WEBVTT 1 00:00:00.108 --> 00:00:02.268 This podcast is created by Coelis. 2 00:00:03.988 --> 00:00:15.308 The thing is to understand that prostate cancer was the only solid cancer not visible until MRI came to our clinics. 3 00:00:16.028 --> 00:00:16.808 Systematically, 4 00:00:17.088 --> 00:00:19.508 we can see where the tumor is. 5 00:00:19.768 --> 00:00:23.288 And when you know where your enemy is, 6 00:00:23.828 --> 00:00:28.468 you can provide different ways to fight against it. 7 00:00:29.772 --> 00:00:33.172 Prostate Health. 8 00:00:33.292 --> 00:00:34.532 Dear prostate enthusiasts, 9 00:00:34.592 --> 00:00:37.452 welcome to another riveting episode of Prostate Talk, 10 00:00:37.832 --> 00:00:39.412 where today we are diving deep, 11 00:00:39.812 --> 00:00:40.972 well beyond the surface, 12 00:00:41.012 --> 00:00:41.712 pierce the levels, 13 00:00:42.052 --> 00:00:44.892 into one of the most talked about journeys in male health, 14 00:00:45.292 --> 00:00:49.292 from the moment of diagnosis to the complexity of treatment for prostate cancer. 15 00:00:50.132 --> 00:00:57.552 And who better to help us navigate this medical labyrinth than someone who brings both expertise and a Mediterranean touch of forms? 16 00:00:58.028 --> 00:00:59.049 Join me today is Dr. 17 00:00:59.109 --> 00:00:59.449 Mignena, 18 00:00:59.890 --> 00:01:04.573 a renowned Spanish urologist who knows exactly how to deliver toast news, 19 00:01:05.114 --> 00:01:06.555 smart treatment plans, 20 00:01:06.975 --> 00:01:08.156 and most importantly, 21 00:01:08.496 --> 00:01:08.776 hope, 22 00:01:09.037 --> 00:01:10.358 with a side of tapas of course. 23 00:01:10.878 --> 00:01:11.859 So sit back, 24 00:01:12.319 --> 00:01:12.680 relax, 25 00:01:12.800 --> 00:01:14.541 but maybe cross your legs gently, 26 00:01:14.921 --> 00:01:18.744 because we are about to unpack prostate cancer from diagnosis to treatment, 27 00:01:19.205 --> 00:01:20.706 and discover why knowledge, 28 00:01:21.186 --> 00:01:21.767 compassion, 29 00:01:22.227 --> 00:01:25.590 and precision medicine might just be the best prescription of all. 30 00:01:28.256 --> 00:01:28.416 Hello, 31 00:01:28.456 --> 00:01:28.736 Dr. 32 00:01:28.776 --> 00:01:29.097 Mignana. 33 00:01:29.637 --> 00:01:30.798 Welcome to Prostatalk. 34 00:01:30.838 --> 00:01:33.400 I'm really happy to be here with you during the 35 00:01:33.860 --> 00:01:34.901 EAU Congress in Madrid. 36 00:01:35.362 --> 00:01:35.842 First of all, 37 00:01:36.022 --> 00:01:37.643 how are you and how the Congress is going? 38 00:01:38.044 --> 00:01:38.344 Yes, 39 00:01:38.424 --> 00:01:38.924 I'm fine, 40 00:01:38.984 --> 00:01:39.265 thanks. 41 00:01:39.285 --> 00:01:43.708 I'm very happy to be here with you and to participate in this podcast. 42 00:01:43.788 --> 00:01:43.988 Yes, 43 00:01:44.008 --> 00:01:45.970 I'm enjoying this Congress, 44 00:01:46.150 --> 00:01:47.051 this EAU Congress. 45 00:01:47.691 --> 00:01:49.313 Let's see if I can help you. 46 00:01:49.813 --> 00:01:51.254 So before to start this interview, 47 00:01:51.334 --> 00:01:55.137 could you please present yourself to our listeners to tell us who is Dr. 48 00:01:55.157 --> 00:01:55.417 Mignana? 49 00:01:56.220 --> 00:01:56.400 Well, 50 00:01:56.520 --> 00:01:58.582 I'm a Spanish urologist. 51 00:01:58.962 --> 00:02:05.527 After being working in the public systems for almost all my life since 2017, 52 00:02:05.567 --> 00:02:08.149 I was appointed as director, 53 00:02:08.430 --> 00:02:10.411 head of department of urology of the 54 00:02:11.132 --> 00:02:12.893 Clínica Universidad de Navarra. 55 00:02:13.333 --> 00:02:22.361 It's a renowned and private hospital in Spain that depends of the University of Navarra. 56 00:02:22.884 --> 00:02:25.346 quite close from the EAU conferences, 57 00:02:25.646 --> 00:02:25.946 I think, 58 00:02:26.006 --> 00:02:28.909 because I drive away this morning to come here. 59 00:02:29.409 --> 00:02:29.669 Yes, 60 00:02:29.709 --> 00:02:29.910 yes. 61 00:02:30.190 --> 00:02:32.652 Our institution has two headquarters, 62 00:02:32.892 --> 00:02:35.514 one in Pamplona and the other one here in Madrid, 63 00:02:35.554 --> 00:02:36.795 very close to here. 64 00:02:36.935 --> 00:02:37.255 We have 65 00:02:37.796 --> 00:02:42.159 50 years doing advanced urology in Spain. 66 00:02:42.900 --> 00:02:45.622 So it's well known in the Spain center. 67 00:02:45.902 --> 00:02:46.262 Thank you. 68 00:02:46.623 --> 00:02:49.485 And I have heard that you are a director of the 69 00:02:49.544 --> 00:02:50.505 Prostate Center. 70 00:02:50.585 --> 00:02:51.906 Could you explain to us what is it, 71 00:02:51.907 --> 00:02:52.947 the Prostate Center? 72 00:02:53.627 --> 00:02:53.847 Yes, 73 00:02:53.887 --> 00:02:59.592 it's one of the first prostate centers that has been developed in the world. 74 00:02:59.672 --> 00:03:09.239 It's specifically centered in diagnosis and treating prostate diseases from a multidisciplinary comprehensive approach. 75 00:03:09.920 --> 00:03:10.480 We have, 76 00:03:10.560 --> 00:03:11.741 from the very beginning, 77 00:03:11.742 --> 00:03:17.025 we are committed to have the cut-edge in technologies. 78 00:03:17.548 --> 00:03:26.035 both from diagnosis and treatment and with a lot of experience because technology with other experience means nothing. 79 00:03:26.495 --> 00:03:27.276 We totally agree. 80 00:03:27.756 --> 00:03:27.996 Yes, 81 00:03:28.016 --> 00:03:43.208 we treat patients from all over the world and we are committed not only for treating patients but diagnosis and treating patients but also in basic and clinical research and 82 00:03:43.688 --> 00:03:46.991 in the different undergraduates and postgraduate. 83 00:03:47.112 --> 00:03:47.572 programs. 84 00:03:47.853 --> 00:03:50.455 And why did you choose specifically prostate? 85 00:03:50.755 --> 00:03:51.776 There's a lot of myths, 86 00:03:51.896 --> 00:03:52.356 I think, 87 00:03:52.776 --> 00:03:55.018 that used to say we have an organ, 88 00:03:55.058 --> 00:03:55.759 the prostate, 89 00:03:55.859 --> 00:04:01.944 that after 50 is almost an useless organ that give us the problems, 90 00:04:02.044 --> 00:04:05.466 bring us to men a lot of problems, 91 00:04:05.586 --> 00:04:07.348 both benign and malignant. 92 00:04:07.888 --> 00:04:14.053 And we can remind to our listener that one man out of eight will suffer of a prostate cancer in his life, 93 00:04:14.113 --> 00:04:14.313 right? 94 00:04:15.154 --> 00:04:15.434 Yes. 95 00:04:16.296 --> 00:04:19.656 at the time of your birthday. 96 00:04:20.456 --> 00:04:21.936 But if you are 50, 97 00:04:22.156 --> 00:04:23.876 the numbers are higher. 98 00:04:24.756 --> 00:04:32.836 The risk of developing prostate cancer is a risk that is increasing through your lifespan and can reach 99 00:04:33.296 --> 00:04:35.676 70% at 80 years. 100 00:04:35.996 --> 00:04:41.636 So if you live enough that it looks like this good idea, 101 00:04:42.696 --> 00:04:45.656 most of us are going to suffer. 102 00:04:45.864 --> 00:04:46.765 prostate disease. 103 00:04:47.405 --> 00:04:48.726 We are talking about prostates. 104 00:04:48.846 --> 00:04:49.387 First of all, 105 00:04:49.507 --> 00:04:51.749 after a few days of EAU Congress, 106 00:04:51.849 --> 00:04:56.112 could you please tell us what are the hot topics in the urologic field, 107 00:04:56.232 --> 00:04:56.512 please? 108 00:04:57.092 --> 00:05:03.077 I think there are a lot of stuff arising in a huge Congress like this. 109 00:05:03.377 --> 00:05:04.958 But to be concrete, 110 00:05:05.419 --> 00:05:14.586 I would like to talk about the impact of PSMA-PIT scans in all stages of prostate cancer from the very beginning, 111 00:05:14.926 --> 00:05:16.147 or the diagnosis, 112 00:05:16.347 --> 00:05:17.148 prognostic, 113 00:05:17.228 --> 00:05:20.430 and helping making decisions in both localized, 114 00:05:20.771 --> 00:05:21.771 locally advanced, 115 00:05:21.791 --> 00:05:23.493 and metastatic prostate cancer. 116 00:05:24.092 --> 00:05:28.856 We are familiar with this technique since 2019. 117 00:05:29.356 --> 00:05:30.797 We faced with some problems. 118 00:05:30.798 --> 00:05:37.963 We were working out of guidelines because nobody had previously opened a door like this. 119 00:05:38.163 --> 00:05:45.469 And I'm happy to be that it's going to change a lot of treatments and approaches for the patients, 120 00:05:45.729 --> 00:05:50.513 avoiding over-treatment and permitting more personalized treatment. 121 00:05:51.033 --> 00:05:52.274 A lot of stunning things to come. 122 00:05:52.534 --> 00:05:53.595 So let's now get started. 123 00:05:53.596 --> 00:05:54.745 to the heart of the matter. 124 00:05:55.085 --> 00:05:58.268 I have heard that you are a fervent advocate of focal therapy. 125 00:05:58.528 --> 00:06:02.511 Could you explain to us what focal therapy consists and for example, 126 00:06:02.591 --> 00:06:04.573 since how long do you perform focal therapy? 127 00:06:05.073 --> 00:06:05.393 Yes, 128 00:06:05.573 --> 00:06:05.894 yes. 129 00:06:06.254 --> 00:06:11.418 I performed my first focal therapy in 2014 with IRE, 130 00:06:11.798 --> 00:06:13.660 with irreversible electroporation. 131 00:06:14.180 --> 00:06:22.547 And focal therapy means to treat the prostate cancer inside the prostate while preserving 132 00:06:22.916 --> 00:06:23.917 the normal tissue. 133 00:06:24.097 --> 00:06:28.681 It's limited the treatment only to the tumor with a security margin. 134 00:06:29.601 --> 00:06:41.170 So it's been developed for avoiding side effects that are usually accompany whole gland treatments. 135 00:06:41.531 --> 00:06:44.213 So it's a kind of limited treatment. 136 00:06:44.453 --> 00:06:48.656 It has its advantages and its disadvantages. 137 00:06:49.237 --> 00:06:50.678 You mentioned the side effects, 138 00:06:51.058 --> 00:06:51.839 could you tell us... 139 00:06:52.460 --> 00:06:53.020 What can it be, 140 00:06:53.240 --> 00:06:53.760 those effects? 141 00:06:54.500 --> 00:06:54.740 Yes, 142 00:06:54.800 --> 00:06:58.900 the side effects of whole gland treatments are related with continence, 143 00:06:59.240 --> 00:07:00.780 urinary incontinence, 144 00:07:00.840 --> 00:07:03.960 because prostate is very close to the urinary sphincter. 145 00:07:04.760 --> 00:07:17.600 And the erectile dysfunction due to the nerves and vessels that contributes to the menormal erections are run very close to the prostate. 146 00:07:17.620 --> 00:07:20.660 So when you perform a whole gland treatment, 147 00:07:20.680 --> 00:07:21.640 you are compromising. 148 00:07:21.660 --> 00:07:21.900 compromising. 149 00:07:22.184 --> 00:07:25.207 integrity of these structures and then the refusion, 150 00:07:25.287 --> 00:07:27.348 the related functional results. 151 00:07:27.829 --> 00:07:32.192 That's why in the average performance of whole-gland treatment, 152 00:07:32.272 --> 00:07:42.600 a significant number of patients suffer from erectile dysfunction and urinary incontinence due to the whole-gland treatment. 153 00:07:42.680 --> 00:07:50.026 So that's why different approaches of such active surveillance or focal therapy arose. 154 00:07:50.784 --> 00:07:52.045 try to avoid this. 155 00:07:52.806 --> 00:07:58.530 And would you say that focal therapy is for all prostate cancer or there are some criterias? 156 00:07:59.171 --> 00:07:59.291 No, 157 00:07:59.411 --> 00:07:59.531 no, 158 00:07:59.611 --> 00:07:59.731 no, 159 00:07:59.871 --> 00:07:59.991 no, 160 00:08:00.151 --> 00:08:00.271 no. 161 00:08:00.332 --> 00:08:12.701 The best thing is to understand that prostate cancer was the only solid cancer not visible until MRI came to our clinics. 162 00:08:13.422 --> 00:08:14.182 Systematically, 163 00:08:14.463 --> 00:08:20.347 we can see where the tumor is and when you know where your enemy is. 164 00:08:20.692 --> 00:08:25.256 is you can provide different ways to fight against it. 165 00:08:25.416 --> 00:08:29.839 And nowadays we have a lot of experience with focal therapy, 166 00:08:29.939 --> 00:08:31.380 but I am a robotic surgeon. 167 00:08:31.681 --> 00:08:36.244 I perform more robotic surgeries than focal therapies. 168 00:08:36.645 --> 00:08:37.906 But nowadays, 169 00:08:38.426 --> 00:08:39.667 around 10% 170 00:08:39.867 --> 00:08:45.772 of our patients are very good candidates because they had to be highly selected patients. 171 00:08:46.412 --> 00:08:48.974 The tumor has to be visible on MRI. 172 00:08:49.194 --> 00:08:49.615 you have 173 00:08:50.044 --> 00:09:02.634 to perform an MRI ultrasound fusion biopsy in order to see that the lesion you are seeing in MRI is really the tumor and the remaining prostate is free from any tumor. 174 00:09:03.214 --> 00:09:11.981 And then you have to be skilled enough to access with different technologies and destroy to apply this tumor with enough security margin. 175 00:09:12.622 --> 00:09:16.705 And why do you believe in focal therapy when it's a divisive subject? 176 00:09:17.526 --> 00:09:19.407 What are the goals of a good focal therapy? 177 00:09:20.052 --> 00:09:24.696 The main goal of the focal therapy is the same of any whole-gland therapy, 178 00:09:24.876 --> 00:09:26.157 is to control the tumor, 179 00:09:27.118 --> 00:09:28.399 to cure the patients, 180 00:09:28.699 --> 00:09:31.661 or at least to modify its natural history, 181 00:09:31.861 --> 00:09:37.305 to allow patients or to help patients to live without a cancer, 182 00:09:37.526 --> 00:09:44.071 or at least live with the cancer with no metastasis and not dying for the cancer. 183 00:09:44.591 --> 00:09:46.913 This is the goal of all treatments, 184 00:09:47.133 --> 00:09:47.353 but 185 00:09:47.668 --> 00:09:50.250 So there's no difference with the others. 186 00:09:50.670 --> 00:09:55.434 But the most important characteristic of focal therapy is, 187 00:09:55.614 --> 00:09:57.196 as we commented before, 188 00:09:57.776 --> 00:09:59.697 that we can avoid the side effects. 189 00:10:00.200 --> 00:10:04.644 And you said that this is still focal therapies, 190 00:10:04.844 --> 00:10:05.905 some controversies. 191 00:10:06.045 --> 00:10:09.047 And let me see a little bit controversial in this. 192 00:10:09.507 --> 00:10:18.114 I think it's a divisive subject issue right now because urologists have some prejudices. 193 00:10:18.334 --> 00:10:19.976 If you let me explain, 194 00:10:19.996 --> 00:10:22.678 I think I'm going to be a little bit controversial. 195 00:10:22.758 --> 00:10:24.879 But we have two types of urologists. 196 00:10:25.180 --> 00:10:29.963 Those who have no very good results with their prostatectomy. 197 00:10:31.052 --> 00:10:32.432 So in the average, 198 00:10:33.152 --> 00:10:36.052 in their hands or in their institutions, 199 00:10:36.312 --> 00:10:42.572 their rates of urinary incontinence and erectile dysfunction are unacceptable. 200 00:10:42.812 --> 00:10:49.392 And that's why they advocate more for active surveillance and even focal therapy. 201 00:10:49.832 --> 00:10:51.012 So they're biased, 202 00:10:51.352 --> 00:10:54.492 but they are right because the results are there. 203 00:10:55.012 --> 00:10:56.152 In the other extreme, 204 00:10:56.272 --> 00:10:58.632 you have very skilled surgeons. 205 00:10:58.860 --> 00:11:01.882 with very low side effects in their hands, 206 00:11:02.243 --> 00:11:04.464 on their high volume institutions. 207 00:11:04.985 --> 00:11:05.886 And they think, 208 00:11:06.106 --> 00:11:08.047 why to do a focal therapy? 209 00:11:08.448 --> 00:11:11.770 Because in my hands this has no side effects. 210 00:11:11.930 --> 00:11:16.274 And they have the argument that breast cancer usually is multifocal. 211 00:11:16.874 --> 00:11:19.016 So if you are treating a tumor, 212 00:11:19.216 --> 00:11:23.639 maybe you are leaving another tumor untreated and they are right as well. 213 00:11:24.360 --> 00:11:28.143 So the solution to these crepenses 214 00:11:28.968 --> 00:11:29.388 of course, 215 00:11:29.408 --> 00:11:32.388 has to be not to be biased. 216 00:11:33.008 --> 00:11:34.588 And that is what's happened with us. 217 00:11:35.268 --> 00:11:36.768 We have no preferences. 218 00:11:37.268 --> 00:11:44.648 We are very skilled surgeons with very good results in terms not only oncological, 219 00:11:44.748 --> 00:11:45.628 but functional. 220 00:11:45.948 --> 00:11:48.268 And we are very skilled doing focal therapy. 221 00:11:48.408 --> 00:11:50.108 So we have no preferences. 222 00:11:50.148 --> 00:11:53.588 We are in the middle of those extremes. 223 00:11:54.208 --> 00:11:58.168 So if you think all three types. 224 00:11:58.912 --> 00:11:59.372 are right. 225 00:11:59.692 --> 00:12:00.392 And that's, 226 00:12:00.672 --> 00:12:01.732 in my opinion, 227 00:12:02.072 --> 00:12:06.012 the most important source of these discrepancies. 228 00:12:07.072 --> 00:12:12.072 It's an interesting point of view and thank you for sharing with us your vision. 229 00:12:12.852 --> 00:12:13.992 In practical terms, 230 00:12:14.152 --> 00:12:17.152 how does focal treatment work in your practice? 231 00:12:17.512 --> 00:12:22.412 Do you follow your patient from diagnosis to treatment or do you only deal with treatment? 232 00:12:23.212 --> 00:12:23.332 No, 233 00:12:23.333 --> 00:12:23.772 of course, 234 00:12:23.812 --> 00:12:24.272 of course, 235 00:12:24.352 --> 00:12:28.572 we accompany the patient from the very beginning from the high PSA, 236 00:12:28.772 --> 00:12:31.992 which is a normal way to go to the urologist. 237 00:12:32.012 --> 00:12:37.772 A doctor have a high PSA when they discuss to perform an MRI afterwards. 238 00:12:38.372 --> 00:12:41.332 MRI leads you to a biopsy or not. 239 00:12:41.392 --> 00:12:42.592 If you have a normal MRI, 240 00:12:42.632 --> 00:12:44.032 you can avoid a biopsy. 241 00:12:44.332 --> 00:12:46.552 when then when we have an 242 00:12:46.800 --> 00:12:47.481 abnormal 243 00:12:48.141 --> 00:12:54.986 MRI, we proceed to a fusion ultrasound MRI fusion biopsy and then with the result discuss with the patients, 244 00:12:55.647 --> 00:12:57.368 look this is where the tumor is, 245 00:12:57.909 --> 00:12:59.530 the tumor is located here, 246 00:13:00.050 --> 00:13:05.014 the tumor has this aggressiveness because we are taking course, 247 00:13:05.094 --> 00:13:16.043 we are taking samples from the very center of the tumors and discuss with the patients in a shared making decision process what's the different approaches that can help him. 248 00:13:16.312 --> 00:13:18.654 in getting free from his tumor. 249 00:13:19.535 --> 00:13:19.955 Perfect. 250 00:13:20.475 --> 00:13:22.477 And if we are really talking logistic, 251 00:13:22.497 --> 00:13:24.038 do you need several systems, 252 00:13:24.258 --> 00:13:27.741 machines to cover the entire patient care pathway? 253 00:13:28.061 --> 00:13:28.321 I mean, 254 00:13:28.402 --> 00:13:29.602 to make diagnosis, 255 00:13:29.603 --> 00:13:30.383 to make treatment, 256 00:13:30.423 --> 00:13:32.164 to make robotic surgery, 257 00:13:32.505 --> 00:13:37.929 do you need many systems or do you have like one system for making of the patient journey? 258 00:13:38.830 --> 00:13:39.030 Well, 259 00:13:39.070 --> 00:13:41.412 this is a very interesting question. 260 00:13:41.712 --> 00:13:42.272 Of course, 261 00:13:42.473 --> 00:13:44.654 the most important is because 262 00:13:45.096 --> 00:13:48.859 Everything right now relies on information coming from MRI. 263 00:13:49.279 --> 00:13:50.460 The most important, 264 00:13:50.901 --> 00:13:51.601 in my opinion, 265 00:13:51.921 --> 00:14:00.208 is to have a very good MRI ultrasound fusion systems because the information coming from this process, 266 00:14:00.388 --> 00:14:01.669 these systems, 267 00:14:02.290 --> 00:14:03.270 depends on all. 268 00:14:03.911 --> 00:14:08.014 And you can discuss with your patient if you perform a robotic surgery. 269 00:14:08.054 --> 00:14:13.178 I think robotic surgery has allowed us surgeons to be reliable. 270 00:14:13.418 --> 00:14:14.159 It's the surgeon. 271 00:14:14.468 --> 00:14:17.851 In the volume of surgeries he performs, 272 00:14:18.211 --> 00:14:20.193 who gives you the results, 273 00:14:20.213 --> 00:14:24.856 who leads you to be a surgeon with very few side effects, 274 00:14:25.196 --> 00:14:27.718 is the number and your abilities, 275 00:14:27.738 --> 00:14:28.599 your capabilities, 276 00:14:29.240 --> 00:14:29.940 your skills. 277 00:14:30.661 --> 00:14:35.344 But robotic surgery has allowed us to be more reliable. 278 00:14:35.945 --> 00:14:36.285 Today, 279 00:14:36.605 --> 00:14:42.210 we can almost assume in a young man under 60 with a tumor. 280 00:14:43.389 --> 00:14:45.030 located in the prostate, 281 00:14:45.130 --> 00:14:51.075 we can almost assume continence and a very high probability and around 90% 282 00:14:51.076 --> 00:14:56.399 of the semi-potency due to the help that the robotic surgery, 283 00:14:56.439 --> 00:14:58.901 the precision has given us to the surgeons. 284 00:14:59.816 --> 00:15:01.237 And regarding focal therapy, 285 00:15:01.397 --> 00:15:02.138 in my opinion, 286 00:15:02.278 --> 00:15:11.405 you don't need a lot of technologies because it wouldn't be affordable to maybe in a public system. 287 00:15:11.485 --> 00:15:18.371 You need always a very good system for making so proceeding with the MRI fusion system. 288 00:15:18.771 --> 00:15:23.294 And then robotic is important in one or two sources, 289 00:15:23.655 --> 00:15:25.376 maybe one of focal therapies. 290 00:15:26.397 --> 00:15:26.757 Thank you. 291 00:15:27.256 --> 00:15:27.676 And Dr. 292 00:15:27.696 --> 00:15:27.976 Mignogna, 293 00:15:27.996 --> 00:15:29.376 a question comes to my mind. 294 00:15:29.636 --> 00:15:30.996 To perform focal therapy, 295 00:15:31.316 --> 00:15:32.756 which approach is the best? 296 00:15:32.876 --> 00:15:33.456 Transrectal, 297 00:15:33.876 --> 00:15:34.516 Transparenal, 298 00:15:34.576 --> 00:15:34.936 and why? 299 00:15:36.436 --> 00:15:36.616 Yes, 300 00:15:36.956 --> 00:15:37.596 it depends. 301 00:15:37.616 --> 00:15:38.536 It depends on the... 302 00:15:38.776 --> 00:15:39.796 In my opinion, 303 00:15:39.996 --> 00:15:42.936 there's no difference with the sources of energy. 304 00:15:43.036 --> 00:15:46.216 If you are good at a source of energy, 305 00:15:46.516 --> 00:15:47.176 for example, 306 00:15:47.296 --> 00:15:47.616 HIFU, 307 00:15:48.276 --> 00:15:50.256 then proceed with HIFU. 308 00:15:50.436 --> 00:15:52.376 You're good at cryo or fiery. 309 00:15:53.156 --> 00:15:53.576 Of course, 310 00:15:53.596 --> 00:15:55.216 if you are going to do Haifu, 311 00:15:55.456 --> 00:15:55.836 you have to do it. 312 00:15:55.904 --> 00:15:57.966 to have a transectal approach. 313 00:15:58.646 --> 00:16:06.272 I'm more happy with a transparent approach because it allows you to access any part of the prostate and treat only the lesion, 314 00:16:06.893 --> 00:16:08.854 what we call the index lesion, 315 00:16:09.395 --> 00:16:19.022 is that one that is visible on MRI with a security margin and preserving to treat a large amount of prostate. 316 00:16:20.023 --> 00:16:21.364 Thanks for this clarification. 317 00:16:21.824 --> 00:16:22.825 I have another question. 318 00:16:22.845 --> 00:16:23.846 You mentioned MRI. 319 00:16:24.466 --> 00:16:24.747 Does it 320 00:16:25.004 --> 00:16:27.086 essential for performing focal therapies? 321 00:16:27.846 --> 00:16:28.307 Of course, 322 00:16:28.327 --> 00:16:34.011 this isn't all of our treatments relies on information coming from MRI. 323 00:16:34.251 --> 00:16:34.712 Of course, 324 00:16:34.752 --> 00:16:41.817 you can see more suspicious areas using other technologies like micro ultrasound, 325 00:16:41.937 --> 00:16:44.079 but the information coming from MRI, 326 00:16:44.419 --> 00:16:45.500 3D information, 327 00:16:45.980 --> 00:16:53.666 putting the lesion where it is and permits to translate this information to the OR is not 328 00:16:53.876 --> 00:16:57.379 provided by any other diagnostic tool. 329 00:16:58.340 --> 00:17:01.782 So would you say that prostate care tomorrow cannot do without MRI? 330 00:17:02.663 --> 00:17:03.163 Of course, 331 00:17:03.444 --> 00:17:05.485 because you have to take into account, 332 00:17:05.505 --> 00:17:06.246 in my opinion, 333 00:17:06.326 --> 00:17:06.566 that 334 00:17:07.126 --> 00:17:11.230 AI with information coming from the images, 335 00:17:12.370 --> 00:17:13.631 even more precise, 336 00:17:13.792 --> 00:17:19.456 and radiomics is including images with 337 00:17:19.752 --> 00:17:20.313 genes, 338 00:17:20.653 --> 00:17:23.435 the information coming from the expression of different genes, 339 00:17:23.595 --> 00:17:35.004 there's a lot of information that AI in the future are going to get together and give you not only information about what is happening in the prostate right now, 340 00:17:35.144 --> 00:17:36.905 this kind of picture, 341 00:17:37.506 --> 00:17:40.708 but what is happening in this tissue in the future. 342 00:17:41.709 --> 00:17:41.849 So, 343 00:17:42.290 --> 00:17:42.870 of course, 344 00:17:43.130 --> 00:17:48.575 any development of where the prostate cancer is and how to manage it is 345 00:17:48.872 --> 00:17:49.412 In my opinion, 346 00:17:49.413 --> 00:17:51.634 it will be always relying on MRI. 347 00:17:52.435 --> 00:17:52.895 Thanks a lot, 348 00:17:53.015 --> 00:17:53.135 Dr. 349 00:17:53.136 --> 00:17:53.396 Mignogna, 350 00:17:53.436 --> 00:17:54.136 for your answers. 351 00:17:54.516 --> 00:17:56.178 Let's see a little further now. 352 00:17:56.478 --> 00:18:00.261 What projects are you working on and what are your plans for the coming months? 353 00:18:01.122 --> 00:18:01.262 Oh, 354 00:18:02.002 --> 00:18:04.404 this is a personal question. 355 00:18:04.744 --> 00:18:04.965 Well, 356 00:18:05.305 --> 00:18:07.106 I told you before I'm working, 357 00:18:07.807 --> 00:18:10.229 I'm happy and honored to direct a 358 00:18:11.450 --> 00:18:15.693 HAP volume center which are involved in many, 359 00:18:16.073 --> 00:18:17.835 many basic and clinically. 360 00:18:18.396 --> 00:18:22.640 research progress in the educational programs, 361 00:18:22.760 --> 00:18:25.902 both for students in the undergraduate and postgraduate. 362 00:18:26.002 --> 00:18:26.543 Yesterday, 363 00:18:26.623 --> 00:18:31.527 we have a workshop with people coming from all over the world to see how we work. 364 00:18:31.787 --> 00:18:33.248 I'm very happy with this. 365 00:18:33.848 --> 00:18:34.429 But today, 366 00:18:35.169 --> 00:18:41.554 my most important goal in the short terms is we are developing an information system. 367 00:18:42.115 --> 00:18:45.077 It's a recruiting information from nurses, 368 00:18:45.197 --> 00:18:46.718 doctors from 369 00:18:47.036 --> 00:18:48.958 clinical registries to get, 370 00:18:49.118 --> 00:18:49.898 in my opinion, 371 00:18:50.078 --> 00:18:51.780 if we are lucky enough, 372 00:18:52.440 --> 00:18:54.582 in a couple of months, 373 00:18:54.682 --> 00:18:59.866 we will be able to get information real time of the results of our practice. 374 00:19:00.527 --> 00:19:05.350 This is something I've been dreaming of all my life, 375 00:19:05.470 --> 00:19:05.651 and 376 00:19:06.231 --> 00:19:10.294 I'm very close to get to this goal. 377 00:19:11.295 --> 00:19:12.876 We can't wait to see the advancements. 378 00:19:13.337 --> 00:19:13.537 Well, 379 00:19:13.777 --> 00:19:13.997 Dr. 380 00:19:14.017 --> 00:19:14.297 Mignogna, 381 00:19:14.377 --> 00:19:16.179 this is the end of our interview. 382 00:19:16.628 --> 00:19:18.028 Before to get back to the Congress, 383 00:19:18.588 --> 00:19:20.608 I like to finish my interview in music. 384 00:19:21.308 --> 00:19:21.428 So 385 00:19:22.008 --> 00:19:23.648 I would like to ask a last question. 386 00:19:24.368 --> 00:19:26.648 What is your favorite song of all time? 387 00:19:27.868 --> 00:19:28.668 My favorite? 388 00:19:28.669 --> 00:19:29.028 Oh, 389 00:19:29.029 --> 00:19:31.628 that's a very good question. 390 00:19:32.608 --> 00:19:35.048 My favorite song of all time. 391 00:19:35.908 --> 00:19:36.148 Well, 392 00:19:36.188 --> 00:19:36.728 of course, 393 00:19:36.948 --> 00:19:40.848 it has to be with mainly three great artists. 394 00:19:41.768 --> 00:19:43.188 A song of David Bowie, 395 00:19:43.368 --> 00:19:43.888 maybe 396 00:19:44.988 --> 00:19:45.708 Leonard Cohen. 397 00:19:46.349 --> 00:19:48.514 To say maybe Neil Young, 398 00:19:48.634 --> 00:19:51.481 I can't select one of them. 399 00:19:51.781 --> 00:19:53.786 You can imagine they are great, 400 00:19:53.906 --> 00:19:56.633 but they have to be one of ten. 401 00:19:57.678 --> 00:20:06.505 Did you think maybe one space holiday because I'm used to seeing this song a lot with my children since they were very, 402 00:20:06.685 --> 00:20:07.766 very little today. 403 00:20:07.886 --> 00:20:12.490 They are adults and we still sing that song together. 404 00:20:12.650 --> 00:20:14.511 Maybe one of the main favorites one. 405 00:20:15.272 --> 00:20:15.752 Perfect. 406 00:20:16.393 --> 00:20:17.173 Thank you so much. 407 00:20:17.313 --> 00:20:17.474 Eric, 408 00:20:17.514 --> 00:20:18.735 an excellent choice by the way. 409 00:20:19.135 --> 00:20:23.598 Thanks again for your time and I hope you like the exercise and let's go back to the Congress. 410 00:20:23.778 --> 00:20:24.159 Okay. 411 00:20:24.299 --> 00:20:25.039 Thank you very much. 412 00:20:25.220 --> 00:20:25.900 Been a pleasure. 413 00:20:34.258 --> 00:20:36.760 Huge thanks to our dedicated listeners. 414 00:20:37.220 --> 00:20:38.782 If you enjoyed the podcast, 415 00:20:38.962 --> 00:20:41.604 make sure to subscribe for more captivating content. 416 00:20:42.184 --> 00:20:44.086 Your support means the world. 417 00:20:45.787 --> 00:20:47.428 If you found this informative, 418 00:20:47.689 --> 00:20:48.229 quick favor, 419 00:20:48.289 --> 00:20:50.231 please drop up a five-star review. 420 00:20:50.671 --> 00:20:55.074 Your feedback helps us grow and deliver quality insight. 421 00:20:55.075 --> 00:20:56.676 Have topics you'd love us to cover? 422 00:20:57.076 --> 00:21:00.459 Share your ideas in the comments or connect with us on social media. 423 00:21:01.079 --> 00:21:02.460 Your input guides the... 424 00:21:02.490 --> 00:21:03.893 future of Prostatalk. 425 00:21:04.395 --> 00:21:07.181 Thanks for being a crucial part of our community. 426 00:21:08.083 --> 00:21:09.707 For more urology insights, 427 00:21:10.048 --> 00:21:11.190 visit Curlies.com. 428 00:21:11.611 --> 00:21:13.716 Stay tuned and see you next time.