Episode Transcript
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Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU land
Go in Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health, providing straight talk on
a wide range of men's health topics and advice on
how to live your healthiest life. Now on seven ten WOOR.
It's the Chairman of Urology at NYU Land Going Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:38):
Good morning everyone, Welcome to CATS's Corner here on WR
We are live this morning and welcome to the show.
I'm so glad you could join us this morning. If
you have a question and he'd like to give me
a call, the number is eight hundred three two one
zero seven ten. That number again is eight hundred three
to two one zero seven ten. Here on Kats's Corner.
(01:00):
I'm your host for the half hour, Doctor Aaron Katz.
Were in the fourth Sunday.
Speaker 4 (01:07):
Of the month.
Speaker 3 (01:08):
There are five Sundays actually this September, and this is
the fourth. So glad you could join me this morning,
and I really was excited. I am excited about this show.
I wanted to tell you about a meeting that I
just came back from in Washington, d C. Over the
past four days, and that meeting was all about new
(01:28):
forms of treating prostate cancer using focal therapy. And there's
a society that I am a member of actually, it's
called the Society of Focal Therapy, and this society is
all about promoting and educating physicians to end patients as well,
(01:49):
but it's really for doctors this meeting to learn about
the ways of treating prostate cancer using different forms of
energy that I'm going to discuss this morning that can
ablate or eradicate or get rid of prostate cancer in
just the region of the prostate and instead of the
(02:12):
entire prostate, instead of treating the entire hole land, we
can now focus in on where the cancer is in
a subset of men. It's not for all men that
are diagnosed with prostate cancer, but we are seeing many
more men these days that are diagnosed with the elevated PSA.
(02:34):
Most men have no symptoms after an elevation of PSA,
you would get an MRI and I've talked about this
on the show before, and the MRI can show us
the region or the area of interest or the target
there in the prostate that may be concerning, and then
biopsies are done and if the area of the target
(02:58):
confirms its cancer. The MRI is not always one hundred percent.
It may not always be cancer. It could be inflammation,
it could be benign tissue. But if the biopsy confirms
what the MRI is showing that there's cancer in one
quadrant or region of the prostate, then the patient may
(03:20):
be a candidd for different types of focal therapy rather
than taking out the entire prostate or treating the entire
prostate with radiotherapy. And the idea behind this, and this
has been done for other cancer specifically in urology, we
do this for kidney cancer. We do lots of partial
(03:42):
and ephrectomies where we just remove the part of the
kidney cancer with a laparoscopic and robotic procedure to just
remove that area and keep the remaining kidney viable and alive,
which is great from any patient that allows you to
have normal kidney function. We've seen this for many years
(04:06):
in breast cancer where you know, the old thinking of
removing the entire breast is still done but rarely, and
instead the lump can be just removed, sparing normal healthy
breast tissue. And then now we're seeing it in prostate
(04:26):
cancer throughout the world. And I will tell you that
there was great enthusiasm. It was extremely well attended by
urologists from all over the United States and the world,
in Asia, in Europe, Canada, South America that are doing
different types of focal therapy for prostate cancer. And the
(04:48):
idea is that if you can just get rid of
that part of the prostate that has the cancer, you
will spare men some of the known side effects that
can occur with whole gland treatment like hole land removal
or hole land radiation. Those things can be those side
(05:12):
effects that we know such as sexual issue, sexual dysfunction,
erectile dysfunction, or urinary issues, urinary incontinents, leaking of urine,
burning of urine, frequency of urine, things like that that
can occur with some patients after radiation, not all, but some.
(05:34):
So it's really an exciting and an exploding area. There
was lots of discussion about AI and AI and how
we can use some of the platforms that are available
in software programs to map out this particular region and
not only ablate the region or get rid of that region,
(05:58):
but we can go stand out just a little bit
beyond where the cancer is into what's called the margin,
so that you can prevent it from coming back. And
there was lots of discussion about the different energy levels.
Now my personal bias and what I have done actually
(06:19):
for many years in my practice, and it's really, you know,
it's actually really satisfying for me to see that there's
this society and people urologists are really engaging in this.
Some of the top top academic urologists, outstanding people that
(06:40):
are so bright, and lots of young people too as
well are getting into the field of focal therapy and
seeing its benefits. But for me personally, and you've heard
me talk about this if you listen to the show
quite a bit, I employ an energy using cold temperature
called cryotherapy, and I personally gave a lecture at this
(07:06):
meeting on using the cold therapy for patients that have
had radiation already and now the cancer is coming back
into that particular area of the prostate, and what my
results were on several hundred patients, which really has been
quite good, because after radiation, it is rather difficult to
(07:30):
remove the prostate if it comes back with surgery, because
the prostate can become kind of adherent or stuck down
onto to the rectum, and it's a.
Speaker 4 (07:39):
Very difficult operation.
Speaker 3 (07:40):
And I think it's something very important that people need
to know about that if you are thinking about having
radiation or surgery, that you need to know that if
you do have radiation and in this light, chance and
thankfully we have outstanding results here at NYU with our
CyberKnife program, chance that if it did recur, that surgery
(08:02):
would be for the most part off the table. It
really wouldn't be an option for you. And then you
would have that option though, for me to employ cryotherapy,
which is done in an outpatient setting and it's done
with very thin needles that go into the prostate through
the skin, not through the rectum, and into the area
(08:23):
of the cancer, and it can freeze it and kill it.
I'm going to just pause here for a moment and
let you know that I am speaking to you live
this morning on this fourth of fifth Sundays here in
the month of September, and if you'd like to give
me a call, love to hear from you. The number
is eight hundred three two one zero seven ten. That
(08:46):
number again is eight hundred three two one zero seven ten.
We're live here on WR Highheart Radio on CATS's Corner.
I am your host, doctor Aaron Katz, and talking to
you this morning about a meeting that I went to
in Washington, d C, just this past few days and
just got back yesterday. Took Amtrak up and down from
(09:08):
New York down to Union Station in Washington.
Speaker 4 (09:12):
Beautiful.
Speaker 3 (09:13):
You know, I have to tell you one of us.
It's just a great city. Washington really is. And you know,
three hours back and forth on the train from Penn
Station into into d C. If you haven't been to
d C, you know, really it's really beautiful city. I'll
tell you wonderful things to see, historical things, incredible. Anyway,
(09:33):
I didn't get to go outside much, but because I
was in the meeting a lot. But you know, you
got to take a break and you know, get up
and walk around a little bit. So anyway, but back
to the focal therapy, which is the really reason that
I was excited about talking to everyone. So I've been
using the cryo the cold energy for both patients that
have had recurrent cancer after radiation and patients that have
(09:58):
never had any treatment. Maybe patient instead of been on
active surveillance, maybe you've had a low rate grade prostate cancer.
Maybe it's gotten a little bit worse. Maybe you want
to have some treatment, but you don't need whole gland treatment.
You don't want to have radical prostatectomy or radiation treating
the entire prostate. Again, this is for patients that have
(10:18):
localized prostate cancer. On one side. MRI confirms that it's
on that side. The other really interesting thing that came
up in this meeting was the use of some of
these newer scans that we're using to determine it used
(10:39):
to be determined if cancer has spread, and I'm specifically
talking about what's called the Polarify scan or the PET scan.
This is a PET scan that will allow us to
detect any prostate cancer that has spread beyond the prostate
in the lymph node or in the bones. But now,
(11:00):
what many people at this meeting are finding, and I've
actually been noticing this myself, is that the PET scan
can also pick up where the cancer is in the
pro state. And can localize it. And there was a
lot of discussion yesterday in the days before in this
meeting about maybe we don't need an MRI anymore, maybe
(11:21):
we can just go to the PET scan. Now, the
PET scan is you know, it's more expensive, it is,
but it is something that if you are concerned about
that the cancer may have spread, if you have higher
risk prostate cancer, or if you've had treatment already like radiation,
let's say, and you're concerned that it may have been
(11:41):
coming back because your PSA may be going up, this
is a great, great test to get. It's called a pillarify.
It's called a PSMA scan stands for prostate specific membrane anagen.
It's very specific to the prostate tissue and can be
detected and it's injected. You get a CAT scan. It's
(12:01):
a PET scan and really can be very useful in
But you know, now what we're looking at is maybe
it's useful as well, like what's going on within the
prostate itself. Where is the cancer in the prostate? Is
it all over or is it just one side? And
if it isn't one side, well maybe the patient is
a good candidate for focal Now I was talking about
(12:24):
the enter different energy levels, and I've been using cryotherapy,
the cold energy, which I think is great. It's FDA
approved it, it's Medicare approved, it's you know, you don't.
Speaker 4 (12:35):
Have to pay for it.
Speaker 3 (12:36):
The other area, the other technology that has been approved
recently is something called Haifu High intensity focused ultrasound. We
also have this at NYU, both here on Long Island
and in the city. And my colleagues in the city
were at this meeting. Doctor Samir Tanasa was there and
(12:58):
doctor John Weisock was the Jim why Sock's eye Jim,
if you're listening, probably not anyway, but Jim why Sock
and semere Tenasia were there and some of my other
colleagues at n y you were there really showing the results.
And we have had great results with CRIER, but we're
also now using Hifu.
Speaker 4 (13:19):
Hiphu.
Speaker 3 (13:20):
High intensity focused ultrasound uses ultrasound waves that are concentrated
in one specific area.
Speaker 4 (13:28):
Kind of like.
Speaker 3 (13:29):
Thinking of it, and one of the doctors was talking
about I think of it like this like a magnifying
glass that you have and you're, you know, you're taking
the rays of the sun and you're focusing it on
a blade of grass.
Speaker 4 (13:42):
Let's say when you were a kid, I remember doing that.
It's kind of cool.
Speaker 3 (13:46):
Same way, where you can just focus in and concentrate
these ultrasound waves onto a specific region of the prostate
and heat up the area and deliver heat energy. So
those are the two ones, the HAIPU and the cryo
that are currently available in many academic centers. We have
(14:08):
it here, both of them at NYU. Which one is better,
I don't know. I don't know which one is better.
There's thought that maybe if it's in one specific region,
like if it's in the top part of the prostate,
maybe it's better for cryo. If it's in the bottom part,
maybe it's better for hayfu. The answer is, we don't
know yet. It really depends upon the experience, like many
other issues within medicine of the surgeon himself or herself.
(14:32):
But there are some other newer ones that are coming
about that are not yet accepted in most institutions. One
of them is called ire irreversible electroporation, which uses electricity
to and heat up the area of the prostatect using
(14:54):
in the cancer using electrical energy. And the other, which
was quite interesting, is called ulsa, which is the ultrasound
in the urethra, the transjureth roll. And there was also
another one on lasers, a laser replation, which again none
of those are really as accepted and you may have
(15:15):
to pay out of pocket for those, so you got
to be careful with that. But the CRIU and the
haifu have been accepted by the commercial carriers and you
will not have to pay for any of that. We're
live here on KATU's corner. If you like to give
me a call. The number is eight hundred three two
one zero seven ten about any issue. Doesn't have to
(15:35):
be just about the focal therapy that I'm talking about,
but it was kind of you know, really you know, excited.
So the numbers eight hundred three to two one zero
seven ten is a great meeting. Lots of new information,
lots of new hope for many patients. And you know
it's interesting that you know, in just you know, because
(15:56):
I've been in the field now and I think about it,
like thirty years amazing, Like I finished my fellowship in
nineteen ninety four. I did my fellowship at Columbia University.
I stayed on at Columbia many years after that, and
then I made the transition to come over here to
NYU about just about twelve years ago. So I've been
in the field twenty years. But in twenty years, okay,
(16:18):
which is not a long time, right, twenty years is
nothing in the history of medicine. There has been such
a rapid change in the way that we are treating
our prostate cancer patients, the way that we're diagnosing. I mean,
we never had MRIs, We never had something called trans
peronneal fusion biopsy.
Speaker 4 (16:40):
So now if you.
Speaker 3 (16:41):
Get an MRI and it shows that there's an area
of concern, you can target that with a computer guided platform,
which will allow the doctor to take the biopsy needle
with extremely high degree of accuracy and target that even
if it's like really like seven millimeters, even if your
(17:04):
prostrate is large, I mean, the accuracy rate is incredible.
So you overlay the ultrasound with the MRI and you
can do these fusion guided biopsies. And actually, if you
are listening and you've been told you have an elevated PSA,
you had an MRI and you might need a biopsy,
that's what that's the biopsy that you should have these days. Okay,
(17:25):
there's no doubt in my mind that everyone should have
a fusion biopsy, so make sure you speak with your
physician about that. But that's changed, okay. And then it
was well, everyone with prostate cancer needs treatment. Well that's changed.
I mean, we know with genomics and genetics and velocity
of PSA and MRI and biopsy characteristics that not everybody
(17:47):
needs to be treated. In fact, they're saying that, you know,
the recent statistics show that thirty to forty percent of
people that get diagnosed with prostate cancer have the low energy,
the low not low energy, low risk prostate cancer. And
you can go on as active surveillance. Now, look, there's
there's different caveats of active surveillance, and we know that
(18:09):
there's certainly something that is well known, which is patient anxiety,
and patients say, look, I have cancer. I don't I
don't want to just watch this, you know, I gotta
I gotta treat this. So okay, you know there's that,
But we do know that it used to be that,
you know, people would would never consider, you know, active
(18:29):
surveillance for cancer, but we are certainly doing that. It
used to be when I was just out of my
fellowship that if you had cancer, you were treated. You
either had two choices. You had radiation or you had
your prostate removed.
Speaker 4 (18:44):
That was it.
Speaker 3 (18:45):
And if you had your prostate removed, it was done open.
Now it's done ninety nine percent, i would say, of
all surgeries in this country for prostate cancer are done robotically.
And even so that's changed over the last twenty years.
And now in this meeting, which was actually a joint
(19:08):
meeting between the Focal Therapy Society and the Society of
Eurologic Robotic Surgeons, there's lots of interest in robotic surgery
using what's called a single port, where you can just
use one robotic arm that goes into the belly button
rather than multiple ports. But anyway, that's but it's robotic
surgery has certainly changed. The way that we deliver radiation
(19:31):
has changed. It used to be everybody got forty five days.
Now everybody it's five days of radiation. Well not everybody,
but most people are good candidates for the five days
of radiation called what we have here, and you know,
we talked a lot with doctor Jonathan Hasse and his
colleagues here on Katz's corner. Using cyber knife, it's five days.
(19:53):
Actually they're doing a clinical trial looking at two days.
So maybe I'll bet that that's going to be the
standard of care in a few years too. I mean,
we went from forty five days to five days and
now two days incredible with outstanding results. So you know,
for me, it was really interesting to see this and
now we're going from lots of these the old theory.
(20:15):
You know, it's amazing if people get stuck on one
way of treating and this is the only way, well,
you know, you don't need to take out or treat
the entire prostrate in many situations, you can do focal therapy.
So that is really something that is not only in
the future, but it's here now. And you know, it's
now going to be part of the AUA and the
(20:39):
National Cancer Institute guidelines. It's already part of the European guidelines.
It will be very shortly part of the United States
guidelines as well to include focal therapy in the discussion
of patients who have prostate cancer. And this was like wow,
(21:00):
like no one would ever thought that you could you
could do that, But because of the because of the MRI,
because of the platforms, and the computer guided approaches and
our targeting and our ability to really predict what's going
on in the prostate using genomic testing. There's there's certainly
a role for it. Got a few minutes left here
(21:21):
on Katz's corner. Phone lines are open if you want
to give me a call. The number is one eight
hundred three two one zero seven ten. The number is
one eight hundred three to two one zero seven ten
left to hear from you. We just have I guess
about maybe five or six minutes left here on Katz's corner.
Speaker 4 (21:41):
Uh.
Speaker 3 (21:41):
And if you do have a focal therapy, then the
question is, well, how do you know if it was
a successful?
Speaker 4 (21:47):
Good question? Oh thank you doctor Cats for asking that. Yeah.
Speaker 3 (21:50):
Sure, well that was brought up in a lot of
the meetings over the last few days as to how
to monitor a patient who now has their prostate in
We deliver the energy, whether it be HAIFU or cryo
or a laser or whatever it may be. And then
you say, well, how do we know that the patient's cure. Well, again,
(22:11):
it goes back to multiple factors, one being the PSA.
And you know the PSA. You know in the thirty
years that I'm in practice. The PSA is still here.
It's it's still probably best useful after treatment and monitoring patients,
and we still rely on it quite heavily for detecting
(22:32):
prostate cancer, but also for monitoring patients. So we know
with reasonable certainty that after you do an ablation, the
PSA should go down, absolutely should go down. It should
not stay stable. It shouldn't say the same number. It
should go down. How far should it go down? What
level should it be? If you're just treating one area?
(22:53):
Now we know that if you take the whole prostate out,
PSA should be zero point zero. If you have radiation,
PSA should be probably less than one. What should your
PSA be after focal therapy? H good question. Well, different
energy forms maybe have different reductions in PSA, but for
(23:14):
the most part it should be going down. It should
probably go If you're just treating let's say half of
the prostate, it should go down more than fifty percent
of what your initial PSA was. Can we rely just
on the PSA? Well, probably not, And so what are
we going to do. Well, we're going to rely on
(23:35):
things like again imaging test, and the best imaging test
right now has been the MRI. So if you get
a focal therapy, you probably need an MRI, probably in
about a year. That's the consensus panel that most of
us feel MRI in the year because the MRI, if
you had an area of cancer there right, it should
(23:56):
be gone out clearly, but there should be no other
areas that have popped up in the prostate that are
showing cancer.
Speaker 4 (24:04):
So MRI is really good.
Speaker 3 (24:06):
The question is are there other imaging tests that might
be better, And that's where that PET scan, that PSMA
test that I was talking about earlier may be the
right solutions or answer. So we're gonna see. We've got
just notified. We've got three minutes left if you want
(24:28):
to get in a call, but I don't not so
sure at this point, but through eight hundred and three
to two one zero seven ten. But anyway, so the
PSA that's how you're going to monitor that after a
focal therapy. And then of course it's always about not
only the oncologic or the cancer results of focal therapy,
(24:52):
but the quality of life. How are the patients doing
in terms of urinary issues erection issues. The consensus at
the meeting was that the urinary and sexual issues are
much less in terms of the side effects with focal
therapy than with whole gland therapy, which obviously it's intuitive,
(25:14):
it makes sense you would think that then if you're
just treating one area or region of the prostate, that
you know you're not gonna have urinary leak and you're
not gonna have sexual issues.
Speaker 4 (25:26):
But there are.
Speaker 3 (25:26):
Patients that still can have some sexual issues, and it
really depends upon the patient's sexual function prior to undergoing
focal therapy. So that if you know you're perfect and
you never need any of the medications and your erections
are perfect, by and large, most patients will maintain that
and will not need medications, but some of the other peddications.
(25:48):
Some of the other patients, if you're a little older,
let's say we've had some difficulties with erections, more than
likely you're going to need some of the medications, either
say or viagra. But you know, it was really exciting
for me to be at this meeting, having done cryo
for many years and now seeing that it is becoming
(26:10):
much more accepted. There's lots of new technologies that are
coming into to this field for imaging, for detecting prostate
cancer and for employing the way that we can eradicate
the disease. So I did want to let all of
you know that I feel that it's my responsibility here
(26:33):
on Kats's Corner and part of NYU to bring all
of you the latest and greatest in mental health each week,
and certainly in my own area of expertise, which is
a prostate cancer. So I hope you enjoyed listening to me,
and we'll be back here next week with another great
(26:56):
show here on Katsa's Corner every Sunday at seven am ELI.
You can also check us out on the podcast and
the wr iHeart radio station.
Speaker 4 (27:05):
And I wish you all a wonderful day.
Speaker 3 (27:08):
I think that that is the end of the show,
so I want to thank you all for taking the
time to listen.
Speaker 4 (27:13):
And certainly if you were.
Speaker 3 (27:14):
A loved one a diagnosed with cross date cancer, or
you have a question and maybe focal therapy is right
for you, we would love to hear you have a
consultation with you here at NYU on Long Island.
Speaker 2 (27:30):
You've been listening to Cancer's Corner, come back every week
to hear more straight talk on a wide range of
men's health topics and advice on how to live your
healthiest life.
Speaker 1 (27:41):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU land
Go in Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health, providing straight talk on
a wide range of men's health topics and advice on
how to live your healthiest life. Now on seven ten WOOR.
It's the Chairman of Urology at NYU Land Going Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:38):
Good morning everyone, Welcome to CATS's Corner here on WR
We are live this morning and welcome to the show.
I'm so glad you could join us this morning. If
you have a question and he'd like to give me
a call, the number is eight hundred three two one
zero seven ten. That number again is eight hundred three
to two one zero seven ten. Here on Kats's Corner.
(01:00):
I'm your host for the half hour, Doctor Aaron Katz.
Were in the fourth Sunday.
Speaker 4 (01:07):
Of the month.
Speaker 3 (01:08):
There are five Sundays actually this September, and this is
the fourth. So glad you could join me this morning,
and I really was excited. I am excited about this show.
I wanted to tell you about a meeting that I
just came back from in Washington, d C. Over the
past four days, and that meeting was all about new
(01:28):
forms of treating prostate cancer using focal therapy. And there's
a society that I am a member of actually, it's
called the Society of Focal Therapy, and this society is
all about promoting and educating physicians to end patients as well,
(01:49):
but it's really for doctors this meeting to learn about
the ways of treating prostate cancer using different forms of
energy that I'm going to discuss this morning that can
ablate or eradicate or get rid of prostate cancer in
just the region of the prostate and instead of the
(02:12):
entire prostate, instead of treating the entire hole land, we
can now focus in on where the cancer is in
a subset of men. It's not for all men that
are diagnosed with prostate cancer, but we are seeing many
more men these days that are diagnosed with the elevated PSA.
(02:34):
Most men have no symptoms after an elevation of PSA,
you would get an MRI and I've talked about this
on the show before, and the MRI can show us
the region or the area of interest or the target
there in the prostate that may be concerning, and then
biopsies are done and if the area of the target
(02:58):
confirms its cancer. The MRI is not always one hundred percent.
It may not always be cancer. It could be inflammation,
it could be benign tissue. But if the biopsy confirms
what the MRI is showing that there's cancer in one
quadrant or region of the prostate, then the patient may
(03:20):
be a candidd for different types of focal therapy rather
than taking out the entire prostate or treating the entire
prostate with radiotherapy. And the idea behind this, and this
has been done for other cancer specifically in urology, we
do this for kidney cancer. We do lots of partial
(03:42):
and ephrectomies where we just remove the part of the
kidney cancer with a laparoscopic and robotic procedure to just
remove that area and keep the remaining kidney viable and alive,
which is great from any patient that allows you to
have normal kidney function. We've seen this for many years
(04:06):
in breast cancer where you know, the old thinking of
removing the entire breast is still done but rarely, and
instead the lump can be just removed, sparing normal healthy
breast tissue. And then now we're seeing it in prostate
(04:26):
cancer throughout the world. And I will tell you that
there was great enthusiasm. It was extremely well attended by
urologists from all over the United States and the world,
in Asia, in Europe, Canada, South America that are doing
different types of focal therapy for prostate cancer. And the
(04:48):
idea is that if you can just get rid of
that part of the prostate that has the cancer, you
will spare men some of the known side effects that
can occur with whole gland treatment like hole land removal
or hole land radiation. Those things can be those side
(05:12):
effects that we know such as sexual issue, sexual dysfunction,
erectile dysfunction, or urinary issues, urinary incontinents, leaking of urine,
burning of urine, frequency of urine, things like that that
can occur with some patients after radiation, not all, but some.
(05:34):
So it's really an exciting and an exploding area. There
was lots of discussion about AI and AI and how
we can use some of the platforms that are available
in software programs to map out this particular region and
not only ablate the region or get rid of that region,
(05:58):
but we can go stand out just a little bit
beyond where the cancer is into what's called the margin,
so that you can prevent it from coming back. And
there was lots of discussion about the different energy levels.
Now my personal bias and what I have done actually
(06:19):
for many years in my practice, and it's really, you know,
it's actually really satisfying for me to see that there's
this society and people urologists are really engaging in this.
Some of the top top academic urologists, outstanding people that
(06:40):
are so bright, and lots of young people too as
well are getting into the field of focal therapy and
seeing its benefits. But for me personally, and you've heard
me talk about this if you listen to the show
quite a bit, I employ an energy using cold temperature
called cryotherapy, and I personally gave a lecture at this
(07:06):
meeting on using the cold therapy for patients that have
had radiation already and now the cancer is coming back
into that particular area of the prostate, and what my
results were on several hundred patients, which really has been
quite good, because after radiation, it is rather difficult to
(07:30):
remove the prostate if it comes back with surgery, because
the prostate can become kind of adherent or stuck down
onto to the rectum, and it's a.
Speaker 4 (07:39):
Very difficult operation.
Speaker 3 (07:40):
And I think it's something very important that people need
to know about that if you are thinking about having
radiation or surgery, that you need to know that if
you do have radiation and in this light, chance and
thankfully we have outstanding results here at NYU with our
CyberKnife program, chance that if it did recur, that surgery
(08:02):
would be for the most part off the table. It
really wouldn't be an option for you. And then you
would have that option though, for me to employ cryotherapy,
which is done in an outpatient setting and it's done
with very thin needles that go into the prostate through
the skin, not through the rectum, and into the area
(08:23):
of the cancer, and it can freeze it and kill it.
I'm going to just pause here for a moment and
let you know that I am speaking to you live
this morning on this fourth of fifth Sundays here in
the month of September, and if you'd like to give
me a call, love to hear from you. The number
is eight hundred three two one zero seven ten. That
(08:46):
number again is eight hundred three two one zero seven ten.
We're live here on WR Highheart Radio on CATS's Corner.
I am your host, doctor Aaron Katz, and talking to
you this morning about a meeting that I went to
in Washington, d C, just this past few days and
just got back yesterday. Took Amtrak up and down from
(09:08):
New York down to Union Station in Washington.
Speaker 4 (09:12):
Beautiful.
Speaker 3 (09:13):
You know, I have to tell you one of us.
It's just a great city. Washington really is. And you know,
three hours back and forth on the train from Penn
Station into into d C. If you haven't been to
d C, you know, really it's really beautiful city. I'll
tell you wonderful things to see, historical things, incredible. Anyway,
(09:33):
I didn't get to go outside much, but because I
was in the meeting a lot. But you know, you
got to take a break and you know, get up
and walk around a little bit. So anyway, but back
to the focal therapy, which is the really reason that
I was excited about talking to everyone. So I've been
using the cryo the cold energy for both patients that
have had recurrent cancer after radiation and patients that have
(09:58):
never had any treatment. Maybe patient instead of been on
active surveillance, maybe you've had a low rate grade prostate cancer.
Maybe it's gotten a little bit worse. Maybe you want
to have some treatment, but you don't need whole gland treatment.
You don't want to have radical prostatectomy or radiation treating
the entire prostate. Again, this is for patients that have
(10:18):
localized prostate cancer. On one side. MRI confirms that it's
on that side. The other really interesting thing that came
up in this meeting was the use of some of
these newer scans that we're using to determine it used
(10:39):
to be determined if cancer has spread, and I'm specifically
talking about what's called the Polarify scan or the PET scan.
This is a PET scan that will allow us to
detect any prostate cancer that has spread beyond the prostate
in the lymph node or in the bones. But now,
(11:00):
what many people at this meeting are finding, and I've
actually been noticing this myself, is that the PET scan
can also pick up where the cancer is in the
pro state. And can localize it. And there was a
lot of discussion yesterday in the days before in this
meeting about maybe we don't need an MRI anymore, maybe
(11:21):
we can just go to the PET scan. Now, the
PET scan is you know, it's more expensive, it is,
but it is something that if you are concerned about
that the cancer may have spread, if you have higher
risk prostate cancer, or if you've had treatment already like radiation,
let's say, and you're concerned that it may have been
(11:41):
coming back because your PSA may be going up, this
is a great, great test to get. It's called a pillarify.
It's called a PSMA scan stands for prostate specific membrane anagen.
It's very specific to the prostate tissue and can be
detected and it's injected. You get a CAT scan. It's
(12:01):
a PET scan and really can be very useful in
But you know, now what we're looking at is maybe
it's useful as well, like what's going on within the
prostate itself. Where is the cancer in the prostate? Is
it all over or is it just one side? And
if it isn't one side, well maybe the patient is
a good candidate for focal Now I was talking about
(12:24):
the enter different energy levels, and I've been using cryotherapy,
the cold energy, which I think is great. It's FDA
approved it, it's Medicare approved, it's you know, you don't.
Speaker 4 (12:35):
Have to pay for it.
Speaker 3 (12:36):
The other area, the other technology that has been approved
recently is something called Haifu High intensity focused ultrasound. We
also have this at NYU, both here on Long Island
and in the city. And my colleagues in the city
were at this meeting. Doctor Samir Tanasa was there and
(12:58):
doctor John Weisock was the Jim why Sock's eye Jim,
if you're listening, probably not anyway, but Jim why Sock
and semere Tenasia were there and some of my other
colleagues at n y you were there really showing the results.
And we have had great results with CRIER, but we're
also now using Hifu.
Speaker 4 (13:19):
Hiphu.
Speaker 3 (13:20):
High intensity focused ultrasound uses ultrasound waves that are concentrated
in one specific area.
Speaker 4 (13:28):
Kind of like.
Speaker 3 (13:29):
Thinking of it, and one of the doctors was talking
about I think of it like this like a magnifying
glass that you have and you're, you know, you're taking
the rays of the sun and you're focusing it on
a blade of grass.
Speaker 4 (13:42):
Let's say when you were a kid, I remember doing that.
It's kind of cool.
Speaker 3 (13:46):
Same way, where you can just focus in and concentrate
these ultrasound waves onto a specific region of the prostate
and heat up the area and deliver heat energy. So
those are the two ones, the HAIPU and the cryo
that are currently available in many academic centers. We have
(14:08):
it here, both of them at NYU. Which one is better,
I don't know. I don't know which one is better.
There's thought that maybe if it's in one specific region,
like if it's in the top part of the prostate,
maybe it's better for cryo. If it's in the bottom part,
maybe it's better for hayfu. The answer is, we don't
know yet. It really depends upon the experience, like many
other issues within medicine of the surgeon himself or herself.
(14:32):
But there are some other newer ones that are coming
about that are not yet accepted in most institutions. One
of them is called ire irreversible electroporation, which uses electricity
to and heat up the area of the prostatect using
(14:54):
in the cancer using electrical energy. And the other, which
was quite interesting, is called ulsa, which is the ultrasound
in the urethra, the transjureth roll. And there was also
another one on lasers, a laser replation, which again none
of those are really as accepted and you may have
(15:15):
to pay out of pocket for those, so you got
to be careful with that. But the CRIU and the
haifu have been accepted by the commercial carriers and you
will not have to pay for any of that. We're
live here on KATU's corner. If you like to give
me a call. The number is eight hundred three two
one zero seven ten about any issue. Doesn't have to
(15:35):
be just about the focal therapy that I'm talking about,
but it was kind of you know, really you know, excited.
So the numbers eight hundred three to two one zero
seven ten is a great meeting. Lots of new information,
lots of new hope for many patients. And you know
it's interesting that you know, in just you know, because
(15:56):
I've been in the field now and I think about it,
like thirty years amazing, Like I finished my fellowship in
nineteen ninety four. I did my fellowship at Columbia University.
I stayed on at Columbia many years after that, and
then I made the transition to come over here to
NYU about just about twelve years ago. So I've been
in the field twenty years. But in twenty years, okay,
(16:18):
which is not a long time, right, twenty years is
nothing in the history of medicine. There has been such
a rapid change in the way that we are treating
our prostate cancer patients, the way that we're diagnosing. I mean,
we never had MRIs, We never had something called trans
peronneal fusion biopsy.
Speaker 4 (16:40):
So now if you.
Speaker 3 (16:41):
Get an MRI and it shows that there's an area
of concern, you can target that with a computer guided platform,
which will allow the doctor to take the biopsy needle
with extremely high degree of accuracy and target that even
if it's like really like seven millimeters, even if your
(17:04):
prostrate is large, I mean, the accuracy rate is incredible.
So you overlay the ultrasound with the MRI and you
can do these fusion guided biopsies. And actually, if you
are listening and you've been told you have an elevated PSA,
you had an MRI and you might need a biopsy,
that's what that's the biopsy that you should have these days. Okay,
(17:25):
there's no doubt in my mind that everyone should have
a fusion biopsy, so make sure you speak with your
physician about that. But that's changed, okay. And then it
was well, everyone with prostate cancer needs treatment. Well that's changed.
I mean, we know with genomics and genetics and velocity
of PSA and MRI and biopsy characteristics that not everybody
(17:47):
needs to be treated. In fact, they're saying that, you know,
the recent statistics show that thirty to forty percent of
people that get diagnosed with prostate cancer have the low energy,
the low not low energy, low risk prostate cancer. And
you can go on as active surveillance. Now, look, there's
there's different caveats of active surveillance, and we know that
(18:09):
there's certainly something that is well known, which is patient anxiety,
and patients say, look, I have cancer. I don't I
don't want to just watch this, you know, I gotta
I gotta treat this. So okay, you know there's that,
But we do know that it used to be that,
you know, people would would never consider, you know, active
(18:29):
surveillance for cancer, but we are certainly doing that. It
used to be when I was just out of my
fellowship that if you had cancer, you were treated. You
either had two choices. You had radiation or you had
your prostate removed.
Speaker 4 (18:44):
That was it.
Speaker 3 (18:45):
And if you had your prostate removed, it was done open.
Now it's done ninety nine percent, i would say, of
all surgeries in this country for prostate cancer are done robotically.
And even so that's changed over the last twenty years.
And now in this meeting, which was actually a joint
(19:08):
meeting between the Focal Therapy Society and the Society of
Eurologic Robotic Surgeons, there's lots of interest in robotic surgery
using what's called a single port, where you can just
use one robotic arm that goes into the belly button
rather than multiple ports. But anyway, that's but it's robotic
surgery has certainly changed. The way that we deliver radiation
(19:31):
has changed. It used to be everybody got forty five days.
Now everybody it's five days of radiation. Well not everybody,
but most people are good candidates for the five days
of radiation called what we have here, and you know,
we talked a lot with doctor Jonathan Hasse and his
colleagues here on Katz's corner. Using cyber knife, it's five days.
(19:53):
Actually they're doing a clinical trial looking at two days.
So maybe I'll bet that that's going to be the
standard of care in a few years too. I mean,
we went from forty five days to five days and
now two days incredible with outstanding results. So you know,
for me, it was really interesting to see this and
now we're going from lots of these the old theory.
(20:15):
You know, it's amazing if people get stuck on one
way of treating and this is the only way, well,
you know, you don't need to take out or treat
the entire prostrate in many situations, you can do focal therapy.
So that is really something that is not only in
the future, but it's here now. And you know, it's
now going to be part of the AUA and the
(20:39):
National Cancer Institute guidelines. It's already part of the European guidelines.
It will be very shortly part of the United States
guidelines as well to include focal therapy in the discussion
of patients who have prostate cancer. And this was like wow,
(21:00):
like no one would ever thought that you could you
could do that, But because of the because of the MRI,
because of the platforms, and the computer guided approaches and
our targeting and our ability to really predict what's going
on in the prostate using genomic testing. There's there's certainly
a role for it. Got a few minutes left here
(21:21):
on Katz's corner. Phone lines are open if you want
to give me a call. The number is one eight
hundred three two one zero seven ten. The number is
one eight hundred three to two one zero seven ten
left to hear from you. We just have I guess
about maybe five or six minutes left here on Katz's corner.
Speaker 4 (21:41):
Uh.
Speaker 3 (21:41):
And if you do have a focal therapy, then the
question is, well, how do you know if it was
a successful?
Speaker 4 (21:47):
Good question? Oh thank you doctor Cats for asking that. Yeah.
Speaker 3 (21:50):
Sure, well that was brought up in a lot of
the meetings over the last few days as to how
to monitor a patient who now has their prostate in
We deliver the energy, whether it be HAIFU or cryo
or a laser or whatever it may be. And then
you say, well, how do we know that the patient's cure. Well, again,
(22:11):
it goes back to multiple factors, one being the PSA.
And you know the PSA. You know in the thirty
years that I'm in practice. The PSA is still here.
It's it's still probably best useful after treatment and monitoring patients,
and we still rely on it quite heavily for detecting
(22:32):
prostate cancer, but also for monitoring patients. So we know
with reasonable certainty that after you do an ablation, the
PSA should go down, absolutely should go down. It should
not stay stable. It shouldn't say the same number. It
should go down. How far should it go down? What
level should it be? If you're just treating one area?
(22:53):
Now we know that if you take the whole prostate out,
PSA should be zero point zero. If you have radiation,
PSA should be probably less than one. What should your
PSA be after focal therapy? H good question. Well, different
energy forms maybe have different reductions in PSA, but for
(23:14):
the most part it should be going down. It should
probably go If you're just treating let's say half of
the prostate, it should go down more than fifty percent
of what your initial PSA was. Can we rely just
on the PSA? Well, probably not, And so what are
we going to do. Well, we're going to rely on
(23:35):
things like again imaging test, and the best imaging test
right now has been the MRI. So if you get
a focal therapy, you probably need an MRI, probably in
about a year. That's the consensus panel that most of
us feel MRI in the year because the MRI, if
you had an area of cancer there right, it should
(23:56):
be gone out clearly, but there should be no other
areas that have popped up in the prostate that are
showing cancer.
Speaker 4 (24:04):
So MRI is really good.
Speaker 3 (24:06):
The question is are there other imaging tests that might
be better, And that's where that PET scan, that PSMA
test that I was talking about earlier may be the
right solutions or answer. So we're gonna see. We've got
just notified. We've got three minutes left if you want
(24:28):
to get in a call, but I don't not so
sure at this point, but through eight hundred and three
to two one zero seven ten. But anyway, so the
PSA that's how you're going to monitor that after a
focal therapy. And then of course it's always about not
only the oncologic or the cancer results of focal therapy,
(24:52):
but the quality of life. How are the patients doing
in terms of urinary issues erection issues. The consensus at
the meeting was that the urinary and sexual issues are
much less in terms of the side effects with focal
therapy than with whole gland therapy, which obviously it's intuitive,
(25:14):
it makes sense you would think that then if you're
just treating one area or region of the prostate, that
you know you're not gonna have urinary leak and you're
not gonna have sexual issues.
Speaker 4 (25:26):
But there are.
Speaker 3 (25:26):
Patients that still can have some sexual issues, and it
really depends upon the patient's sexual function prior to undergoing
focal therapy. So that if you know you're perfect and
you never need any of the medications and your erections
are perfect, by and large, most patients will maintain that
and will not need medications, but some of the other peddications.
(25:48):
Some of the other patients, if you're a little older,
let's say we've had some difficulties with erections, more than
likely you're going to need some of the medications, either
say or viagra. But you know, it was really exciting
for me to be at this meeting, having done cryo
for many years and now seeing that it is becoming
(26:10):
much more accepted. There's lots of new technologies that are
coming into to this field for imaging, for detecting prostate
cancer and for employing the way that we can eradicate
the disease. So I did want to let all of
you know that I feel that it's my responsibility here
(26:33):
on Kats's Corner and part of NYU to bring all
of you the latest and greatest in mental health each week,
and certainly in my own area of expertise, which is
a prostate cancer. So I hope you enjoyed listening to me,
and we'll be back here next week with another great
(26:56):
show here on Katsa's Corner every Sunday at seven am ELI.
You can also check us out on the podcast and
the wr iHeart radio station.
Speaker 4 (27:05):
And I wish you all a wonderful day.
Speaker 3 (27:08):
I think that that is the end of the show,
so I want to thank you all for taking the
time to listen.
Speaker 4 (27:13):
And certainly if you were.
Speaker 3 (27:14):
A loved one a diagnosed with cross date cancer, or
you have a question and maybe focal therapy is right
for you, we would love to hear you have a
consultation with you here at NYU on Long Island.
Speaker 2 (27:30):
You've been listening to Cancer's Corner, come back every week
to hear more straight talk on a wide range of
men's health topics and advice on how to live your
healthiest life.
Speaker 1 (27:41):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed
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