This podcast is created by Coelis.
I think screening is important because if you detect it early,
then we have a lot more options.
So as we detect it later,
you know,
if it's metastatic,
we can't technically cure prostate cancer.
Prostatalk.
Welcome to Prostatalk,
your go-to destination for all things prostate cancer.
I'm your host,
Thomas.
And today we are diving deep into the world of prostate cancer screening,
a topic that's not only important but also incredibly nuanced.
Joining us for today's discussion is none other than
Dr. Michael Lees,
a leading authority in prostate cancer care.
Dr.
Lees is a dedicated specialist who spent years refining his approach to early screening and emerging quality.
In this episode,
we will explore why early detection is crucial in the fight against prostate cancer.
and why that quality of diagnostic images can make the difference.
So,
buckle up and get ready for some invaluable insight.
Hello Dr.
Lys,
welcome to Prostatalk.
First,
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,
Texas.
Can you tell us a bit about
the day and what motivated you to lead this type of educational event with your peers?
Sure.
Thank you very much for inviting me today.
Always happy to talk about prostate cancer and awareness.
So we had a workshop yesterday with the Coelis device.
It's a very interesting way to do the biopsies in that it has a 3D ultrasound,
which allows me to target tumors more accurately.
So it's a newer technology that's coming out,
so not the exposure.
is what we wanted to look at.
So we had some doctors come in early.
I did a dry run first.
We're getting everything ready.
We had the patients come in.
I alerted the patients that we had other urologists there.
They were very happy to see that,
you know,
urologists are teaching other urologists.
So they're very comfortable with everything.
Our room was great.
We had some big screen TVs so everyone could see what was going on.
I wanted them to be there in the room early to see the setup.
How do we set it up?
Some of the targeting,
how do we circle the...
images and how do we target the lesions differently.
So we had 10 biopsies that day,
actually,
that they were willing to stay for some of those,
get some hands-on experience in another room.
It was a really great day overall.
Sounds like a really good day of procedures and physician education.
Before getting to the heart of the matters,
let's start with having you tell us a bit about yourself,
your background,
and your current urology practice.
Sure.
Well,
I'll start back even farther.
So my grandfather had prostate cancer.
when I was in medical school,
which really guided that.
Those discussions back then really guided how I thought about prostate cancer.
Is anybody doing about this?
And how did he even know to get his screening test?
And maybe that could have been done earlier.
He ended up having surgery and things like that.
So some of those discussions drove me to say,
okay,
we need to do something about early detection and education and advocacy for prostate cancer.
So I joined a lab,
started doing research.
I did my residency at UC Irvine in California,
a fellowship specifically in cancer at the University of California,
San Diego,
and then moved to San Antonio about 10 years ago,
getting to work with leaders in the field like Ian Thompson,
who did the prostate cancer prevention trial and things like that.
So really getting into how do we do clinical trials and how do we change the field of prostate cancer.
My practice here is mostly prostate cancer at this point,
fusion biopsies,
MRI.
and surgical options for prostate.
Perfect.
In my research leading up to this conversation,
I came across an educational video you did on understanding prostate cancer.
It was clear that you firmly believe in early screening as an important step in the management of prostate cancer.
Can you speak a bit about that?
I think screening is important because if you detect it early,
then we have a lot more options.
So as we detect it later,
if it's metastatic,
we can't technically cure.
prostate cancer.
So we can cure it if we find it earlier,
and that man has more options.
So we know there's a lot of controversy behind PSA testing,
and that I think we need to be careful about not just throwing away the PSA test,
because it's actually one of the best biomarkers.
I mean,
other cancers would love to have a biomarker that could detect a cancer early.
So a lot of it is adjusting the knowledge that we get from screening.
and then appropriately doing procedures on men who need it,
right?
Double checking the PSA.
So
I try to tell people not to be afraid of the test.
We have to get the test and then knowledge is power.
And then we use that knowledge to risk assess.
that patient on whether they need more procedures or not.
And so,
sure,
it's going to be changing all the time,
and we need to stay up and still continue to push the field on how we diagnose prostate cancer.
But I think that really thinking about it,
and if you haven't been checked before,
asking your doctor and having that discussion about it.
And if you're a partner,
you need to tell your partner,
hey,
let's talk about it with the doctor.
Yeah.
And do you think that improved screening and prevention measures for prostate cancer could
potentially reduce healthcare expenditures and the costs associated with patient management and treatment,
considering that early detection leads to better patient outcomes and may prevent the need for radical interventions such as prostatectomy.
I think most of the costs related to cancer is usually at the very end,
chemotherapies and immunotherapies that are coming out.
And so if we detect it late,
and that's our only option,
the costs really will be driven up.
So if we can find the tumors early,
some of them can just be monitored,
and some of them,
we may need to do prostatectomy or radiation,
but if we can stop it in its tracks and stop the progression,
in the end,
I think the costs would be lower.
So early detection,
again,
is winning,
not only for your options,
but cure rates are better,
and cost in the long run would probably be better as well.
Perfect.
And in my previous question,
I mentioned prostatectomy.
But here are a number of treatment options for men that have been diagnosed with prostate cancer.
Could you tell us more about these options and what they are and now treatment types are determined?
I usually describe that there's about four buckets of interventions that we could do.
The first one would be active surveillance or just monitoring.
So if you have low-grade cancer,
we may talk about this.
And that's a really hard pill for some men to swallow.
I have cancer and then we're going to monitor it.
But we have a lot of data on this,
and it's very safe to do as long as you're following the protocols.
The next bucket would be focal therapy,
and that's where early detection comes in.
If it's too advanced,
then focal therapy would not be an option.
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.
The next one would be prostatectomy.
And I think that's still a very,
very good option.
We have a lot of high-risk men with localized prostate cancer.
And then there's radiation therapy as well.
And of these buckets,
we have to look at,
okay,
what's your stage?
What's your risk profile?
What's the size of the tumor?
And then in radiation and surgery,
have you had previous surgery before?
Or do you have inflammatory bowel disease?
And maybe you shouldn't,
they want to avoid radiation therapy.
So it's not there's a right answer.
It's that we have to look at all the data.
and we're making a team decision on what your care would be.
Very interesting hearing that here are a number of options available for men in various stages of this disease.
I would like to get back to the diagnosing stage.
Upon screening results,
a man may need to undergo biopsy procedures to confirm whether cancer is present.
Historically,
this has been done by what is known as a transrectal technique.
Today,
we are hearing more and more about the transperineal approach.
and we are seeing a number of urologists adopt this newer technique.
It is my understanding that you have adopted the transperineal approach for your prostate biopsies.
I could see that during your workshop.
Could you explain to us a bit about the procedural differences?
Well,
a really long time ago,
they used to do transperineal,
and then once ultrasounds became better,
they switched to the transrectal approach,
and that's what I've done for many,
many years.
And I was one of the advocates in the...
a long time ago about infection risk and how do we prevent infections.
So we developed rectal swabs and things like that to look for who would be at high risk for infection.
And so when that came about,
one of the options would be,
well,
why don't we avoid the rectum and do a transperineal?
Now,
I still do occasionally,
and I actually did one during the workshop at TransRectal just because certain situations where you still need to be able to do both,
and I think that's appropriate.
The transperineal approach really allows us to map out the prostate.
And one of those buckets I talked about earlier for treatment was focal therapy.
And you can't necessarily,
if you wanted to do certain types of focal therapy,
it would need to be done transperineally.
HIFU can be done transrectally.
So certain options open up when you're doing transperineal.
I think the patients do very well afterwards.
We use numbing medications and you can do it in the clinic or in a operating room area.
And I think either way is appropriate.
I started out in the operating room and slowly we're giving him less and less sedation.
As you learn how to numb up the area really well and make it comfortable for patients.
So once I think more people get comfortable with,
okay,
this is just a new technique.
We've got to switch our brain a little bit and get used to this.
And I think many urologists would like that approach.
To fellow urologists that may be intrigued at this idea of performing transpirinal biopsies,
what advice would you give them?
Well.
I called some of my colleagues that were doing them,
and so they did share,
and that was very good.
But patient preparation was key,
making sure you get good visualizations before the procedure.
And then during the procedure,
I always recommended starting out doing a couple in a sedation area,
basically,
either with sedation or with an anesthesiologist,
only because as you're learning,
it takes time.
And the patients also know that when they're awake.
So maybe to get those times down a little bit,
do a few to get,
okay,
how am I going to do my numbing technique?
And how long is this going to take me?
So when I first started,
it was taking a bit longer,
maybe 40 minutes or something.
And now we can do them routinely under 20 minutes.
And now I'm more comfortable.
Okay,
they don't necessarily need sedation as much.
So starting out slow,
don't be hard on yourself,
you know,
and be open with the patient talking about that.
and it was actually very interesting.
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,
oh,
we're doing that technique and he was actually quite excited about it.
So I think patients are open to this procedure as well.
And they are making their own research about their treatments and their option as well.
And I'm sure those urologists listening will find it quite valuable.
Something else that comes to my mind is that you rely on emerging fusion for your prostate procedures.
for example,
MRI ultrasound fusion.
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?
Yeah,
I really feel that MRI,
if you've already selected to go to biopsy,
then
MRI is very helpful at placing the needles in the accurate location.
You're already doing what most men would consider an invasive procedure,
even though we consider it minimally invasive.
But to a man,
that's an invasive procedure.
Please do the best job you can while we do it.
So getting an MRI,
localizing the tumors,
or region of interest,
and I tell them,
and it may not be a cancer,
but we have to put a needle in it to know if it is or not.
So guiding that,
and then we still do the standard systematic biopsies to make sure,
because imaging is not perfect.
So
I'm also doing research,
like you alluded to,
on how do we make the imaging better?
So it's every step of the way,
you know,
from
who's on the table getting that biopsy,
risk stratified,
what's the best imaging that we can do,
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.
So I think all those are connected.
And we are hearing more and more about artificial intelligence,
whether in business,
the arts,
or healthcare.
And I'm very interested in the marketing of prostate cancer player,
as you can imagine.
And I'm seeing more and more claims of AI and so on.
What is your...
point of view about this new technology?
And are you using AI in your daily practice?
Yeah,
AI is very interesting.
I think it's going to be a big shift and it's going to change medicine for sure.
Just having more data,
being able to do these,
looking at imaging,
but even in the clinic,
they can record your notes for you,
right?
I mean,
there's big changes coming with AI.
And I think rather than shunning it,
accepting it and being involved as physicians,
we need to be guiding it.
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.
So that's part of it.
We do do research.
It's called restriction spectrum imaging.
That's the imaging research I was doing before.
There's some AI components in there.
How do we enhance that image,
overlay it,
get urologists comfortable with looking at images?
You know,
I think the fear for AI,
for radiologists and pathologists is a little bit unfounded.
Sure,
it can help with...
training your eyes to look where you're supposed to be looking.
But I still have great relationship with my radiologists and my pathologists,
and we need them.
We absolutely need them.
And they need to be guiding those AI to help them.
And so it's not a us or them or us versus machines.
We need to be learning how to use them better and how can we enhance the experience.
That brings me to my next question.
What projects or research are you currently working on?
You mentioned a few of that,
but what are your plans for the future?
Yeah,
I think...
continue to work on the MRI.
We have a lot of variation in MRI quality.
So improving that quality to get better images,
that's one of my main focuses.
And then continuing to work on fusion biopsies,
diagnostics,
techniques that will enhance the...
really the patient experience too.
I want to look at things that are making it better for patients so they're not fearing the biopsy as much.
And that's a reason maybe they don't come to get their
PSA checked.
So how can we shift the fears for patients?
So that's what I'm working on.
Thank you so much,
Dr.
Lys,
for your time and for this interesting discussion.
Before to conclude,
I'd like to ask our guest a special question.
Are you ready?
Yeah.
What is your favorite song,
please?
My favorite song?
Cole plays the scientist.
Thank you so much for this interview and see you soon,
I hope.
Bye-bye.
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