WEBVTT

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This podcast is created by Coelis.

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I think screening is important because if you detect it early,

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then we have a lot more options.

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So as we detect it later,

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you know,

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if it's metastatic,

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we can't technically cure prostate cancer.

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Prostatalk.

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Welcome to Prostatalk,

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your go-to destination for all things prostate cancer.

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I'm your host,

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Thomas.

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And today we are diving deep into the world of prostate cancer screening,

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a topic that's not only important but also incredibly nuanced.

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Joining us for today's discussion is none other than

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Dr. Michael Lees,

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a leading authority in prostate cancer care.

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Dr.

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Lees is a dedicated specialist who spent years refining his approach to early screening and emerging quality.

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In this episode,

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we will explore why early detection is crucial in the fight against prostate cancer.

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and why that quality of diagnostic images can make the difference.

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So,

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buckle up and get ready for some invaluable insight.

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Hello Dr.

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Lys,

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welcome to Prostatalk.

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First,

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I would like to mention that I was extremely lucky to take part in your workshop that you organized at the University Health here in San Antonio,

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Texas.

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Can you tell us a bit about

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the day and what motivated you to lead this type of educational event with your peers?

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Sure.

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Thank you very much for inviting me today.

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Always happy to talk about prostate cancer and awareness.

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So we had a workshop yesterday with the Coelis device.

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It's a very interesting way to do the biopsies in that it has a 3D ultrasound,

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which allows me to target tumors more accurately.

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So it's a newer technology that's coming out,

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so not the exposure.

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is what we wanted to look at.

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So we had some doctors come in early.

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I did a dry run first.

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We're getting everything ready.

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We had the patients come in.

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I alerted the patients that we had other urologists there.

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They were very happy to see that,

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you know,

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urologists are teaching other urologists.

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So they're very comfortable with everything.

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Our room was great.

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We had some big screen TVs so everyone could see what was going on.

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I wanted them to be there in the room early to see the setup.

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How do we set it up?

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Some of the targeting,

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how do we circle the...

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images and how do we target the lesions differently.

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So we had 10 biopsies that day,

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actually,

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that they were willing to stay for some of those,

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get some hands-on experience in another room.

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It was a really great day overall.

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Sounds like a really good day of procedures and physician education.

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Before getting to the heart of the matters,

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let's start with having you tell us a bit about yourself,

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your background,

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and your current urology practice.

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Sure.

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Well,

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I'll start back even farther.

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So my grandfather had prostate cancer.

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when I was in medical school,

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which really guided that.

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Those discussions back then really guided how I thought about prostate cancer.

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Is anybody doing about this?

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And how did he even know to get his screening test?

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And maybe that could have been done earlier.

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He ended up having surgery and things like that.

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So some of those discussions drove me to say,

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okay,

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we need to do something about early detection and education and advocacy for prostate cancer.

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So I joined a lab,

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started doing research.

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I did my residency at UC Irvine in California,

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a fellowship specifically in cancer at the University of California,

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San Diego,

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and then moved to San Antonio about 10 years ago,

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getting to work with leaders in the field like Ian Thompson,

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who did the prostate cancer prevention trial and things like that.

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So really getting into how do we do clinical trials and how do we change the field of prostate cancer.

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My practice here is mostly prostate cancer at this point,

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fusion biopsies,

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MRI.

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and surgical options for prostate.

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Perfect.

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In my research leading up to this conversation,

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I came across an educational video you did on understanding prostate cancer.

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It was clear that you firmly believe in early screening as an important step in the management of prostate cancer.

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Can you speak a bit about that?

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I think screening is important because if you detect it early,

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then we have a lot more options.

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So as we detect it later,

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if it's metastatic,

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we can't technically cure.

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prostate cancer.

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So we can cure it if we find it earlier,

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and that man has more options.

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So we know there's a lot of controversy behind PSA testing,

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and that I think we need to be careful about not just throwing away the PSA test,

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because it's actually one of the best biomarkers.

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I mean,

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other cancers would love to have a biomarker that could detect a cancer early.

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So a lot of it is adjusting the knowledge that we get from screening.

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and then appropriately doing procedures on men who need it,

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right?

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Double checking the PSA.

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So

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I try to tell people not to be afraid of the test.

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We have to get the test and then knowledge is power.

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And then we use that knowledge to risk assess.

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that patient on whether they need more procedures or not.

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And so,

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sure,

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it's going to be changing all the time,

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and we need to stay up and still continue to push the field on how we diagnose prostate cancer.

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But I think that really thinking about it,

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and if you haven't been checked before,

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asking your doctor and having that discussion about it.

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And if you're a partner,

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you need to tell your partner,

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hey,

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let's talk about it with the doctor.

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Yeah.

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And do you think that improved screening and prevention measures for prostate cancer could

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potentially reduce healthcare expenditures and the costs associated with patient management and treatment,

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considering that early detection leads to better patient outcomes and may prevent the need for radical interventions such as prostatectomy.

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I think most of the costs related to cancer is usually at the very end,

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chemotherapies and immunotherapies that are coming out.

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And so if we detect it late,

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and that's our only option,

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the costs really will be driven up.

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So if we can find the tumors early,

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some of them can just be monitored,

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and some of them,

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we may need to do prostatectomy or radiation,

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but if we can stop it in its tracks and stop the progression,

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in the end,

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I think the costs would be lower.

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So early detection,

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again,

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is winning,

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not only for your options,

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but cure rates are better,

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and cost in the long run would probably be better as well.

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Perfect.

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And in my previous question,

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I mentioned prostatectomy.

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But here are a number of treatment options for men that have been diagnosed with prostate cancer.

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Could you tell us more about these options and what they are and now treatment types are determined?

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I usually describe that there's about four buckets of interventions that we could do.

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The first one would be active surveillance or just monitoring.

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So if you have low-grade cancer,

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we may talk about this.

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And that's a really hard pill for some men to swallow.

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I have cancer and then we're going to monitor it.

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But we have a lot of data on this,

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and it's very safe to do as long as you're following the protocols.

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The next bucket would be focal therapy,

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and that's where early detection comes in.

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If it's too advanced,

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then focal therapy would not be an option.

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But focal therapy is essentially using some type of energy to focus the treatment of a tumor in the location of a prostate and hopefully avoid some of the side effects of more advanced treatments.

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The next one would be prostatectomy.

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And I think that's still a very,

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very good option.

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We have a lot of high-risk men with localized prostate cancer.

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And then there's radiation therapy as well.

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And of these buckets,

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we have to look at,

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okay,

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what's your stage?

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What's your risk profile?

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What's the size of the tumor?

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And then in radiation and surgery,

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have you had previous surgery before?

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Or do you have inflammatory bowel disease?

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And maybe you shouldn't,

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they want to avoid radiation therapy.

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So it's not there's a right answer.

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It's that we have to look at all the data.

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and we're making a team decision on what your care would be.

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Very interesting hearing that here are a number of options available for men in various stages of this disease.

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I would like to get back to the diagnosing stage.

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Upon screening results,

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a man may need to undergo biopsy procedures to confirm whether cancer is present.

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Historically,

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this has been done by what is known as a transrectal technique.

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Today,

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we are hearing more and more about the transperineal approach.

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and we are seeing a number of urologists adopt this newer technique.

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It is my understanding that you have adopted the transperineal approach for your prostate biopsies.

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I could see that during your workshop.

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Could you explain to us a bit about the procedural differences?

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Well,

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a really long time ago,

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they used to do transperineal,

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and then once ultrasounds became better,

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they switched to the transrectal approach,

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and that's what I've done for many,

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many years.

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And I was one of the advocates in the...

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a long time ago about infection risk and how do we prevent infections.

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So we developed rectal swabs and things like that to look for who would be at high risk for infection.

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And so when that came about,

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one of the options would be,

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well,

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why don't we avoid the rectum and do a transperineal?

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Now,

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I still do occasionally,

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and I actually did one during the workshop at TransRectal just because certain situations where you still need to be able to do both,

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and I think that's appropriate.

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The transperineal approach really allows us to map out the prostate.

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And one of those buckets I talked about earlier for treatment was focal therapy.

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And you can't necessarily,

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if you wanted to do certain types of focal therapy,

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it would need to be done transperineally.

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HIFU can be done transrectally.

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So certain options open up when you're doing transperineal.

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I think the patients do very well afterwards.

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We use numbing medications and you can do it in the clinic or in a operating room area.

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And I think either way is appropriate.

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I started out in the operating room and slowly we're giving him less and less sedation.

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As you learn how to numb up the area really well and make it comfortable for patients.

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So once I think more people get comfortable with,

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okay,

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this is just a new technique.

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We've got to switch our brain a little bit and get used to this.

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And I think many urologists would like that approach.

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To fellow urologists that may be intrigued at this idea of performing transpirinal biopsies,

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what advice would you give them?

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Well.

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I called some of my colleagues that were doing them,

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and so they did share,

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and that was very good.

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But patient preparation was key,

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making sure you get good visualizations before the procedure.

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And then during the procedure,

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I always recommended starting out doing a couple in a sedation area,

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basically,

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either with sedation or with an anesthesiologist,

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only because as you're learning,

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it takes time.

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And the patients also know that when they're awake.

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So maybe to get those times down a little bit,

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do a few to get,

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okay,

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how am I going to do my numbing technique?

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And how long is this going to take me?

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So when I first started,

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it was taking a bit longer,

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maybe 40 minutes or something.

262
00:10:50.794 --> 00:10:53.075
And now we can do them routinely under 20 minutes.

263
00:10:53.715 --> 00:10:54.615
And now I'm more comfortable.

264
00:10:54.655 --> 00:10:54.875
Okay,

265
00:10:54.956 --> 00:10:56.916
they don't necessarily need sedation as much.

266
00:10:56.957 --> 00:10:58.377
So starting out slow,

267
00:10:58.857 --> 00:10:59.918
don't be hard on yourself,

268
00:11:00.358 --> 00:11:00.638
you know,

269
00:11:00.818 --> 00:11:04.040
and be open with the patient talking about that.

270
00:11:04.300 --> 00:11:06.102
and it was actually very interesting.

271
00:11:06.142 --> 00:11:11.046
One of the patients didn't know he was getting a TP yesterday and he was so excited that he had read about it and,

272
00:11:11.146 --> 00:11:11.446
oh,

273
00:11:11.506 --> 00:11:14.189
we're doing that technique and he was actually quite excited about it.

274
00:11:14.169 --> 00:11:17.211
So I think patients are open to this procedure as well.

275
00:11:17.792 --> 00:11:22.015
And they are making their own research about their treatments and their option as well.

276
00:11:22.275 --> 00:11:25.678
And I'm sure those urologists listening will find it quite valuable.

277
00:11:25.999 --> 00:11:31.924
Something else that comes to my mind is that you rely on emerging fusion for your prostate procedures.

278
00:11:32.304 --> 00:11:32.924
for example,

279
00:11:32.964 --> 00:11:34.225
MRI ultrasound fusion.

280
00:11:34.665 --> 00:11:42.590
Can you share some insight into the types of imaging that you use and the important role it plays in your diagnosis and treatment of prostate cancer?

281
00:11:42.850 --> 00:11:43.010
Yeah,

282
00:11:43.390 --> 00:11:44.691
I really feel that MRI,

283
00:11:45.171 --> 00:11:47.092
if you've already selected to go to biopsy,

284
00:11:47.512 --> 00:11:47.692
then

285
00:11:48.113 --> 00:11:53.015
MRI is very helpful at placing the needles in the accurate location.

286
00:11:53.075 --> 00:11:56.617
You're already doing what most men would consider an invasive procedure,

287
00:11:56.817 --> 00:11:58.698
even though we consider it minimally invasive.

288
00:11:58.738 --> 00:11:59.799
But to a man,

289
00:12:00.159 --> 00:12:01.260
that's an invasive procedure.

290
00:12:01.760 --> 00:12:03.621
Please do the best job you can while we do it.

291
00:12:04.141 --> 00:12:05.282
So getting an MRI,

292
00:12:05.882 --> 00:12:07.924
localizing the tumors,

293
00:12:08.604 --> 00:12:09.705
or region of interest,

294
00:12:09.945 --> 00:12:10.485
and I tell them,

295
00:12:10.505 --> 00:12:11.926
and it may not be a cancer,

296
00:12:11.966 --> 00:12:14.628
but we have to put a needle in it to know if it is or not.

297
00:12:15.168 --> 00:12:15.908
So guiding that,

298
00:12:15.928 --> 00:12:19.050
and then we still do the standard systematic biopsies to make sure,

299
00:12:19.050 --> 00:12:20.491
because imaging is not perfect.

300
00:12:20.891 --> 00:12:21.011
So

301
00:12:21.492 --> 00:12:22.532
I'm also doing research,

302
00:12:22.592 --> 00:12:23.553
like you alluded to,

303
00:12:23.993 --> 00:12:25.494
on how do we make the imaging better?

304
00:12:26.154 --> 00:12:27.515
So it's every step of the way,

305
00:12:27.896 --> 00:12:28.136
you know,

306
00:12:28.236 --> 00:12:28.476
from

307
00:12:28.776 --> 00:12:30.777
who's on the table getting that biopsy,

308
00:12:30.977 --> 00:12:31.838
risk stratified,

309
00:12:32.658 --> 00:12:34.139
what's the best imaging that we can do,

310
00:12:34.479 --> 00:12:41.163
and what's the best biopsy that we can acquire the actual true diagnosis of that patient so we can get them the best treatment.

311
00:12:41.663 --> 00:12:42.904
So I think all those are connected.

312
00:12:43.504 --> 00:12:47.066
And we are hearing more and more about artificial intelligence,

313
00:12:47.486 --> 00:12:48.287
whether in business,

314
00:12:48.347 --> 00:12:48.927
the arts,

315
00:12:49.067 --> 00:12:49.687
or healthcare.

316
00:12:50.007 --> 00:12:53.129
And I'm very interested in the marketing of prostate cancer player,

317
00:12:53.209 --> 00:12:54.110
as you can imagine.

318
00:12:54.670 --> 00:12:57.672
And I'm seeing more and more claims of AI and so on.

319
00:12:58.132 --> 00:12:58.512
What is your...

320
00:12:58.612 --> 00:13:00.253
point of view about this new technology?

321
00:13:00.413 --> 00:13:03.074
And are you using AI in your daily practice?

322
00:13:03.354 --> 00:13:03.474
Yeah,

323
00:13:03.614 --> 00:13:05.295
AI is very interesting.

324
00:13:05.335 --> 00:13:09.697
I think it's going to be a big shift and it's going to change medicine for sure.

325
00:13:10.097 --> 00:13:11.057
Just having more data,

326
00:13:11.277 --> 00:13:12.738
being able to do these,

327
00:13:13.358 --> 00:13:14.198
looking at imaging,

328
00:13:14.379 --> 00:13:15.259
but even in the clinic,

329
00:13:15.959 --> 00:13:17.300
they can record your notes for you,

330
00:13:17.400 --> 00:13:17.600
right?

331
00:13:17.640 --> 00:13:17.840
I mean,

332
00:13:17.860 --> 00:13:20.581
there's big changes coming with AI.

333
00:13:20.821 --> 00:13:23.362
And I think rather than shunning it,

334
00:13:23.903 --> 00:13:26.404
accepting it and being involved as physicians,

335
00:13:26.444 --> 00:13:27.384
we need to be guiding it.

336
00:13:27.632 --> 00:13:35.096
We shouldn't just let things be and you need to be involved in it to make sure that it's solving the problems for the patients and the physicians.

337
00:13:35.676 --> 00:13:36.597
So that's part of it.

338
00:13:36.917 --> 00:13:37.738
We do do research.

339
00:13:37.758 --> 00:13:39.458
It's called restriction spectrum imaging.

340
00:13:39.499 --> 00:13:41.600
That's the imaging research I was doing before.

341
00:13:41.660 --> 00:13:43.060
There's some AI components in there.

342
00:13:43.601 --> 00:13:44.881
How do we enhance that image,

343
00:13:45.342 --> 00:13:45.902
overlay it,

344
00:13:45.982 --> 00:13:48.183
get urologists comfortable with looking at images?

345
00:13:48.764 --> 00:13:49.024
You know,

346
00:13:49.304 --> 00:13:51.345
I think the fear for AI,

347
00:13:51.445 --> 00:13:55.347
for radiologists and pathologists is a little bit unfounded.

348
00:13:55.407 --> 00:13:55.567
Sure,

349
00:13:55.567 --> 00:13:56.708
it can help with...

350
00:13:56.988 --> 00:13:59.470
training your eyes to look where you're supposed to be looking.

351
00:13:59.791 --> 00:14:02.973
But I still have great relationship with my radiologists and my pathologists,

352
00:14:03.294 --> 00:14:03.814
and we need them.

353
00:14:04.074 --> 00:14:04.875
We absolutely need them.

354
00:14:04.875 --> 00:14:07.277
And they need to be guiding those AI to help them.

355
00:14:07.818 --> 00:14:11.021
And so it's not a us or them or us versus machines.

356
00:14:11.521 --> 00:14:14.984
We need to be learning how to use them better and how can we enhance the experience.

357
00:14:15.404 --> 00:14:17.046
That brings me to my next question.

358
00:14:17.486 --> 00:14:20.229
What projects or research are you currently working on?

359
00:14:20.249 --> 00:14:21.310
You mentioned a few of that,

360
00:14:21.390 --> 00:14:23.131
but what are your plans for the future?

361
00:14:23.391 --> 00:14:23.512
Yeah,

362
00:14:23.552 --> 00:14:23.832
I think...

363
00:14:24.032 --> 00:14:25.293
continue to work on the MRI.

364
00:14:25.313 --> 00:14:28.356
We have a lot of variation in MRI quality.

365
00:14:29.056 --> 00:14:32.299
So improving that quality to get better images,

366
00:14:32.379 --> 00:14:33.840
that's one of my main focuses.

367
00:14:33.920 --> 00:14:36.723
And then continuing to work on fusion biopsies,

368
00:14:37.123 --> 00:14:38.024
diagnostics,

369
00:14:38.404 --> 00:14:40.646
techniques that will enhance the...

370
00:14:41.258 --> 00:14:42.619
really the patient experience too.

371
00:14:42.919 --> 00:14:47.984
I want to look at things that are making it better for patients so they're not fearing the biopsy as much.

372
00:14:48.464 --> 00:14:50.286
And that's a reason maybe they don't come to get their

373
00:14:50.766 --> 00:14:51.827
PSA checked.

374
00:14:51.827 --> 00:14:55.310
So how can we shift the fears for patients?

375
00:14:55.370 --> 00:14:56.651
So that's what I'm working on.

376
00:14:56.891 --> 00:14:57.672
Thank you so much,

377
00:14:57.732 --> 00:14:57.992
Dr.

378
00:14:58.032 --> 00:14:58.192
Lys,

379
00:14:58.252 --> 00:15:00.554
for your time and for this interesting discussion.

380
00:15:00.995 --> 00:15:01.775
Before to conclude,

381
00:15:01.855 --> 00:15:04.337
I'd like to ask our guest a special question.

382
00:15:04.878 --> 00:15:05.278
Are you ready?

383
00:15:05.518 --> 00:15:05.659
Yeah.

384
00:15:06.219 --> 00:15:07.540
What is your favorite song,

385
00:15:07.600 --> 00:15:07.900
please?

386
00:15:08.341 --> 00:15:09.322
My favorite song?

387
00:15:11.034 --> 00:15:28.028
Cole plays the scientist.

388
00:15:28.048 --> 00:15:31.090
Thank you so much for this interview and see you soon,

389
00:15:31.130 --> 00:15:31.891
I hope.

390
00:15:31.991 --> 00:15:32.712
Bye-bye.

391
00:15:32.712 --> 00:15:35.834
Bye-bye.

392
00:15:35.854 --> 00:15:38.316
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393
00:15:38.777 --> 00:15:40.318
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394
00:15:40.518 --> 00:15:43.140
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395
00:15:43.720 --> 00:15:45.622
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396
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397
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398
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399
00:15:52.226 --> 00:15:55.709
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400
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401
00:15:58.631 --> 00:16:01.993
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402
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403
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404
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405
00:16:11.588 --> 00:16:12.731
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406
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