May 14, 2025 • 14 mins
Urologist and president of the Duval County Medical Society Dr. Ali Kasraeian joins Dr. Michael Koren to update us on recent advances in Urology. In Part 3 of this series, Dr. Koren and Dr. Kasraeian dive deep into the latest advancements in prostate cancer detection and treatment options. They explore the evolution from basic PSA screening to personalized approaches . Dr. Kasraeian focuses on the modern shift to patient-focused, individualized approaches that meet patients where they are by balancing early detection with quality of life considerations.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:00):
Welcome to MedEvidence!, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts Hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence!, and I've
been having this fabulousconversation with Dr.
Ali Kasraeian, a urologist anda media person and somebody
that's involved in organizedmedicine.
In our last segment we werejust talking about the
controversy around PSA and howyou have to customize that, the
(00:33):
number that you get to thespecifics of a person.
So, higher risk people you'regoing to be more aggressive If
you had a family history, orAfrican-American, for example
and lower risk people maybe youwatch it for a longer period of
time.
But interestingly, even whenyou get to imaging, there's ways
of getting a sense for what theprognosis will be over the next
5, 10, 15, 20 years.
So that was a fascinatingdiscussion.
So let's jump into that pointabout what you see as the future
(00:55):
for getting better atdiagnosing prostate cancer and
also identifying the people thattruly need to be treated
aggressively.
Dr. Ali Kasraeian (01:05):
Yeah, you know smarter screening, you know
PSA can save your life.
Talk to your doctor about PSAscreening, know your family
history.
So if we start with a lab testand it's concerning, then we
kind of talk about what to donext.
If you show up with a PSA of 10, we recheck it's still elevated
, it makes sense to do a biopsy.
I think the MRI allows us to doa better biopsy.
If we're on the fence you've hadrepeat negative biopsies and
(01:27):
things of that nature then youknow, can we use biomarkers.
Biomarkers are lab andurine-based tests that can help
guide us to see what is theprobability or the possibility
that your elevated PSA is due tonot just a prostate cancer but
a intermediate or higher riskprostate cancer, meaning a
(01:48):
prostate cancer that if we foundwe would treat A lot of times
these tests.
If the score is in the lowerrange, that risk is low.
If it's in the intermediate tohigher range, it's an
incremental higher risk.
We can take that with an MRIscan, put them together and give
a discussion or initiate adiscussion of what is the risk,
what is your comfort level, whatis our next move, and we can
(02:09):
personalize it to you, yourhistory and other medical issues
that you're going through inyour age.
Dr. Michael Koren (02:14):
So, starting with the diagnosis, are there
specific biomarkers other thanPSA that you can mention in this
podcast?
Dr. Ali Kasraeian (02:21):
Yeah, absolutely so, the three that I
use.
You know, right now oneblood-based test that I use
quite a bit is a thing calledthe 4K score.
It looks at PSA with threeother cousins intact PSA, total
PSA, free PSA, intact PSA andthis thing called HK2, a
Kallikrein protein 2, which arekind of all in the same family.
Dr. Michael Koren (02:43):
So a doctor has to order that specific panel
.
Dr. Ali Kasraeian (02:45):
It's a lab test, yeah.
And then it comes back with ascore and if the score is in the
lower risk range, you have avery, very low risk of having an
intermediate or higher riskprostate cancer.
Dr. Michael Koren (02:58):
Is that something you should do before
just getting a standard PSA?
Do you think
because, honestly, if you have alow PSA, a stable PSA, why
would you leap to another testlike that?
Because what if it comes backwith an in-between result?
And now you have a low PSA andit's only valid for PSAs that
are a little bit increasedanyway.
From that standpoint, two urinetests that are wonderful and
(03:19):
great science with them.
One's an exosome DX test, anexosome DS test.
Beautiful science that theyfound that exosomes, which we
before thought just hadmitochondria, actually have
messenger RNA in them and sothey found it coming off urine.
It carries with it messengerRNA and great genetic and DNA
information, carbon copies of itcoming off urine.
(03:41):
That could get prostateinformation, so that first part
of the stream, and they can getpredictive information of the
risk of prostate cancer off it.
Amazing science.
So if you're in the low level,the risk of having a prostate
cancer that's seven or higher isa little bit higher.
If it's in the low range, it'sa very low risk of that.
So you can do that.
And during the COVID pandemicwe were very fortunate to be
(04:01):
part of the first team usingthat on an at-home test and it
was really really powerful forus to use to be able to guide
patients on whether they need tocome in and talk about doing a
biopsy at a time where peopledidn't want to leave their house
.
So that was really powerful.
Again, that's not for peoplewith a low PSA.
Those are people that areidentified as having higher PSAs
(04:23):
and taking the next step.
Dr. Ali Kasraeian (04:24):
Yeah So is someone with a PSA change
that we want to be mindful of.
Do we need to do a biopsy next?
from that standpoint,
Dr. Michael Koren (04:32):
And would that test, if it was negative,
make you feel comfortable thatyou don't need to do?
Imaging of the prostate.
Dr. Ali Kasraeian (04:39):
So that's a very controversial discussion
and there are a lot of paperslooking at that and we as a as
urology have not come up with anabsolute answer for that.
For some people the MRI scanfirst makes sense.
For some people, doing thebiomarker first makes sense.
Some people are are.
You know, the genetics trumpthe imaging.
Some people, imaging trumpsthat so so for me it's a very
(05:01):
personalized approach, you knowfrom that standpoint.
So really, for me personally,it's a patient by patient
discussion
Dr. Michael Koren (05:06):
Got it.
Dr. Ali Kasraeian (05:08):
Another test that we use frequently is a My
Prostate score.
It's a newer of the three.
Great test and what I likeabout this test is a very high
negative predictive value.
So for someone who's never hada biopsy, they have a 95%
negative predictive value.
If your score is in the lowrange, you have a 95% likelihood
(05:29):
of not having prostate cancer.
If you've had a previousnegative biopsy, you have almost
a 99% negative predictive value.
So that's very powerful.
So I use it often with peoplewho've had negative biopsies and
then we want to think aboutwhether or not to do another
biopsy, especially if they havehad a negative MRI scan.
Dr. Michael Koren (05:45):
Yeah.
So for listeners out there,tests that have a high negative
predictive value usually have avery high sensitivity, so they
pick up things.
So when they're negative, youfeel pretty comfortable that
you're not dealing with theproblem.
The flip side is, when they'repositive, it doesn't always mean
that you have the problem.
Dr. Ali Kasraeian (06:02):
Yeah, it tells you that search further.
Right, and that's how I kind ofcounsel people.
You know, if this is a higher,it doesn't mean that we have
cancer Absolutely.
It just means that we shouldprobably look If it's negative.
We feel comfortable that it'snegative.
Dr. Michael Koren (06:14):
Any other novel biomarkers that you want
to?
Dr. Ali Kasraeian (06:17):
One thing that's really interesting.
That's not quite as novel, butsomething to keep in the back
pocket.
There's some tests that weactually use when people have
had previous biopsies to decidein the next biopsy if their PSA
changes.
There's a test called theConfirm MDX where you can
actually go back and look at thegenetics of a previous negative
biopsy and it can tell you atany of those cores that you took
could there be genetic changesthat could heighten the risk of
(06:44):
a positive biopsy at that site.
So then when you do the nextbiopsy it can help guide you to
take a few more cores at thatsite.
And that's in the diagnosticphase.
And then there are what arecalled genomic tests that you
can do after the biopsy.
That can then guide you interms of the therapeutics and
the treatment activesurveillance versus treatment so
you don't again undertreat acancer that may be able to be
monitored versus overtreating acancer that can be watched and
you know, and an undertreating acancer that should be treated.
Dr. Michael Koren (07:08):
And you mentioning about AI, maybe
helping people withdecision-making, so I know a big
issue of course is, once you'rediagnosed with prostate cancer,
do you take the prostate out?
Do you treat it locally?
Dr. Ali Kasraeian (07:22):
Yeah.
So the treatment for prostatecancer is always, you know, very
controversial and the thingthat often drives a lot of
people away from actuallyscreening because they think
everyone needs a prostatectomy,everyone needs radiation and
unfortunately, with both ofthose technologies, with the
advances in robotics, theadvances in radiation therapy,
especially in high-volumecenters, the side effect
profiles are getting better, butthey're not perfect.
(07:44):
So in doing that we want to seecan we offer people things like
focal therapies now with highintensity focus, ultrasound,
cryotherapy, focal laserablations, a lot of these
technologies where if you have atargetable lesion and that's
the only area that we havecancer can we just treat that
area and leave the unaffectedportions of the prostate
(08:04):
untreated, and so the moreprostate you preserve, the more
function you preserve.
Is that safe to do?
We're working with a companyand we're very fortunate to have
been early in the adoption ofthis technology called Unfold AI
by a company called AvendaHealth really well-validated
technology where you take theMRI scan, the biopsy, and then
(08:26):
put all of the informationtogether and it tells you how
much of the prostate you have totreat, meaning target plus a
margin to give you a very highconfidence that you treated all
the cancer with a high cure rateprobability, and so you can
talk to the patient aboutexactly what we need to do and
whether they're a wonderfulcandidate for focal therapy or
(08:48):
we should actually pursue awhole gland treatment.
And so that's another way youcan personalize the treatment so
you don't undertreat a cancerthat needs a more robust whole
gland treatment and then you canvery appropriately offer
personal focal therapy.
And it's a wonderful technology, very smart.
And the way from a datastandpoint it was monitored, or
(09:08):
whether it was studied, is theytook the MRI scan compared to a
whole mount prostatectomy,meaning they sliced the
pathology specimen like animaging study, had radiologists
look at it by itself, had AIlook at it by itself and look at
it together, and they found theAI actually did better than the
radiologists by themselves, butboth together did better than
each alone, amazingly wellvalidated.
Dr. Michael Koren (09:30):
Are there multiple companies that are
pursuing these concepts, or isit
Dr. Ali Kasraeian (09:33):
Absolutely?
I mean?
there are more companies andthere are more to come.
The big thing for us to bemindful is how they're validated
, how the science goes, and AI,like every AI that we look at,
we have to be mindful of.
AI is only as smart as ateacher, so what goes in it
makes what comes out as smart asit can be.
And what I really like aboutthis technology it is really
(09:57):
smart.
The CEO of the company his PhDwas in MRI and MRI sciences for
the prostate.
I mean I don't know how muchmore specific you can get from
that in terms of a PhD, but verysmart people looked into it and
they continue to advance it andput more data into the
technology.
So it continues to grow, with avery specific focus on having
(10:21):
people have better options oftreating their prostate cancer
and more information to makebetter choices.
Again, it's personalizing it,very similar to breast cancer.
So when people get diagnosedwith breast cancer, the amount
of information they have, adiagnosis to make very wonderful
personalized choices for theirpresent and their future and
also, you know, for the geneticinformation for their family's
(10:43):
future.
And with prostate cancer we'relooking to catch up and we're,
you know I used to say we'reabout 20, 20, 30 years behind
breast cancer.
We're catching up and I thinkin the next several years we're
going to be very, very quick tothat, especially in advanced
prostate cancer.
The amount of medications andthe science going into that
field is revolutionary and ourguidelines keep changing faster
than we can keep up, which is agreat thing.
Dr. Michael Koren (11:05):
Interesting.
We're getting to the end of ourtime together, but any clinical
trials that are ongoing thatare particularly fascinating to
you.
Dr. Ali Kasraeian (11:16):
Many.
We're always trying to pushenvelopes in terms of better
studies for the focal therapyavenue with diagnostics.
There are always things goingon in the advanced prostate
cancer.
There are many things.
I mean it's not quite relatedto this, but you know, when
people are diagnosed withprostate cancer advanced
prostate cancer, metastaticprostate cancer historically we
used to give a hormone blockademedication and there's some
(11:38):
studies that came out in thepast couple of years where you
can give a pill by itself andthat's similar outcome for
people that have recurrentprostate cancer.
We're hoping those studiescontinue so you can potentially
treat those patients better.
We're now, you know, we hope tomove and make those kind of
diseases, those parts of thisdisease that used to be
uniformly fatal.
(11:58):
We're approaching where we werehaving 30 to 60 percent
radiographic response rate,where things that used to be on
imaging are no longer there.
Outcomes are better, medicinesare better tolerated and so the
hope for people with the moreadvanced prostate cancer is
becoming much, much, much, muchbetter.
And you know, organ-confinedprostate cancer approaches 100%
(12:22):
five-year survival, 98% 10-yearsurvival, and so the idea with
prostate cancer is don't beafraid of getting screened,
because the implication of whatthe therapy associated with that
diagnosis would mean, becausewe on this side of that
diagnosis are very keenly awareof those fears and we're pushing
(12:43):
the envelope of trying to domore precise diagnosis.
We're trying to do more precisetherapies so that we can be
impactfully aware of the qualityof life impact of this disease
and the science is trying tocatch up and be aware of that
alongside you as your partner,in terms of the right treatment
(13:07):
for the gentleman at the righttime so that we can achieve both
in a personalized way.
Dr. Michael Koren (13:12):
So it sounds like there's been tremendous
progress across the wholespectrum of diagnosis,
particularly early diagnosis,identifying risk, identifying
intermediate cases, identifyingthe people that really need to
be treated, and then doing aswell as possible, even at
advanced stages.
So it's pretty fascinating
Dr. Ali Kasraeian (13:31):
yeah amazing study, new England Journal of
Medicine.
In Europe they do studies likethis randomized trial, active
observation, surgery, radiationtherapy 10-year, 15-year data 97
, 98% of men alive and then 15years, similar, identical, high,
(13:52):
90, I think it was 97, 98% of10 years, 96, 97% of 15 years.
However, in the observation armmore people needed surgery and
radiation somewhere along theline and a slight amount of
people needed a hormone blockadebecause of metastatic disease,
but it didn't cause them to passaway.
Opens up the discussion of thepower of active surveillance
appropriately and it opens upthe discussion of focal therapy
(14:15):
appropriately when you find theright disease in the properly
selected patient.
So what that tells people ispeople may not die of prostate
cancer if you catch it at theright time and you find the
right treatment again for theright gentleman at the right
time.
That starts with screening atthe right time.
Dr. Michael Koren (14:30):
Ali, that was an amazing discussion.
Thank you for being part ofMedEvidence!.
Dr. Ali Kasraeian (14:34):
I appreciate it, and anytime we can have
better and smarter conversations, you're the best person to have
these conversations with.
Announcer (14:40):
Thanks for joining the MedEvidence! podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
Welcome to MedEvidence!, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts Hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence!, and I've
been having this fabulousconversation with Dr.
Ali Kasraeian, a urologist anda media person and somebody
that's involved in organizedmedicine.
In our last segment we werejust talking about the
controversy around PSA and howyou have to customize that, the
(00:33):
number that you get to thespecifics of a person.
So, higher risk people you'regoing to be more aggressive If
you had a family history, orAfrican-American, for example
and lower risk people maybe youwatch it for a longer period of
time.
But interestingly, even whenyou get to imaging, there's ways
of getting a sense for what theprognosis will be over the next
5, 10, 15, 20 years.
So that was a fascinatingdiscussion.
So let's jump into that pointabout what you see as the future
(00:55):
for getting better atdiagnosing prostate cancer and
also identifying the people thattruly need to be treated
aggressively.
Dr. Ali Kasraeian (01:05):
Yeah, you know smarter screening, you know
PSA can save your life.
Talk to your doctor about PSAscreening, know your family
history.
So if we start with a lab testand it's concerning, then we
kind of talk about what to donext.
If you show up with a PSA of 10, we recheck it's still elevated
, it makes sense to do a biopsy.
I think the MRI allows us to doa better biopsy.
If we're on the fence you've hadrepeat negative biopsies and
(01:27):
things of that nature then youknow, can we use biomarkers.
Biomarkers are lab andurine-based tests that can help
guide us to see what is theprobability or the possibility
that your elevated PSA is due tonot just a prostate cancer but
a intermediate or higher riskprostate cancer, meaning a
(01:48):
prostate cancer that if we foundwe would treat A lot of times
these tests.
If the score is in the lowerrange, that risk is low.
If it's in the intermediate tohigher range, it's an
incremental higher risk.
We can take that with an MRIscan, put them together and give
a discussion or initiate adiscussion of what is the risk,
what is your comfort level, whatis our next move, and we can
(02:09):
personalize it to you, yourhistory and other medical issues
that you're going through inyour age.
Dr. Michael Koren (02:14):
So, starting with the diagnosis, are there
specific biomarkers other thanPSA that you can mention in this
podcast?
Dr. Ali Kasraeian (02:21):
Yeah, absolutely so, the three that I
use.
You know, right now oneblood-based test that I use
quite a bit is a thing calledthe 4K score.
It looks at PSA with threeother cousins intact PSA, total
PSA, free PSA, intact PSA andthis thing called HK2, a
Kallikrein protein 2, which arekind of all in the same family.
Dr. Michael Koren (02:43):
So a doctor has to order that specific panel
.
Dr. Ali Kasraeian (02:45):
It's a lab test, yeah.
And then it comes back with ascore and if the score is in the
lower risk range, you have avery, very low risk of having an
intermediate or higher riskprostate cancer.
Dr. Michael Koren (02:58):
Is that something you should do before
just getting a standard PSA?
Do you think
because, honestly, if you have alow PSA, a stable PSA, why
would you leap to another testlike that?
Because what if it comes backwith an in-between result?
And now you have a low PSA andit's only valid for PSAs that
are a little bit increasedanyway.
From that standpoint, two urinetests that are wonderful and
(03:19):
great science with them.
One's an exosome DX test, anexosome DS test.
Beautiful science that theyfound that exosomes, which we
before thought just hadmitochondria, actually have
messenger RNA in them and sothey found it coming off urine.
It carries with it messengerRNA and great genetic and DNA
information, carbon copies of itcoming off urine.
(03:41):
That could get prostateinformation, so that first part
of the stream, and they can getpredictive information of the
risk of prostate cancer off it.
Amazing science.
So if you're in the low level,the risk of having a prostate
cancer that's seven or higher isa little bit higher.
If it's in the low range, it'sa very low risk of that.
So you can do that.
And during the COVID pandemicwe were very fortunate to be
(04:01):
part of the first team usingthat on an at-home test and it
was really really powerful forus to use to be able to guide
patients on whether they need tocome in and talk about doing a
biopsy at a time where peopledidn't want to leave their house
.
So that was really powerful.
Again, that's not for peoplewith a low PSA.
Those are people that areidentified as having higher PSAs
(04:23):
and taking the next step.
Dr. Ali Kasraeian (04:24):
Yeah So is someone with a PSA change
that we want to be mindful of.
Do we need to do a biopsy next?
from that standpoint,
Dr. Michael Koren (04:32):
And would that test, if it was negative,
make you feel comfortable thatyou don't need to do?
Imaging of the prostate.
Dr. Ali Kasraeian (04:39):
So that's a very controversial discussion
and there are a lot of paperslooking at that and we as a as
urology have not come up with anabsolute answer for that.
For some people the MRI scanfirst makes sense.
For some people, doing thebiomarker first makes sense.
Some people are are.
You know, the genetics trumpthe imaging.
Some people, imaging trumpsthat so so for me it's a very
(05:01):
personalized approach, you knowfrom that standpoint.
So really, for me personally,it's a patient by patient
discussion
Dr. Michael Koren (05:06):
Got it.
Dr. Ali Kasraeian (05:08):
Another test that we use frequently is a My
Prostate score.
It's a newer of the three.
Great test and what I likeabout this test is a very high
negative predictive value.
So for someone who's never hada biopsy, they have a 95%
negative predictive value.
If your score is in the lowrange, you have a 95% likelihood
(05:29):
of not having prostate cancer.
If you've had a previousnegative biopsy, you have almost
a 99% negative predictive value.
So that's very powerful.
So I use it often with peoplewho've had negative biopsies and
then we want to think aboutwhether or not to do another
biopsy, especially if they havehad a negative MRI scan.
Dr. Michael Koren (05:45):
Yeah.
So for listeners out there,tests that have a high negative
predictive value usually have avery high sensitivity, so they
pick up things.
So when they're negative, youfeel pretty comfortable that
you're not dealing with theproblem.
The flip side is, when they'repositive, it doesn't always mean
that you have the problem.
Dr. Ali Kasraeian (06:02):
Yeah, it tells you that search further.
Right, and that's how I kind ofcounsel people.
You know, if this is a higher,it doesn't mean that we have
cancer Absolutely.
It just means that we shouldprobably look If it's negative.
We feel comfortable that it'snegative.
Dr. Michael Koren (06:14):
Any other novel biomarkers that you want
to?
Dr. Ali Kasraeian (06:17):
One thing that's really interesting.
That's not quite as novel, butsomething to keep in the back
pocket.
There's some tests that weactually use when people have
had previous biopsies to decidein the next biopsy if their PSA
changes.
There's a test called theConfirm MDX where you can
actually go back and look at thegenetics of a previous negative
biopsy and it can tell you atany of those cores that you took
could there be genetic changesthat could heighten the risk of
(06:44):
a positive biopsy at that site.
So then when you do the nextbiopsy it can help guide you to
take a few more cores at thatsite.
And that's in the diagnosticphase.
And then there are what arecalled genomic tests that you
can do after the biopsy.
That can then guide you interms of the therapeutics and
the treatment activesurveillance versus treatment so
you don't again undertreat acancer that may be able to be
monitored versus overtreating acancer that can be watched and
you know, and an undertreating acancer that should be treated.
Dr. Michael Koren (07:08):
And you mentioning about AI, maybe
helping people withdecision-making, so I know a big
issue of course is, once you'rediagnosed with prostate cancer,
do you take the prostate out?
Do you treat it locally?
Dr. Ali Kasraeian (07:22):
Yeah.
So the treatment for prostatecancer is always, you know, very
controversial and the thingthat often drives a lot of
people away from actuallyscreening because they think
everyone needs a prostatectomy,everyone needs radiation and
unfortunately, with both ofthose technologies, with the
advances in robotics, theadvances in radiation therapy,
especially in high-volumecenters, the side effect
profiles are getting better, butthey're not perfect.
(07:44):
So in doing that we want to seecan we offer people things like
focal therapies now with highintensity focus, ultrasound,
cryotherapy, focal laserablations, a lot of these
technologies where if you have atargetable lesion and that's
the only area that we havecancer can we just treat that
area and leave the unaffectedportions of the prostate
(08:04):
untreated, and so the moreprostate you preserve, the more
function you preserve.
Is that safe to do?
We're working with a companyand we're very fortunate to have
been early in the adoption ofthis technology called Unfold AI
by a company called AvendaHealth really well-validated
technology where you take theMRI scan, the biopsy, and then
(08:26):
put all of the informationtogether and it tells you how
much of the prostate you have totreat, meaning target plus a
margin to give you a very highconfidence that you treated all
the cancer with a high cure rateprobability, and so you can
talk to the patient aboutexactly what we need to do and
whether they're a wonderfulcandidate for focal therapy or
(08:48):
we should actually pursue awhole gland treatment.
And so that's another way youcan personalize the treatment so
you don't undertreat a cancerthat needs a more robust whole
gland treatment and then you canvery appropriately offer
personal focal therapy.
And it's a wonderful technology, very smart.
And the way from a datastandpoint it was monitored, or
(09:08):
whether it was studied, is theytook the MRI scan compared to a
whole mount prostatectomy,meaning they sliced the
pathology specimen like animaging study, had radiologists
look at it by itself, had AIlook at it by itself and look at
it together, and they found theAI actually did better than the
radiologists by themselves, butboth together did better than
each alone, amazingly wellvalidated.
Dr. Michael Koren (09:30):
Are there multiple companies that are
pursuing these concepts, or isit
Dr. Ali Kasraeian (09:33):
Absolutely?
I mean?
there are more companies andthere are more to come.
The big thing for us to bemindful is how they're validated
, how the science goes, and AI,like every AI that we look at,
we have to be mindful of.
AI is only as smart as ateacher, so what goes in it
makes what comes out as smart asit can be.
And what I really like aboutthis technology it is really
(09:57):
smart.
The CEO of the company his PhDwas in MRI and MRI sciences for
the prostate.
I mean I don't know how muchmore specific you can get from
that in terms of a PhD, but verysmart people looked into it and
they continue to advance it andput more data into the
technology.
So it continues to grow, with avery specific focus on having
(10:21):
people have better options oftreating their prostate cancer
and more information to makebetter choices.
Again, it's personalizing it,very similar to breast cancer.
So when people get diagnosedwith breast cancer, the amount
of information they have, adiagnosis to make very wonderful
personalized choices for theirpresent and their future and
also, you know, for the geneticinformation for their family's
(10:43):
future.
And with prostate cancer we'relooking to catch up and we're,
you know I used to say we'reabout 20, 20, 30 years behind
breast cancer.
We're catching up and I thinkin the next several years we're
going to be very, very quick tothat, especially in advanced
prostate cancer.
The amount of medications andthe science going into that
field is revolutionary and ourguidelines keep changing faster
than we can keep up, which is agreat thing.
Dr. Michael Koren (11:05):
Interesting.
We're getting to the end of ourtime together, but any clinical
trials that are ongoing thatare particularly fascinating to
you.
Dr. Ali Kasraeian (11:16):
Many.
We're always trying to pushenvelopes in terms of better
studies for the focal therapyavenue with diagnostics.
There are always things goingon in the advanced prostate
cancer.
There are many things.
I mean it's not quite relatedto this, but you know, when
people are diagnosed withprostate cancer advanced
prostate cancer, metastaticprostate cancer historically we
used to give a hormone blockademedication and there's some
(11:38):
studies that came out in thepast couple of years where you
can give a pill by itself andthat's similar outcome for
people that have recurrentprostate cancer.
We're hoping those studiescontinue so you can potentially
treat those patients better.
We're now, you know, we hope tomove and make those kind of
diseases, those parts of thisdisease that used to be
uniformly fatal.
(11:58):
We're approaching where we werehaving 30 to 60 percent
radiographic response rate,where things that used to be on
imaging are no longer there.
Outcomes are better, medicinesare better tolerated and so the
hope for people with the moreadvanced prostate cancer is
becoming much, much, much, muchbetter.
And you know, organ-confinedprostate cancer approaches 100%
(12:22):
five-year survival, 98% 10-yearsurvival, and so the idea with
prostate cancer is don't beafraid of getting screened,
because the implication of whatthe therapy associated with that
diagnosis would mean, becausewe on this side of that
diagnosis are very keenly awareof those fears and we're pushing
(12:43):
the envelope of trying to domore precise diagnosis.
We're trying to do more precisetherapies so that we can be
impactfully aware of the qualityof life impact of this disease
and the science is trying tocatch up and be aware of that
alongside you as your partner,in terms of the right treatment
(13:07):
for the gentleman at the righttime so that we can achieve both
in a personalized way.
Dr. Michael Koren (13:12):
So it sounds like there's been tremendous
progress across the wholespectrum of diagnosis,
particularly early diagnosis,identifying risk, identifying
intermediate cases, identifyingthe people that really need to
be treated, and then doing aswell as possible, even at
advanced stages.
So it's pretty fascinating
Dr. Ali Kasraeian (13:31):
yeah amazing study, new England Journal of
Medicine.
In Europe they do studies likethis randomized trial, active
observation, surgery, radiationtherapy 10-year, 15-year data 97
, 98% of men alive and then 15years, similar, identical, high,
(13:52):
90, I think it was 97, 98% of10 years, 96, 97% of 15 years.
However, in the observation armmore people needed surgery and
radiation somewhere along theline and a slight amount of
people needed a hormone blockadebecause of metastatic disease,
but it didn't cause them to passaway.
Opens up the discussion of thepower of active surveillance
appropriately and it opens upthe discussion of focal therapy
(14:15):
appropriately when you find theright disease in the properly
selected patient.
So what that tells people ispeople may not die of prostate
cancer if you catch it at theright time and you find the
right treatment again for theright gentleman at the right
time.
That starts with screening atthe right time.
Dr. Michael Koren (14:30):
Ali, that was an amazing discussion.
Thank you for being part ofMedEvidence!.
Dr. Ali Kasraeian (14:34):
I appreciate it, and anytime we can have
better and smarter conversations, you're the best person to have
these conversations with.
Announcer (14:40):
Thanks for joining the MedEvidence! podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
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