Focal Therapy for Prostate Cancer/Prostate Cancer Awareness

September 14, 2020

Information

September 6, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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00:00Support for Yale Cancer Answers
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00:06to providing innovative treatment
00:09options for people living with
00:13cancer. Learn more at astrazeneca-us.com.
00:14Welcome to Yale Cancer Answers.
00:16with your host Dr. Anees Chagpar.
00:19Yale Cancer Answers features the
00:21latest information on cancer care by
00:23welcoming oncologists and specialists
00:25who are on the forefront of the
00:27battle to fight cancer. This week,
00:29it's a conversation about focal
00:30therapy for prostate cancer
00:32with Doctor Preston Sprenkle.
00:33Doctor Sprenkle is an associate
00:36professor of urology at the Yale School
00:39of Medicine where Doctor Chagpar
00:41is a professor of surgical oncology.
00:44September is
00:46Prostate Cancer Awareness Month.
00:48Tell us what's new and
00:51interesting in the world
00:52of prostate cancer.
00:54Well, we're making a lot of
00:56advances in the treatment of
00:59high risk advanced disease with
01:01many new medications that have
01:04been released in treatments
01:06on the diagnostic side,
01:08we've continued to pioneer
01:10improvements in noninvasive
01:11diagnostics such as prostate MRI.
01:14And we're very excited to continue
01:16to identify patients who may
01:18not need evaluation.
01:19Or maybe we can avoid a prostate biopsy.
01:22Wow, that all sounds
01:23really interesting.
01:24Those are two very
01:26different ends of the spectrum,
01:28so maybe we will take each of them in turn
01:31and work our way from prevention
01:34all the way up to metastatic disease.
01:37In terms of prevention and detection,
01:40you mentioned that you have been doing
01:42some great work in terms of detection.
01:45Tell us more about that and
01:47what are the current guidelines in terms
01:50of what people should be doing in order
01:53to either prevent prostate cancer or
01:56find it early.
01:58Prostate cancer screening, which is evaluation of risk
02:00factors for prostate cancer,
02:02has been somewhat controversial
02:04over the last decade. Fortunately,
02:06within the past five or six years,
02:09it has become pretty clear that screening
02:12for prostate cancer remains a very important
02:15part of menn's general health.
02:17So we screen for prostate cancer
02:20starting in men at around the age of 50.
02:23If a man has a higher risk feature for
02:26potentially having prostate cancer,
02:28which currently is a first degree
02:31relative with prostate cancer or
02:33being of Afro Caribbean descent,
02:35those men can be screened even
02:37earlier at around age 40 to 45.
02:40And by screening.
02:41this entails a PSA blood test.
02:43So it's a simple blood test
02:45as well as a
02:48physical examination of the prostate
02:49with a digital rectal exam.
02:52Are those recommendations in terms of if you
02:54don't have one of those high risk features,
02:57every man at the age of 50 should have
02:59a PSA and a digital rectal exam?
03:02As you say,
03:04it's been so controversial and it seems
03:07like it gets really confusing.
03:09They say everybody should do this,
03:10sometimes they say, well,
03:12you should really talk to your
03:14doctor about pros and cons.
03:16So where are we at right now?
03:18I think the large part
03:21depends on who you talk to.
03:24Unfortunately, the US Preventive Services
03:26Task Force which is given the power
03:30to review and make recommendations on
03:33what kind of screening is necessary,
03:35in 2016, finally gave prostate cancer a
03:38more likely to be beneficial than not
03:42in terms of prostate cancer screening,
03:45so it is still, however,
03:47something that not everyone does routinely.
03:49I think for a man who is concerned
03:52about possibly having prostate cancer,
03:55they definitely should be screened.
03:57There are men who preferred not to,
04:00and the language,
04:01as used in many of the guidelines,
04:04is informed decision-making.
04:06And informed decision making is
04:08a challenging term because who
04:10is informing the patient?
04:11Very often primary care physicians
04:13do not have time to have a full
04:16informed discussion with their
04:18patients about what are the risks and
04:21benefits of prostate cancer screening.
04:23And so it is kind of challenging for
04:26them to be able to figure out when they
04:30should screen and when they should not.
04:33As urologists we are very comfortable
04:35having those discussions,
04:37but it's hard to say that across the
04:40board everyone should be screened.
04:48I think I'm still a little confused because,
04:51you know, at least coming
04:53from the breast cancer world,
04:54which is kind of my neck of the woods,
04:58it seems to me that screening
05:00allows people to detect cancer earlier,
05:02so if you told a woman
05:06you can get a mammogram,
05:07but it's really up to you,
05:10most women would say, well,
05:12I want to detect cancer early so that it
05:15can be treated more effectively and it
05:17reduces my chances of dying of the disease.
05:20So what does that conversation really
05:22look like in terms of prostate cancer?
05:25When you're talking to a man about,
05:28should you get prostate cancer
05:30screening or not?
05:31Let's suppose that they don't have
05:33one of those high risk features.
05:35They haven't had a family history and
05:37they are not of Afro Caribbean descent,
05:40but they are your regular 60
05:42year old Caucasian gentleman who
05:44really doesn't have family history
05:46of cancer but doesn't want to be
05:49the first one to get it either.
05:51And doesn't want to find it late.
05:54What does that conversation look like?
05:57How do men make that decision?
06:00because it seems to me that a
06:02lot of gentlemen are going
06:04to do whatever you recommend.
06:07I think you hit it on the head
06:10when you said men don't want to be the
06:13first one to be diagnosed with it either.
06:16I think there is a large
06:19component of fear.
06:22And as we discussed mens health,
06:25many men do not necessarily take care of
06:29themselves to the extent that women do,
06:32and so in a sense, we,
06:35as urologists and as physicians that
06:37are concerned with men's health,
06:40a large part of it is
06:43an information campaign to
06:45reassure men that we do have ways
06:48of managing these scary diseases,
06:50so the conversations are a large part
06:54about information,
06:56and helping men assess what is their
06:59actual risk of having prostate cancer.
07:02What is the drawback to screening?
07:04What is a drawback to having
07:07a simple blood test,
07:09which can be exceptionally
07:11reassuring if it's normal
07:13and a little bit anxiety provoking
07:15if it's not.
07:16But then what are the benefits of doing that?
07:20So there are more extended risk benefit
07:22discussions on a pretty routine basis.
07:25Overall the important thing to
07:27understand is that
07:29prostate cancer is common,
07:30but it's not so common that everyone gets it.
07:34It's common enough though,
07:35that most men as they get older
07:38are at risk and it's worth having
07:40some simple tests to evaluate if
07:42you are at higher risk than others.
07:45Because cancer can definitely be
07:48treated and stopped in his tracks, right?
07:50So it sounds like the general recommendation,
07:53and I know that
07:55we don't always want to give
07:57general recommendations,
07:58but it seems to me that in general this
08:01is something that people really should
08:03consider andvtalk to their doctor
08:06about in terms of getting screened.
08:09So let's move on to the next kind
08:11of phase after screening comes detection,
08:14and you alluded to some of the really
08:17interesting work that's been happening
08:19and pioneered really here at Yale.
08:21Tell us more about that work and
08:24where we are in terms of state of the
08:27art detection for prostate cancer.
08:31The first step as you
08:33mentioned is screening so that the
08:35first test with a PSA blood test and a
08:37prostate exam are the initial ways
08:40that we evaluate if a man may be at
08:42risk for harboring a prostate cancer.
08:47As you mentioned, Yale was one of the
08:50first sites around the country to
08:52be interested in use an MRI or a non
08:55invasive imaging test to evaluate a prostate
08:59and look at a prostate for
09:01possible cancers within it.
09:03It's really interesting as the
09:05prostate is the only solid organ
09:07until we started doing these mris,
09:09for which we did not have cross sectional
09:12imaging that could look inside the
09:15inside that organ to evaluate for tumors.
09:18So this has been a real boon
09:21in terms of our ability to
09:24diagnose prostate cancer in
09:24a non invasive manner.
09:30And so if somebody's
09:32PSA comes back high or
09:35somebody finds a lump in their
09:37prostate on digital rectal exam,
09:39is that the next step?
09:41It is at our institution.
09:44It is not the next step everywhere,
09:46because the reading and performance
09:48of the mris is an acquired skill
09:50and it does take experience.
09:52It is becoming more widespread to use
09:55an MRI of the prostate as the next step,
09:58and there recently have been
10:00some publications in major medical journals,
10:03including the New England
10:04Journal of Medicine,
10:06looking at MRI of the prostate,
10:08and really the important thing
10:10about MRI is combining it with
10:13a targeted prostate biopsy.
10:15So then using that information from
10:17the MRI and if suspicious areas are
10:19identified using that information
10:21to target or direct prostate
10:24biopsies to detect prostate cancer,
10:26the MRI alone is very useful,
10:29but it's really in combination
10:31with the biopsy.
10:32And is MRI
10:35covered by insurance
10:37for people who are at risk
10:40of prostate cancer or
10:42people who have an elevated
10:43PSA and so on, are most
10:46insurance companies covering this?
10:48I would say most
10:49are and especially now after
10:51some of those recent articles,
10:53including the one in the New England Journal,
10:56there is more support of that,
10:59but there still are some insurance
11:02companies that will not pay for an MRI
11:05as an initial diagnostic biopsy,
11:07they still require an initial transrectal
11:10ultrasound guided prostate biopsy,
11:11which is the goal which has been
11:15the gold standard for 30-40 years.
11:19They will require that first,
11:21and only if that does not detect cancer
11:23would they pay for an MRI targeted biopsy.
11:26I believe we're continuing
11:27to see a shift, though toward
11:29use of MRI as an initial diagnostic tool.
11:31In the United Kingdom
11:34it actually is mandatory.
11:36Anyone with an abnormal PSA
11:37that next step is an MRI,
11:39and they use it as a screening tool.
11:42We're not quite to that point
11:44yet in the United
11:45States.
11:47That's so interesting because we always think
11:48about the UK as being
11:50a country that really does put
11:52a premium on value in terms of
11:54healthcare costs and so on
11:57and their National Health System.
11:59It seems if they're adopting it,
12:02they have such a rigorous process to
12:04make sure that things are cost effective,
12:07that that would be reasonable to adopt.
12:11I think we're starting to get into
12:14some of the nuances of
12:17the health care systems and some
12:19of the cost and price disparities
12:22across providers that we see in
12:24the United States,
12:27which is a much bigger and
12:29more complicated discussion.
12:30But in general MRI is significantly
12:33cheaper across the pond than it is here.
12:37Interesting, so the next step,
12:39as you mentioned that goes hand in hand
12:43with the MRI of course is the biopsy.
12:46So tell me a little bit more
12:49about some of the work that's been
12:52going on with prostate biopsies.
12:55I understand that people are now
12:57looking at artificial intelligence
12:59and machine learning to improve
13:01biopsies of the prostate.
13:03That just sounds so Avantgarde.
13:07Well it is. It is one of the
13:10directions that
13:12we are embracing technology
13:15to improve what we do
13:18using that same MRI image
13:20in an MRI of the prostate,
13:22we are able to make a 3D model
13:25of the prostate gland and we
13:27combine that with a real time
13:30ultrasound 3D model of the prostate
13:33to guide our needle biopsy in
13:35the office so it's different than
13:37doing it in the MRI scanner where
13:40you do have an image and you
13:42have a 2D image and you can place
13:45the needle by using 3D imaging
13:47which allows us to perform the procedure
13:50in the office in the outpatient
13:52setting in a more convenient and for
13:54many patients more comfortable way.
13:56The machine learning is
13:59enhancing our modeling so it is
14:01making the way that we target
14:03the biopsy is much more accurate.
14:06We need to do delve more into that,
14:09but first we need to take short break
14:12for a medical minute. Please stay
14:15tuned to learn more about prostate
14:17cancer with my guest doctor
14:19Preston Spenkle.
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14:39it causes the most skin cancer
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14:43however, Melanoma is easily treated
14:45and highly curable. Clinical
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15:10You're listening to Connecticut public radio.
15:15Welcome
15:16back to Yale Cancer Answers.
15:18This is doctor Anees Chagpar
15:20and I am joined tonight by my
15:23guest doctor Preston Sprenkle.
15:25We're talking about diagnosis and
15:27treatment of prostate cancer and
15:30right before the break Preston you
15:32were talking about this really cool
15:34technique of using MRI to diagnose
15:37prostate cancer and what was interesting
15:39was that you were talking about how
15:42that really gets paired with biopsy,
15:45but you're not doing biopsies
15:47in the MRI suite,
15:48which I can imagine is just
15:51claustrophobic and not the most
15:53comfortable setting in the world for men.
15:55But tell me a little bit more about how
15:58you take that MRI guided image
16:01to actually guide a biopsy that you're
16:05doing with ultrasound in your office.
16:09Yeah, so there are a few different
16:11technologies that are available.
16:13We talk about this as sort of a fusion.
16:16How do we fuse these two images
16:18and we can use cognitive fusion which
16:21is using the human brain to look at
16:252 pictures side by side and say OK
16:27this looks like where they line up.
16:30We then use computer fusion which is what
16:33we use at Yale with our Artemis Device.
16:36And then there are quite a few
16:38of these computer fusion devices
16:40that exist around the world.
16:46And we like using this Artemis device because it has,
16:48like I mentioned earlier,
16:50the ability to take a 3D model
16:53of the prostate from the MRI.
16:56We use Artemis Device to create a 3D model of
17:00the prostate with the ultrasound
17:02and then we overlap those and
17:04we're moving towards the computer
17:06having the ability to overlap them.
17:09Right now the urologist and surgeon are
17:12very involved in making sure
17:14the pictures lineup,
17:16but then the artificial intelligence
17:18side is learning what are the shapes
17:21of these prostates and can we predict
17:23how these prostates are going to
17:25deform and change and really matching
17:28up that fusion product or that model
17:31of the prostate so that it's much
17:34more precise and this translates
17:36to more accurate biopsies.
17:38The Artemis Device, just so that
17:41I've got this straight,
17:43I kind of get the idea that the
17:47man goes in and gets an MRI of the prostate,
17:51just like you get an MRI of your
17:54knee or your brain or whatever else.
17:57They get an MRI of the prostate.
17:59This Artemis device kind of takes that
18:02image and transforms it into an image
18:05that you could get with an ultrasound
18:07so that it can overlay it well.
18:10Interestingly,
18:11we still rely very much on
18:13non human interpretation so
18:15the radiologist takes the MRI,
18:16so a man will have an MRI of his prostate,
18:20the radiologist will read that and will
18:22evaluate and look at the MRI for
18:24any areas that look suspicious,
18:26they grade it on a standardized grading
18:28scale that was helped developed by
18:30one of our radiologist here at Yale,
18:32Jeff Weinreb.
18:33So it's an international scale and is
18:34now the gold standard,
18:36and that was partly designed at Yale,
18:39so they'll get a score of any
18:41lesions that are in the prostate.
18:43The radiologist then
18:45outlines the prostate and those images
18:47are imported into our Artemis device.
18:53I, or one of our other urologists,
18:55are doing the biopsies.
18:57We similarly use an ultrasound to
18:59make a model of the prostate and,
19:01then the job of the computer and what
19:04we're trying to improve with some of
19:06our mathematical models and
19:08artificial intelligence has now improved how
19:10those two pictures of the prostate,
19:13look or
19:16if they look different,
19:17why are they different and how do
19:18we correct for that difference?
19:21So this is interesting
19:24because you're taking two different
19:25pictures of the same organ done by
19:28different modalities, and
19:30if I understand this correctly,
19:32you're putting both of them
19:34into this Artemis system,
19:36which kind of lines them up and says
19:39what you saw here on the MRI is what
19:42you see here on the ultrasound and
19:45kind of making this image that
19:48when you see that on the ultrasound,
19:51that really is that area that was
19:52on the MRI and that's what you
19:54need to go after with your biopsy.
19:57Do I have that right?
19:58Yep, you're absolutely correct,
19:59so it's taking
20:00two things side by side.
20:02You can imagine these
20:04two pictures just merging into
20:06one and overlapping and we make
20:08sure that where those overlap
20:10appears correct and so then
20:11that that is a real boon because then
20:14you can use something that is
20:17patient friendly like an ultrasound
20:19and do the biopsy in the office.
20:21I mean that is just such cool technology.
20:24I wonder if the same thing can
20:26be done in other organ systems.
20:28Do you know if this Artemis
20:31devices is being used in other
20:33diseases?
20:35It isn't really
20:37because
20:39if you think about many other
20:41lesions, in liver lesions,
20:43many of those are very well
20:45visualized with ultrasound,
20:46and so the real time ultrasound is actually
20:50as good or better at characterizing
20:53where the lesion is than MRI or CT.
20:57That kind of fusion that we need
20:59to do for the prostate is kind of
21:02unique compared to, for example,
21:04the brain where you have a solid
21:07calvarium around the brain and
21:09so the ability to predict and do
21:11stereotactic localization within
21:13this solid structure is much
21:15easier than with a soft,
21:17malleable organ that is very able
21:19to move around within the pelvis.
21:22So the process is really kind of a
21:24unique location and a unique target
21:27given all these sort of anatomic limitations.
21:35Moving on from once you get the biopsy,
21:38let's talk a little
21:41bit about getting screening or a
21:43gentleman went and got screening,
21:45he got his MRI,
21:47he had this really cool artificial
21:49intelligence thing happening so
21:51he could have his biopsy in the
21:54office and he gets diagnosed
21:56with early stage prostate cancer
21:58because he found it really early.
22:02Tell us a little bit more about what's
22:04new and interesting in terms of the
22:07management of early prostate cancer.
22:10In the field of
22:12urology we are becoming much
22:15more comfortable with active
22:17surveillance or really a deferred
22:20treatment for men with prostate cancer.
22:22And that's based on many large studies.
22:25Now with long term follow up as well
22:27as a better understanding of the
22:30genomic nature of prostate cancer.
22:33So not only are we typically talking
22:36about things like the Gleason score
22:38when we are diagnosed with prostate cancer
22:41and the higher the Gleason score,
22:44the sort of worse the prognosis,
22:45or the more aggressive prostate cancer
22:47we are now able to sub stratify
22:50many of these patients using
22:52genomic testing which is specialized
22:54testing of the cancer cells themselves
22:56that tells us if it is at a lower risk
22:59and intermediate risk or higher risk of
23:01progression and developing metastasis.
23:03So I think one of the many
23:05exciting things is we feel more
23:08comfortable knowing who does not
23:10need treatment and really can avoid
23:12many of the side effects that
23:14we associate with treatment.
23:17And part and parcel of that is,
23:20I know that many gentlemen who
23:22get their prostate biopsy,
23:24they've got a low Gleason score and
23:26they're put on this watchful
23:28waiting regimen.
23:29But for some of them,
23:31that's really anxiety provoking, right?
23:32Because they're sitting there
23:34and we already talked before the break
23:37about how fearful some people are
23:38with a diagnosis of prostate cancer.
23:40Here you are telling people
23:42you've got a prostate cancer,
23:44but it's really
23:46pretty indolent, we think,
23:48so you don't need to be treated,
23:50but it sounds like with genomics
23:52you can get a little bit more
23:54personalized and say no,
23:55we've looked at your tumor,
23:57this is a very low score,
23:59but are there some people who would normally
24:02be in the watchful waiting category who,
24:04based on genomic analysis,
24:05you think, geez,
24:06I need to be a little bit more aggressive?
24:10I just want to
24:12caution and correct
24:13the terminology just for a second.
24:15So active surveillance is what
24:17we do for men with low grade,
24:19and low risk prostate cancer.
24:21Watchful waiting is what we
24:23characterize men with prostate
24:24cancer who do not want to treat it,
24:26nor do they want to do any follow up of it.
24:29Because prostate cancer
24:30is so slow growing,
24:31there are some men who are diagnosed
24:33who are elderly or have other health
24:35problems that decide they do not
24:36want to treat it because prostate
24:38cancer is so slow growing it will
24:40not cause them a problem ever.
24:42Those are sort of who we say are on
24:43watchful waiting because we're waiting
24:45for them to have any symptoms of
24:47their prostate cancer before we treat.
24:49Active surveillance is kind of the
24:51other end of the spectrum where
24:53men have a very low grade,
24:55low risk prostate cancer and we
24:57are actively surveilling their
24:59cancer for any signs that it has
25:01progressed or gotten to the point
25:03where it may require treatment
25:05or we may advise treatment,
25:06but you're absolutely right with
25:08a genomic testing we can now have
25:11much more confidence and much
25:12more security and telling some
25:14men that it's appropriate to watch
25:16their cancer and not treat it.
25:18And you're right,
25:19anxiety is a major component.
25:21Very understandably, I think we
25:23gain confidence with
25:24data in the genomic testing,
25:26we can more strongly tell our patients with
25:29security that they don't need treatment.
25:31They are not in danger from this cancer.
25:38Let's say there are some men though that
25:41do really want to have treatment.
25:44As a general rule,
25:45if they have very low risk
25:48and low risk prostate cancer,
25:50we do not treat them. Getting
25:52into an intermediate risk,
25:54some of those men actually
25:56don't need treatment either.
25:57Some intermediate risk men
25:59may benefit from treatment,
26:00and again we're using genomic
26:02testing to stratify that.
26:04An one of the main reasons that
26:06we are concerned and we try not to
26:10treat everyone with prostate cancer
26:12is that there are side effects so
26:14there can be an impact on urinary function.
26:17There can be an impact on sexual function
26:20with any treatment for prostate cancer,
26:22whether surgery or radiation
26:24or even ablation.
26:25So we're going to talk a little
26:27bit about that unless you had
26:29another question.
26:31I'd love to learn more about ablation,
26:33because it sounds like
26:36that might be a minimally invasive
26:38way to treat prostate cancer without
26:40having major surgery that can cause more
26:43side effects, so
26:48much of the discussion that we
26:51have in the urology community is,
26:53will ablation replace surgery,
26:54or radiation?
26:56I would say no, it is not a replacement for
26:58these gold standard treatments,
27:01but it is an alternative for the appropriate
27:04person and it is a good alternative.
27:06So ablation is typically using
27:08some form of energy beacon.
27:11Heat, or we can use cold, we can use other
27:14things like light or ultrasound
27:17or electricity to generate heat,
27:19but we're trying to destroy just the part
27:22of the prostate that has prostate cancer.
27:26By doing this,
27:27we can often avoid the structures
27:29and areas near the prostate that
27:32are associated with urinary
27:34control and sexual function,
27:36so we can have much less impact on
27:39someone's quality of life while having
27:42a successful treatment of their cancer.
27:46So do we know what
27:47the long term results of that are?
27:49I mean, do you get recurrence rates
27:51that are as low as you would get with
27:53surgery and radiation with ablation?
27:56It's interesting, there have
27:58been no randomized trials
28:00comparing surgery or radiation
28:01to an ablation, so
28:04all we can do is compare the sort
28:07of data from the different studies.
28:11The combination of treatment with
28:13ablation tends to be quite successful,
28:15though because
28:16we're held to a high standard,
28:19we are doing repeat biopsy's and many of
28:21these patients who are having an
28:24ablation or treatment of
28:25this part of their prostate,
28:27and we find very greater than
28:2980 or 90% success rate when we
28:31biopsy areas that were treated.
28:33The trick is that if we're treating
28:35only part of the prostate and
28:37this is why it's hard to compare
28:40to surgery or radiation.
28:41When we are treating just
28:43part of the prostate,
28:44there still is the other side of
28:46prostate or the rest of prostate that
28:48could develop cancer in the future.
28:50So you know,
28:51if we look at the areas that are ablated
28:54then yes, things like Cryo Ablation,
28:56irreversible electroporation,
28:57HIFU or high intensity focused ultrasound,
28:59those are very good techniques
29:00to destroy the cancer tissue
29:02in the area that is ablated
29:04but inherently it's not treating
29:06the other side of prostate so it
29:08is a little bit of a trade off.
29:10It's a little bit less treatment.
29:12Meaning we're not treating the
29:15whole prostate,
29:16but definitely associated
29:17with fewer side effects.
29:19So in terms of picking patients
29:22in whom this technique might be optimal,
29:26it seems to me that if you've
29:29got somebody who's really worried about
29:32the side effects of radical surgery,
29:35has a relatively small prostate cancer,
29:38and wants a less invasive
29:40technique and may not have
29:43long to really wait and get
29:45a new prostate cancer in another
29:47part of the prostate,
29:49that might be a
29:51good candidate.
29:52Yes, definitely.
29:53And this moves towards focal
29:56ablation so it is becoming more popular,
29:59especially in academic centers,
30:00and this has really grown out of
30:02the interest in it and the increased
30:04usage of these techniques has really grown
30:06out of the MRI in a targeted biopsy,
30:09because we now can localize prostate
30:11cancer within the prostate, which is new.
30:13It's new since MRI.
30:16We can know where to treat.
30:18So one of the reasons we don't
30:20have long term data is this is all
30:23relatively new technology that
30:24has really been born out of our
30:27ability to identify and localized
30:28prostate cancer with much more
30:30accuracy.
30:31Doctor Preston Sprenkle is an associate professor of urology
30:34at the Yale School of Medicine.
30:36If you have questions,
30:37the address is canceranswers@yale.edu
30:39and past editions of the program
30:41are available in audio and written
30:43form at Yalecancercenter.org.
30:44We hope you'll join us next week to
30:47learn more about the fight against
30:50cancer here on Connecticut public radio.