This podcast is created by Coelis.
In my vision of the future,
in my dream,
I foresee the integration of several advanced imaging technologies such as multi-parametric MRI,
PSM-APET and micro-ultrasound.
Hello and welcome to Prostatalk.
Get ready to embark on a fascinating journey into the future of prostate cancer screening.
Trust me,
it's gonna be to be more exciting than a sci-fi movie.
Today,
we are diving into the lightest and greatest in prostate cancer diagnoses techniques with our Belgium guest,
Dr.
Romain Diamant.
We will explore the dynamic duo of cutting-edge technologies and skilled urologists.
Think of it as Batman and Robin,
but with doctor's coats and high-tech machines.
We'll also take a peek into the crystal ball to see how this innovation will evolve in the coming years.
Spoiler alert,
the future looks bright!
So sit back,
relax and let's talk about the amazing streets we are making in prostate health.
Because when it comes to early detection and treatment,
we are definitely not kidding around.
Stay tuned and let's get started.
Good morning,
Dr.
Diamant.
We are really pleased to welcome you to our podcast,
Prostatalk.
How are you today?
I am well,
thank you,
and happy to be here with you.
Before to start this interview,
I would like to know who is Dr.
Diamant.
Could you please tell us a bit about yourself?
So I am Romain Diamant,
urologist and associate professor at the Jules Bourdais Institute,
a comprehensive cancer center in Belgium.
since 2020.
My specialities include urologic oncology and robotic surgery with a research focus on MRI targeted biopsy and prostate cancer diagnostic and treatment.
I became a fellow of the European Board of Urology in 2021 and completed my PhD in 2023 which focused on MRI targeted biopsy and prostate cancer risk assessment.
This work was recently rewarded by the Royal Society of Medicine which is
A very good news for me and for my team.
I treat patients with prostate cancer and bladder cancer.
I perform robotic-assisted radical prostatectomies and cystectomies,
do transrectal and transpirinal MRI-targeted biopsy,
supervise clinical research on prostate cancer,
and mentor young fellows in clinical practice and research.
I also want to take the opportunity to congratulate you on receiving the prestigious
Henri Fauconnier and Jeanne-Marie François
academic award from the Royal Academy of Medicine of Belgium just a few weeks ago at the time of this interview.
For our listeners,
this award recognizes work aimed at cancer treatment and,
in a way,
marked the culmination of your PhD in medical sciences.
Could you please tell us more about this award,
what it means to you and especially how it serves as a springboard for your research?
So thank you and this reward is here to reward
The best work in cancer and it gives us the opportunity to have more fun and more legitimacy to do more research in the future with my team.
So it's a very good news for us and for the patient,
obviously.
Congrats.
Could you explain to us what is the landscape of the prostate cancer in Belgium?
Do you have any reimbursements,
specific screening plans?
So prostate cancer is a significant health issue in Belgium,
being the most commonly diagnosed cancer among men.
with an incidence of more than 11,000 new cases in 2021,
surpassing even breast cancer.
In Belgium,
the ILS-Care system provides reimbursement for many aspects of prostate cancer care.
This includes obviously tests like PSA,
but only for screening in case of positive family history and post-treatment follow-up.
In other cases,
the cost of PSA testing is approximately
11 euros.
Reimbursements also cover multi-parametric MRI
and prostate biopsy but there is no specific nomenclature for targeted biopsy.
Viro-treatment options such as surgery and radiation therapy are also reimbursed.
Unfortunately,
Belgium does not have a national prostate cancer screening program.
However,
opportunistic screening is very common where PSA testing is performed during routine health check-ups for men,
particularly those over the age of 50 or younger in case of genetic mutation or African origin.
We have also dedicated training structures such as the Cancer Prevention and Screening Center at Jules Baudet Institute that offer a cancer risk assessment service for all men.
How do you take part of it?
I mean,
how do you push to your own way,
like a specific reimbursement or specific new screening plan,
for example?
Yes,
obviously,
I deal with screening,
treatment and follow-up for my patients.
Our department of urology is deeply involved in advocating for the establishment of a new nomenclature,
especially to secure reimbursement for targeted biopsy.
Additionally,
we are dedicated
to promoting the implementation of a national screening program for prostate cancer in Belgium and across Europe.
This morning,
I had the chance to assist to a focal therapy session.
It was a TMA procedure,
a targeted microevabulation.
Could you please explain to our listeners what is it?
So TMA used a microwave energy to eat and destroy cancer cells in the prostate gland.
A dedicated probe is placed transrectally or transparently into the prostate under ultrasound guidance.
using 3D MRI ultrasound fusion technology combined with real-time prostate tracking.
This approach precisely targets and kills MRI lesion and prostate cancer cells while minimizing damage to LCA tissue.
One of the significant advantages of this thermoablative technique is that the procedure is performed under mild sedation,
allowing patients to go home the same day and recover very quickly.
Additionally,
if treatment failure occurs,
Radical treatment can still be performed afterward without difficulty,
for example for the dissection of the neurovascular bundle as demonstrated in our recent ABLET and RESECT study Faustine 1b.
They are very promising results with TMA and we are very involved in the recent multicentric study VIOLETS evaluating the treatment's efficacy including a biopsy control one year after treating isolated grade 2 prostate cancer.
We have observed
a real enthusiasm among patients benefiting from this treatment.
This enthusiasm has made our center one of the most active in studio recruitments,
allowing us to include more patients than initially planned.
Wow,
well done.
Thanks for these precisions.
Dr.
Diamant,
well,
when I was preparing this interview,
I have noticed that you do a lot of researches and you mentioned your recent research and publication about TMA,
for example,
but also about many other topics,
all in prostate field,
obviously.
I assume that you have a particular interest in innovation and disruptive technique,
right?
Yes indeed,
my involvement in ClinCa research is driven by two main objectives.
Firstly,
I aim to respond to the daily questions and challenges that urologists have in their daily practice.
Recently,
my team has published several papers on optimal biopsy templates.
These include for example the exact area to target within the MRI lesion,
determining the optimal number of targeted biopsy cores,
evaluating the added value of sampling the periliginal area,
and assessing the role of systematic biopsy based on the location of MRI lesion.
Additionally,
we have published numerous papers on using biopsy information in multivariate models to predict outcomes such as the risk of lymph node invasion,
the risk of extraprostatic extension,
and the risk of unfavorable disease in active surveillance cores.
These research efforts were made
possible by a large network of friends and colleagues among several European centers,
both academic and private,
over several years.
To date,
approximately 27 European centers have participated in at least one of our studies,
and we have collected data from over 5,000 patients diagnosed by MRI-targeted biopsy and approximately 3,000 who underwent radical prostatectomies.
And stop me if I'm wrong,
Dr.
Diamant,
but your recent study on prostate cancer diagnosis examined the impact of transitioning from transrectal to transperineal biopsies,
focusing on their effectiveness and clinically significant concern detection rate.
This somewhat goes against the grain of those advocating exclusively for transperineal biopsy and abandoning the transrectal approach.
Could you present the main findings of your research?
and their implications for the future diagnosis practice.
So we did research on a large cohort of patients in Europe and we found that a transparent approach gives us better accuracy and detection rate for prostate cancer.
Obviously,
we need level 1 evidence with randomized trials and we have no data on that actually.
The recent data show that maybe the risk of complication and more particularly the infection one is that the risk of complication is higher
It's not very different between the two approaches,
but at one condition,
that transperinale biopsy is no longer associated with antibiotics.
So I think that in terms of antibiotics problem and resistance,
it's better to switch to transperinale.
But in terms of detection,
we have some data that shows that maybe transperinale is associated with better outcome,
but we need more 11.1 evidence.
Okay,
good.
That brings me to my next question.
How do you see the diagnostic pathway of prostate cancer in the next few years?
Over the next few years,
we can expect significant advancements in diagnostic prostate cancer,
but this is a very complex issue.
Firstly,
better imaging technique will play a crucial role.
Improvements in multi-parametric MRI protocols will offer more precise imaging,
helping physicians better identify and target biopsy areas.
This improves image quality and for example we have the PQAL score that gives us an information regarding the image quality,
the radiologist expertise with precise criteria to define how a radiologist is considered as an expert and the biopsy procedure itself depending on the expertise of the physician who performs the biopsy and the biopsy platform obviously.
Additionally combining PSMF
PET and MRI is expected to become a standard tool in my opinion.
This approach will help to detect and locate prostate cancer more accurately,
identifying significant cancer and reducing unnecessary biopsy.
We will also have better ultrasound probes with improved image resolution,
particularly with the generalization of micro-ultrasound platforms.
Secondly,
biomarkers and liquid biopsy will revolutionize early detection and monitoring.
We will see new blood and urine tests based on genomic biomarkers that can detect prostate cancer in high accuracy.
Finally,
artificial intelligence will significantly impact diagnostic pathway.
AI-driven imaging analysis will improve the interpretation of imaging studies,
making diagnoses more accurate and consistent.
I expect that prostate and suspicious lesion will be automatically delineated for biopsy.
Predictive models developed through AI will assess individual patient risk using a combination of clinical,
imaging and molecular data,
leading to more personalized and precise diagnostic pathways.
Does that mean that PSA tests,
high-quality MRI or,
I don't know,
even a urine exam will be enough to diagnose prostate cancer?
Not necessarily.
I think there's many,
many new technologies that will be there in the diagnostic pathway.
and the combination of all this data will improve and personalize the diagnostic pathway.
Interesting.
So taking into account all this information,
for you,
what will be the biopsy of the future?
So in my vision of the future,
in my dream,
I foresee the integration of several advanced imaging technologies,
such as multi-parametric MRI,
PSM-APET,
and micro-ultrasound.
These modalities,
each offering unique strengths in detecting
prostate cancer lesion will work synergistically.
Artificial intelligence will automate detection and delineation of the prostate with suspicious lesion.
Real-time evaluation of biopsy trajectory will further enhance accuracy with systems signaling any deviation for immediate correction.
I believe systematic biopsy will no longer be necessary,
resulting in shorter procedures.
How soon do you think these biopsies of the future will be available to doctors and beneficial for patients?
The technologies of MRI,
PSMA PET and micro-ultrasound are already available individually.
Artificial intelligence has shown promising results,
such as a recent study by Saha in the Lancet Oncology demonstrating improved diagnostic abilities compared to radiologists.
However,
integrating these technologies into a clinical trial is not possible.
cohesive system present a significant challenge in a competitive market driven by financial interest.
Achieving the biopsy of the future will require open source data and technologies along with extensive collaboration and dedication.
I am hopeful that with enough motivation and effort we can make these integrated technologies accessible within the next decade.
I hope.
So I want to jump to a topic that you mentioned previously.
In a world where artificial intelligence,
robotic surgery or any technologies are taking more and more space,
how do you see the collaboration between physicians and especially urologists and technology in the future?
AI will significantly enhance urologist abilities.
It will help us interpret imaging studies more efficiently and create personalized treatment plans for each patient.
Given that,
future cooperation will be fundamental.
Urologists will work closely with engineers,
data scientists,
and software developers to innovate and refine technologies specific to urological cares.
Continuous education will be crucial.
Urologists must stay updated with the latest technology and undergo specialized training to integrate this technology and innovation effectively.
In the episode 3,
we asked Dr.
Michael Lees from San Antonio,
Texas,
about his opinion about AI.
For him,
AI is very interesting and it's going to be,
I mean,
like a big shift and it's going to change medicine for sure.
Are you OK with that?
I totally agree with Assumption that AI will be a real revolution in our daily practice in terms of the prediction of prostate cancer and for the daily practice with image analysis and treatment solutions.
So,
yes,
it will be a big shift in our practice.
And how does this progress and changes are impacting your daily work and how this will impact on patients?
As a neurologist and researcher,
I've seen how new technologies are becoming more complex to adopt and understand.
While we develop new ways to diagnose and treat patients,
it's crucial for us to work closely with engineers.
Our main challenge is to create straightforward and easy-to-use interfaces that everyone can use to benefit from our research.
Do you have any tips?
our advice is to give to our listeners who don't know how to handle the progresses or the one who fears about technology.
As I mentioned,
developing these technologies is complex,
but not everyone needs to understand all the details,
I think.
What matters most is how to reuse them practically and they add real added value in daily practice.
The goal of all this advancement is simple,
to improve patient care and quality of life by reducing over-diagnostic and over-treatment.
There are more and more training courses,
especially during international meetings such as the EAU or AUI congresses,
where experts share their knowledge.
It's normal to feel a bit worried about this change,
but humans will be still crucial in the diagnostic and treatment process.
Thank you,
Dr.
Diamant.
Talking about future,
could you tell us what are you working on and what are your next plans?
Well,
my question is a bit leaning because
I've heard that you want to establish a prostate clinic.
Is that true?
Yes,
that's true.
This is a project with our department and with our hospital,
but we are just at the beginning of this project.
So I will give you more detail in the future.
And regarding the next research project,
as I said,
my main project focuses on evaluating the benefit of PSMH-PetMRI for patients with uncertain cancer risk and developing AI-based prediction models.
We have a strong collaboration with...
AI units at the University Health Network and CNA systems in Toronto,
where we are actively working on several AI models.
In my next research,
I plan to improve surgical procedure for better evaluating prostate cancer detection during surgery,
aiming to reduce the risk of positive margin.
We are exploring new methods like rapid
3D PET imaging,
confocal microscopy,
and fluorescence imaging.
This is one of many projects we can...
take part so I hope we'll have new response in the next day or years.
Great,
we can't wait to follow these projects.
I have a last question,
like a surprise question,
sorry for that Dr.
Diamant.
What is your song of the moment?
Very good question.
I'm from France,
as a French guy I like some French band like Justice.
So the last one I heard every morning,
the morning to have energy before working.
is never under from justice.
Okay,
really good choice.
Thanks again for your time and this precious information.
We hope you enjoyed the exercise.
And I give you the next invitation to few months few few years about your clinic projects.
With pleasure.
Thanks.
Thank you.
Bye bye.
Thanks a lot.
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