentation. 77 00:03:41.904 --> 00:03:45.827 So let's now talk about prostate and especially focal therapy, 78 00:03:46.007 --> 00:03:46.528 if you want. 79 00:03:46.888 --> 00:03:47.188 First, 80 00:03:47.268 --> 00:03:49.470 could you tell us more about your practice? 81 00:03:50.892 --> 00:03:51.132 Okay, 82 00:03:51.692 --> 00:03:53.954 so my daily practice is quite busy. 83 00:03:54.174 --> 00:03:59.339 So my normal day is packed with four or five operations that I'm doing, 84 00:04:00.059 --> 00:04:02.141 mostly two robotic surgeries, 85 00:04:02.241 --> 00:04:04.964 but also endoscopic procedures. 86 00:04:05.584 --> 00:04:07.446 But on two or three days, 87 00:04:07.486 --> 00:04:14.232 we are doing a lot of fusion biopsies and by the selection of very good MRI. 88 00:04:14.856 --> 00:04:18.339 Around 70% of these patients come back with prostate cancer. 89 00:04:18.439 --> 00:04:24.784 So quite a lot of these patients are seen in our department and need treatment. 90 00:04:24.884 --> 00:04:30.228 So we have the option to offer radical prostatectomy or other options like ectosurveillance. 91 00:04:30.228 --> 00:04:35.972 But also we are trying to find good candidates for focal therapy among these patients. 92 00:04:36.793 --> 00:04:38.374 What kind of therapy are you performing? 93 00:04:38.374 --> 00:04:39.956 You mentioned IFU previously. 94 00:04:40.536 --> 00:04:41.036 On the IFU, 95 00:04:41.197 --> 00:04:44.279 do you perform also with the other energy and what are they? 96 00:04:44.967 --> 00:04:49.109 The field of focal therapy has evolved tremendously during the last years. 97 00:04:49.490 --> 00:04:50.850 We see many technologies, 98 00:04:51.391 --> 00:04:56.514 but the only technology I'm experienced with is HIFU with the Focal One device, 99 00:04:56.974 --> 00:05:00.636 which is a very good technology for mainly treating basal tumors, 100 00:05:01.136 --> 00:05:04.078 tumors at the dorsolateral aspect of the prostate. 101 00:05:04.198 --> 00:05:05.419 But if I had the chance, 102 00:05:05.479 --> 00:05:11.182 I would always recommend somebody who is starting with focal therapy to have another option, 103 00:05:11.242 --> 00:05:12.223 mainly a needle-based. 104 00:05:12.787 --> 00:05:21.113 technology to treat anterior tumors because these are the ones I would not treat with HIFU because they have inferior results, 105 00:05:21.153 --> 00:05:22.994 they have morbidity and so on. 106 00:05:23.054 --> 00:05:26.757 So that's the only technology I'm experienced with that's HIFU. 107 00:05:27.377 --> 00:05:30.779 That's very interesting and I have a practical question about that. 108 00:05:31.260 --> 00:05:35.243 What would you advise to a colleague for example that would like to perform focal 109 00:05:37.071 --> 00:05:41.335 If this colleague has the chance to have a list of devices he needs, 110 00:05:41.415 --> 00:05:42.336 then first of all, 111 00:05:42.716 --> 00:05:45.238 he needs to start with a good diagnostic device, 112 00:05:45.298 --> 00:05:45.658 which is 113 00:05:46.139 --> 00:05:47.680 MRI fusion biopsy device, 114 00:05:48.361 --> 00:05:52.164 or maybe a high-resolution ultrasound device. 115 00:05:53.025 --> 00:05:56.648 Then he needs one technology to perform the treatment. 116 00:05:57.248 --> 00:06:00.011 It doesn't necessarily have to be bought at the beginning. 117 00:06:00.051 --> 00:06:04.535 So there are rental models that are possible to get one of these devices. 118 00:06:05.231 --> 00:06:07.773 If he has the chance to get a second technology, 119 00:06:07.973 --> 00:06:11.736 then he should try to get a needle-based treatment device, 120 00:06:12.316 --> 00:06:15.658 either cryotherapy or IRE or microwave. 121 00:06:15.778 --> 00:06:21.122 One of these needle-based treatments that are performed perineally to treat anterior tumors. 122 00:06:21.142 --> 00:06:25.665 So that's the complete package to perform focal therapy in a good setting. 123 00:06:26.746 --> 00:06:29.068 And you mentioned good fusion biopsy systems. 124 00:06:29.148 --> 00:06:33.150 The challenge is to guide precisely the needle of the energy, 125 00:06:33.531 --> 00:06:33.751 right? 126 00:06:33.951 --> 00:06:34.951 to make a good treatment? 127 00:06:35.691 --> 00:06:35.852 Yes. 128 00:06:35.892 --> 00:06:36.952 So the challenge is, 129 00:06:36.972 --> 00:06:37.452 first of all, 130 00:06:37.492 --> 00:06:38.812 to get the right patient, 131 00:06:38.832 --> 00:06:42.053 to make a patient selection as good as possible, 132 00:06:42.633 --> 00:06:44.974 which is one of the main drawbacks in focal therapy, 133 00:06:45.194 --> 00:06:53.556 that we have no option to really classify the patient as a patient with a unifocal clinically significant cancer patient. 134 00:06:53.736 --> 00:06:55.457 Most of them are multifocal. 135 00:06:55.577 --> 00:06:56.917 And the better the imaging is, 136 00:06:56.957 --> 00:06:59.098 the better the fusion device is, 137 00:06:59.558 --> 00:07:02.979 the better we will know if this is a patient for focal therapy or not. 138 00:07:03.299 --> 00:07:03.459 But... 139 00:07:03.619 --> 00:07:08.503 better for a radical treatment such as prostatectomy or radiotherapy. 140 00:07:08.783 --> 00:07:14.668 So everything starts with good diagnostic workup and for that we need a good radiologist performing good 141 00:07:15.048 --> 00:07:17.410 MRIs that we use for 142 00:07:18.231 --> 00:07:19.332 MRI fusion biopsy. 143 00:07:21.033 --> 00:07:28.600 And do you work with your own radiologist in your hospital or sometimes patients can make their MRI outside of the hospital? 144 00:07:28.760 --> 00:07:32.683 And do you have some issue with that when the patient arrives with this MRI? 145 00:07:33.583 --> 00:07:33.703 Yeah, 146 00:07:33.723 --> 00:07:34.824 so the radiologists, 147 00:07:35.064 --> 00:07:36.245 especially in my department, 148 00:07:36.265 --> 00:07:38.987 they are not experienced with a multi parametric MRI. 149 00:07:39.587 --> 00:07:40.608 But in the neighbor hospital, 150 00:07:40.668 --> 00:07:45.792 we have very experienced radiologists performing a multi parametric MRI since many, 151 00:07:45.832 --> 00:07:46.372 many years. 152 00:07:46.972 --> 00:07:51.155 And they always check with two colleagues for the final result. 153 00:07:51.195 --> 00:07:52.957 And they make very clear reports. 154 00:07:53.437 --> 00:07:56.139 So either it's pirates two or four or five. 155 00:07:56.159 --> 00:08:00.742 So they very rarely classify a patient with a pirates three lesion, 156 00:08:00.842 --> 00:08:01.863 which might be either 157 00:08:02.535 --> 00:08:04.196 BPH or cancer. 158 00:08:04.957 --> 00:08:08.240 So the more often you have a radiologist reporting pyro 3, 159 00:08:08.520 --> 00:08:09.821 the unsafer he is. 160 00:08:10.141 --> 00:08:13.064 So then you should change the radiologist. 161 00:08:13.064 --> 00:08:15.966 So most of our patients are coming from this department, 162 00:08:16.006 --> 00:08:17.688 but as I mentioned, 163 00:08:18.388 --> 00:08:21.711 some come with their own results and they are of differing quality. 164 00:08:22.371 --> 00:08:23.813 So in another way, 165 00:08:24.313 --> 00:08:26.415 it's like a teamwork with the radiologist, 166 00:08:26.595 --> 00:08:27.295 the patients, 167 00:08:27.536 --> 00:08:28.637 and you are urologist, 168 00:08:28.697 --> 00:08:28.897 right? 169 00:08:28.897 --> 00:08:30.278 It is. 170 00:08:30.358 --> 00:08:31.579 And they need feedback. 171 00:08:31.579 --> 00:08:31.839 feedback. 172 00:08:32.039 --> 00:08:36.002 So everybody who wants to start a focal therapy program, 173 00:08:36.082 --> 00:08:42.125 he needs to be in a very good team with the radiologists and everybody needs to learn from the other parts. 174 00:08:42.786 --> 00:08:50.950 And they're very happy if they get the prostatectomy results back to see if their classifications are right or if they have to improve. 175 00:08:51.511 --> 00:08:52.972 So that is very important for the beginning. 176 00:08:53.392 --> 00:08:54.372 And according to you, 177 00:08:54.533 --> 00:08:58.435 why should urologist offer focal therapy option to their patients? 178 00:08:59.367 --> 00:09:04.989 Because not every patient is either an active surveillance candidate or a candidate for a radical treatment. 179 00:09:05.149 --> 00:09:07.869 Patients get older and the older they get, 180 00:09:08.109 --> 00:09:12.331 the worse the side effects might be following radical treatment. 181 00:09:12.751 --> 00:09:15.471 No matter how good you're doing the surgery, 182 00:09:16.112 --> 00:09:23.734 continence will decrease with rising age because of decreasing muscle strength of the pelvic floor and so on. 183 00:09:24.334 --> 00:09:26.274 So younger patients definitely run better, 184 00:09:26.414 --> 00:09:27.995 run very good today if you're doing the 185 00:09:28.335 --> 00:09:30.776 the da Vinci prostatectomy in a high quality, 186 00:09:31.356 --> 00:09:33.317 but older patients will have some leak, 187 00:09:33.737 --> 00:09:36.098 no matter how good you are at the surgeon. 188 00:09:36.459 --> 00:09:37.419 And these are the patients, 189 00:09:37.459 --> 00:09:38.640 in my opinion, 190 00:09:38.720 --> 00:09:46.383 that might prefer from a treatment which either cures the patient or which turns the clock back. 191 00:09:47.354 --> 00:09:54.476 which reduces the aggressiveness of the tumor and either cures him or gets him into an active surveillance patient. 192 00:09:55.157 --> 00:09:59.158 And these are the candidates that should offer such a treatment. 193 00:09:59.558 --> 00:10:02.059 It's not a treatment as an alternative to active surveillance, 194 00:10:02.739 --> 00:10:06.240 but it's an alternative to any radical treatment. 195 00:10:07.100 --> 00:10:08.581 So it's no psychotherapy, 196 00:10:08.901 --> 00:10:10.221 it's a cancer treatment, 197 00:10:10.261 --> 00:10:12.142 what we have to do with focal therapy. 198 00:10:13.106 --> 00:10:15.167 You put the patient before your practice, 199 00:10:15.187 --> 00:10:23.650 I mean it depends on the patient and the stage of his disease that you will choose active surveillance or radical prostatectomy or focal therapy. 200 00:10:23.950 --> 00:10:25.651 So it's all matters about patient, 201 00:10:25.711 --> 00:10:25.911 right? 202 00:10:26.311 --> 00:10:26.472 Yes. 203 00:10:26.692 --> 00:10:26.872 Okay. 204 00:10:27.192 --> 00:10:30.533 What is the situation in Germany or in Europe in general? 205 00:10:30.613 --> 00:10:31.273 I mean today, 206 00:10:31.354 --> 00:10:37.116 do you have any special program for focal therapy like reimbursement for example, 207 00:10:37.896 --> 00:10:42.018 or was it missing to make this type of program available in Germany? 208 00:10:42.970 --> 00:10:46.352 We have different situations in European countries. 209 00:10:46.452 --> 00:10:47.893 We have a reimbursement for 210 00:10:48.673 --> 00:10:50.254 HIFU treatment in Germany. 211 00:10:50.974 --> 00:10:53.956 There is a recommendation in France for reimbursement, 212 00:10:54.096 --> 00:10:58.198 which was spoken in 2023, 213 00:10:58.198 --> 00:11:00.179 but there's no decision yet. 214 00:11:00.680 --> 00:11:04.081 There's a reimbursement since last year in Switzerland for 215 00:11:04.722 --> 00:11:06.363 HIFU and focal treatment, 216 00:11:06.463 --> 00:11:11.586 which is about half the reimbursement compared to a radical prostatectomy treatment, 217 00:11:11.646 --> 00:11:12.206 but which is... 218 00:11:12.646 --> 00:11:27.556 enough to cover all the costs and i'm not sure about the situation in in the uk with the nhs but they are doing a lot of haifu and focal treatments there but in germany it's only what 219 00:11:27.576 --> 00:11:41.666 i'm what i'm saying it's only for haifu so i'm not sure about all the other new technologies such as ire such as laser such as microwave there's as far as i know there's no reimbursement situation for that 220 00:11:42.226 --> 00:11:45.107 So these patients should go into any study protocol, 221 00:11:45.868 --> 00:11:47.968 mainly at university departments, 222 00:11:48.509 --> 00:11:49.249 hospital departments. 223 00:11:49.289 --> 00:11:51.510 But I think in the normal setting, 224 00:11:51.890 --> 00:11:55.211 it's difficult to get these patients reimbursed. 225 00:11:55.772 --> 00:11:58.913 And are you part of some research program on your side? 226 00:11:59.293 --> 00:12:01.934 Do you work with other physicians on this subject? 227 00:12:02.554 --> 00:12:06.176 We finished a multicenter study in 2017. 228 00:12:06.536 --> 00:12:08.137 All these results are published, 229 00:12:08.177 --> 00:12:11.018 but our intention is to make a new follow up. 230 00:12:11.558 --> 00:12:16.602 investigation on these patients to see what happens after seven and eight years of these patients. 231 00:12:17.282 --> 00:12:20.044 Our patients are included in the registry right now, 232 00:12:20.144 --> 00:12:23.226 but there's no prospective study that we are doing right now. 233 00:12:24.267 --> 00:12:24.447 Okay, 234 00:12:24.487 --> 00:12:24.907 perfect. 235 00:12:25.668 --> 00:12:26.588 And Professor Ganza, 236 00:12:26.709 --> 00:12:29.951 how do you see the treatment of cancer in the future? 237 00:12:30.511 --> 00:12:32.673 How will technology help physicians? 238 00:12:32.713 --> 00:12:35.174 Will patients be more educated about it? 239 00:12:35.975 --> 00:12:37.936 Will focal therapy become a standard of care? 240 00:12:38.517 --> 00:12:40.358 What is your vision of that? 241 00:12:41.186 --> 00:12:41.366 Yes, 242 00:12:41.807 --> 00:12:47.371 I think many aspects will change and improve in the future and maybe in the near future. 243 00:12:47.371 --> 00:12:48.152 So first of all, 244 00:12:48.713 --> 00:12:52.836 starting with screening and classification and imaging. 245 00:12:53.657 --> 00:12:54.918 So let's start with imaging. 246 00:12:54.998 --> 00:13:01.984 I think that multi-parametric MRI will be added by other imaging modalities like PSMA PET 247 00:13:02.484 --> 00:13:05.747 CT scan and by artificial intelligence. 248 00:13:05.947 --> 00:13:08.610 Especially MRI has a very high... 249 00:13:09.154 --> 00:13:11.316 inter-observer variability. 250 00:13:11.896 --> 00:13:12.757 If you look at the results, 251 00:13:12.777 --> 00:13:19.061 there are studies showing that the same tumor is classified completely different among experienced radiologists. 252 00:13:19.561 --> 00:13:25.346 And we have AI platforms that really show better results than the radiologists. 253 00:13:25.946 --> 00:13:30.009 So I think that this will be the future of imaging. 254 00:13:30.629 --> 00:13:32.430 When we perform better biopsies, 255 00:13:33.371 --> 00:13:36.934 there will be probably help for the pathologists to 256 00:13:37.474 --> 00:13:38.835 to classify the tumor, 257 00:13:39.395 --> 00:13:45.880 probably also by artificial intelligence to classify the tumor as aggressive or not. 258 00:13:46.781 --> 00:13:52.605 And there will be genetic testing for the patients to see like the BRCA mutation, 259 00:13:52.845 --> 00:13:53.605 BRCA1 or 2, 260 00:13:54.326 --> 00:13:58.289 to classify the patient having an aggressive or less aggressive cancer. 261 00:13:58.809 --> 00:14:04.333 And this will probably improve classifying patients for either being candidates for active surveillance, 262 00:14:04.573 --> 00:14:05.214 focal therapy. 263 00:14:05.958 --> 00:14:06.939 or radical treatment. 264 00:14:06.959 --> 00:14:09.021 So I think there will be a lot of improvement. 265 00:14:09.381 --> 00:14:14.245 I'm not quite sure if technology of focal treatment devices will improve a lot. 266 00:14:14.645 --> 00:14:15.526 That's my great wish. 267 00:14:15.606 --> 00:14:16.967 But if we look at HIFU, 268 00:14:17.267 --> 00:14:19.869 the devices are like 10 years or older. 269 00:14:20.510 --> 00:14:23.192 I don't see too much technical improvement. 270 00:14:23.893 --> 00:14:29.777 And a lot of other technologies coming on the market like microwave or IRE, 271 00:14:30.538 --> 00:14:31.599 they have the potential, 272 00:14:31.779 --> 00:14:34.021 but let's see what the future brings. 273 00:14:34.041 --> 00:14:35.122 So I'm not quite sure if... 274 00:14:35.462 --> 00:14:37.165 focal therapy will become standard. 275 00:14:37.646 --> 00:14:47.242 So it's my great wish to have focal therapy somewhere in between radical treatment and for some patients also at this point, 276 00:14:47.502 --> 00:14:50.147 but I'm not quite sure if this will become a clear standard. 277 00:14:50.859 --> 00:14:51.059 Okay, 278 00:14:51.419 --> 00:14:54.220 thanks a lot for your time and for your answer, 279 00:14:54.460 --> 00:14:54.960 Prosegenza. 280 00:14:55.520 --> 00:14:59.462 What are your next plans now and new studies in the pipeline? 281 00:15:00.202 --> 00:15:00.322 Yes, 282 00:15:00.342 --> 00:15:01.462 so what I told you, 283 00:15:01.962 --> 00:15:06.404 we had our meeting with the German working group on focal therapy yesterday, 284 00:15:07.004 --> 00:15:07.564 our session, 285 00:15:07.824 --> 00:15:09.945 and we were discussing about these projects. 286 00:15:10.205 --> 00:15:11.725 We want to follow up these, 287 00:15:12.306 --> 00:15:16.087 it was 51 patients being treated in the HEMI study. 288 00:15:16.847 --> 00:15:23.512 which was the largest prospective multicenter study on focal therapy in Germany with a very clear follow-up. 289 00:15:23.572 --> 00:15:28.135 So we had about 95% of these patients having re-biopsies. 290 00:15:28.435 --> 00:15:30.717 And I'm very interested in the question, 291 00:15:30.877 --> 00:15:33.679 what happened to these patients seven or eight years or even longer, 292 00:15:34.279 --> 00:15:35.740 who received radical treatment, 293 00:15:35.800 --> 00:15:38.182 who is fine with focal treatment? 294 00:15:38.542 --> 00:15:45.507 Because a limitation of most of the studies and technologies that we see in the literature is that the follow-up is not beyond 12 months. 295 00:15:46.279 --> 00:15:48.120 So these are mostly feasibility studies, 296 00:15:48.460 --> 00:15:51.202 but to know where the place of focal therapy is, 297 00:15:51.362 --> 00:15:54.464 we need to know what is 10 years after a treatment. 298 00:15:55.065 --> 00:15:56.826 Is it really turning the clock back, 299 00:15:57.406 --> 00:16:01.609 or is it just some treatment which fails after a certain time? 300 00:16:02.149 --> 00:16:03.890 So I think that's a very important step, 301 00:16:04.150 --> 00:16:06.152 even if the results will be disappointing. 302 00:16:06.172 --> 00:16:07.713 I'm not quite sure about that. 303 00:16:08.393 --> 00:16:09.754 But what we know, 304 00:16:09.894 --> 00:16:11.195 these patients had 305 00:16:11.695 --> 00:16:17.577 much worse inclusion criteria and imaging and biopsy compared to what we have now as a standard. 306 00:16:18.137 --> 00:16:24.959 I think these data will be important and might serve as a reference for upcoming studies, 307 00:16:25.299 --> 00:16:26.979 which have much better results. 308 00:16:27.399 --> 00:16:30.040 So we can't wait to follow these projects. 309 00:16:30.080 --> 00:16:34.861 And I hope we will see you back here for presenting these projects. 310 00:16:35.262 --> 00:16:36.522 Before ending this interview, 311 00:16:36.702 --> 00:16:39.303 I like to ask my guest a surprise question, 312 00:16:39.703 --> 00:16:40.343 Professor Genza. 313 00:16:40.363 --> 00:16:40.723 Thank you. 314 00:16:41.087 --> 00:16:42.588 What is your song of the moment? 315 00:16:43.749 --> 00:16:46.131 I'm a fan of classical music because I play the cello. 316 00:16:46.431 --> 00:16:47.792 So especially here in Leipzig, 317 00:16:49.994 --> 00:16:52.136 I was working here for four years and as a student, 318 00:16:52.316 --> 00:16:55.978 and I was joining a lot of the concerts in the Gewandhaus. 319 00:16:56.099 --> 00:16:58.480 I was a fan of the Gewandhaus Orchestra, 320 00:16:59.041 --> 00:17:00.202 but that's like a hobby for me. 321 00:17:00.342 --> 00:17:02.563 So I'm also interested in jazz music. 322 00:17:02.684 --> 00:17:03.824 And when I'm cycling, 323 00:17:04.285 --> 00:17:06.947 I also listen to trance and motivating music. 324 00:17:07.323 --> 00:17:11.684 But I can't give you a question on that final special favorite song right now. 325 00:17:12.104 --> 00:17:12.805 Thank you so much. 326 00:17:13.325 --> 00:17:14.285 Thanks again for your time. 327 00:17:14.305 --> 00:17:20.027 And I hope you like the exercise and feel free to visit us again in this podcast. 328 00:17:20.427 --> 00:17:21.867 So thank you very much for inviting me. 329 00:17:22.307 --> 00:17:23.047 It was a pleasure. 330 00:17:23.167 --> 00:17:23.508 Thank you. 331 00:17:23.868 --> 00:17:24.228 Thank you. 332 00:17:25.628 --> 00:17:28.109 Huge thanks to our dedicated listeners. 333 00:17:28.569 --> 00:17:30.129 If you enjoyed the podcast, 334 00:17:30.329 --> 00:17:32.950 make sure to subscribe for more captivating content. 335 00:17:33.530 --> 00:17:35.451 Your support means the world. 336 00:17:37.135 --> 00:17:38.776 If you found this informative, 337 00:17:38.876 --> 00:17:39.957 a quick favor please. 338 00:17:40.277 --> 00:17:41.418 Drop up a 5-star review. 339 00:17:41.478 --> 00:17:46.402 Your feedback helps us grow and deliver quality insight. 340 00:17:46.402 --> 00:17:48.023 Have topics you'd love us to cover? 341 00:17:48.423 --> 00:17:51.805 Share your ideas in the comments or connect with us on social media. 342 00:17:52.426 --> 00:17:55.268 Your input guides the future of Pros.Talk. 343 00:17:55.768 --> 00:17:58.530 Thanks for being a crucial part of our community. 344 00:17:59.451 --> 00:18:01.072 For more urology insights, 345 00:18:01.412 --> 00:18:02.553 visit collies.com. 346 00:18:02.953 --> 00:18:05.055 Stay tuned and see you next time.