Full Transcript Introduction and Guest Background 0:00 We found prostate cancer only when it was too late to cure it, you know, and there was not much we could do. 0:05 Finding cancer so early, we don't even know what to do with it. 0:08 So we treated it and then we kind of realized that the side effects of the treatment were way worse than the cancers, right? 0:13 And I think, going through the whole task force recommending against screening was an interesting exercise because it showed a few things. 0:21 One, that there is a way that you could change behavior. 0:26 This is Dr. 0:27 Talks. 0:34 Hello everyone. 0:35 Welcome once again to another episode of the Prostate Cancer Summit. 0:39 I'm your host, Dr. 0:40 Gio Espinosa. 0:42 And I have the great pleasure of introducing to you Dr Sanaj Poonen, who is a board certified urologist with a specialization in oncology. 0:52 He completed his medical degree at Queen's Health Science and a residency in urology at the University of Toronto in Canada. 1:01 So yes. 1:02 We have a Canadian, but you know, no worries. 1:05 He's now in the U S he then completed his fellowship in urology at the university of California, San Francisco, where he attained a master's degree in 1:14 clinical research as well. 1:15 he treats prostate cancer, bladder cancer and kidney cancer. 1:18 And as an expert in robotic surgery. 1:20 Dr. 1:21 Punin also has expertise in using MRI and biomarkers for prostate cancer evaluation and performing MRI-guided and transparenial biopsies of the prostate. 1:33 Dr. 1:34 Poonan does a significant amount of research and is a lead investigator in several trials in at Desai Sedeurology Institute, 1:42 University of Miami, Leonard Miller School of Medicine. 1:46 So you in the house, you end up go hurricanes. 1:49 Now that football season, right around football. 1:52 Exactly. 1:53 Yeah. 1:54 Thanks Sanaj so much for being on. 1:56 I was super stoked to learn that you were going to be on this summit. 1:59 And I think you're one of the leading experts in the field. 2:02 In terms of diagnostics and so forth, I've seen some of your lectures and I have been super impressed with your work and everything you've done in that regard. 2:11 So my first question has to do you like living in Miami more so than you liked living at Toronto? 2:16 I mean, are you ever moving back to Toronto, what's the deal here? 2:21 Yeah, that's a great question. 2:23 Toronto is always probably going to be home for me. 2:26 You know, I've never got to a place yet where I'm considered anywhere else home per se. 2:30 And they're very different, you know. 2:32 I love Toronto. 2:32 It's a great city. 2:33 But, working at Desai Sethi has been such a, great opportunity for, me I have grown in ways I never thought I would imagine, 2:42 professionally and from a family standpoint. 2:45 We were talking about our kids earlier and my wife have raised three beautiful children here in Miami. 2:50 So we're happy where we are. 2:53 Your children are Miamians, aren't they? 2:55 Yes, they are. 2:56 Well, actually, so it depends on how you define it. 2:58 I guess one we did our fellowship is in San Juan, as you mentioned. 3:02 And so my first child was born there and we moved when she was a month. 3:07 Yeah, she's a Miamian. 3:09 Yeah. 3:11 I tried. 3:12 Exactly. 3:14 And I guess you also, you know, it's also nice to enjoy some of the tax benefits as well as a comparison to Toronto, right? 3:20 Yep. 3:21 Absolutely. 3:21 The sun and the sun, that's right. 3:25 It's, a bit much for me, man. 3:27 You know as, as Cuban, You would think, yeah, there's only a matter of time before I moved to South Florida. 3:33 That sun is a bit too much for me, man. 3:38 When you get those weekends, I find myself taking naps more often than I used to. 3:41 I mean, if you go out in the day, it just, It barrels you down. 3:45 Brutal. 3:45 So let's talk a little bit about prostate cancer since this is the Prostate Cancer Summit. 3:50 How I pigeon-holed you already as a prostate canter. 3:55 expert. 3:56 So if I have a bladder cancer case or kidney case, I'm not thinking Dr. 3:59 Punen anymore. 4:00 I am thinking prostate cancer. 4:08 I mean, so there's, there are six people in my group that do just cancer at Dysaisathy. 4:13 And all of us do pretty much whatever comes our way. 4:15 Because for the most part, we're all fairly young and we don't want to just get to a point where we are only doing one thing.
PSA Screening and Prostate Cancer Diagnosis 4:20 So clinically, We do everything. 4:22 Research-wise we have our areas and obviously mine is prostate cancer. 4:26 I think because of that, 80% of what I see has probably been prostate, you know, radical prostatectomy, surveillance, and patients coming in for emigrated 4:36 biopsies is a big chunk of my volume. 4:38 But you, know I still do bladder, I do kidney, still every now and then RPLND will come through. 4:44 So I try to keep, You know still doing everything. 4:46 Yeah, yeah. 4:47 You know, I find that when I talk to colleagues from around the world, only a few areas have the luxury of having this subspecialty in just prostate cancer, 4:57 right? 4:57 In some, like in Colombia, not only are they treating the prostate, they're also treating incontinence in the ED that comes right after. 5:04 All right. 5:05 So they don't have a luxury actually, you know subspezializing in anything. 5:09 Here in U.S. 5:11 Only a few areas, maybe a couple of people in New York, California, right, had the ability of just kind of sub-specializing in just prostate cancer and 5:19 just do that. 5:20 Which for some people they enjoyed, other people that I know is like, yeah, I'd be bored, just doing one thing. 5:26 So it's fascinating how that works. 5:29 Yeah. 5:29 Diagnosis of prostate. 5:31 We've come a long way. 5:33 Here's where, you know, so as you, know I have a podcast. 5:37 And I'm interacting with people on social media, then I see people at the clinic at NYU. 5:41 And here are their concerns, right? 5:44 And, you know, as a, just as, a regular person, I can relate to that. 5:47 Number one, there's a lot of information on the internet. 5:50 It's like, well, PSA doesn't matter. 5:51 PSAs absolute waste. 5:54 Which is not true actually, but. 5:57 As it relates to PSA as a screening tool for prostate cancer, we've learned that it's not the best tool. 6:03 A lot of false positives and false negatives leads to unnecessary treatments, et cetera. 6:09 People really don't wake up in the morning and are excited about getting biopsies, right? 6:14 Even when you think about it, you know, Rod, although I know you do transperoneal, which is great actually, I'm a fan, but it's still, 6:23 whether it is trans perone or trans rectal. 6:26 It's a basic procedure. 6:28 You've got you poking and one of the tissues. 6:32 So you can start this wherever you want. 6:34 Where are we now, as it relates to PSA testing, and where are now as to perhaps other tools that we have to better assess if somebody actually needs a 6:45 biopsy or not? 6:46 Yeah, great question. 6:47 I mean, so, you know, I think prostate cancer, if you look at it over the last few decades, has changed so much. 6:53 Right. 6:54 And you talk about PSA and that really has been a game changer because before PS A, we found prostate, cancer only when it was too late to cure it, 7:04 and there was not much we could do. 7:06 Now you introduce PSa in the early nineties and we're finding cancer so early, We don't even know what to do with it. 7:12 So we treated it, and then we kind of realized that the side effects of the treatment were worse than the cancers. 7:19 And I think going through the whole task force recommending against screening was an interesting exercise because it showed a few things. 7:28 that there was a way that you could change behavior. 7:31 You did see, after that happened, a lot of people who really got that risk versus benefit message start to push active surveillance. 7:41 And I think a of the committees that said there's no benefit to screening really made that recommendation, thinking that we were never going to see the 7:48 kind of uptake of surveillance that were seeing today. 7:51 The second thing is, while we add all these trials to kind of tell us that screening probably helps and more and data we get, 7:57 the more it seems to tell it is. 8:00 You didn't have the actual real world experience of seeing patients coming in with metastatic disease because they never got a PSA and their doctor never 8:08 talked about it with them. 8:09 And a lot of people had those stories. 8:11 So, I think having that experience, has brought us back to kind of coming to a point where most people agree that screening for prostate cancer does save 8:21 lives and PSA is probably the best tool we have right now to do it. 8:24 Now, we all agree it doesn't help us decide who needs a biopsy or not, it does not help decide whose got a high-risk cancer and who doesn´t, 8:32 but it helps us to decide, who need to have at least some further evaluation to make sure they are going to be okay from that standpoint. 8:39 And just like, you know, anything for the heart or the chest, when you get a chest x-ray and you see a small nodule, You don't go right to pithoracotomy. 8:47 You know you got a CT scan and a biopsy and see all these things. 8:50 Right in the past, we would do a PSA and run right through a Biopsi. 8:54 But PSAs doesn't have that power. 8:55 A PSa just above 4 maybe, right? 8:57 Yeah. 8:57 Yeah, or even 2.5 at some points, right? 9:00 Because they said, you know, now we're missing all this cancer below for it. 9:03 We didn't know. 9:03 So, I mean, we created this huge situation where we were just having such a low threshold to look for cancer, a load threshold, 9:11 to treat cancer and guys were suffering, but I think we've learned from that experience, so I thing the way I look at it now is we do screen widely because 9:21 there are benefits to that. 9:22 I thin we are more selective about who we'd do it in. 9:24 we aren't trying to do in older men. 9:27 benefit will be, but then we intervene with evaluations and treatments selectively, right? 9:32 And I think this is where MRI has really helped. 9:35 This is, where I've been biomarkers have really help to give people choices that they can use and some places the combinations of them make it an easier process. 9:43 And now we're doing better biopsies, you know? 9:46 So, I, think the spectrum has come a long way. 9:49 I Think we still have a, long, way to go in terms of improving our overtreatment. 9:54 And there's obviously still men that get undertreated, right? 9:57 Cause we still have guys dying from prostate cancer and we're still not catching them early enough. 10:01 I know. 10:02 You know, this week alone, first time ever, I mean, i've seen several in my career, you know PSAs of 20 negative biopsies, 10:09 multiple negative Biopsys. 10:11 This week, alone two over 20, 23 and 25 biopsy by Samir Tanaja. 10:17 So once it's Samira Tanajah, not questioning that. 10:20 the quality of that biopsy, right? 10:22 Yeah. 10:22 Negative, negative. 10:24 And, and it's, it, this is, is a PI-RAD4 on a, on an MRI. 10:29 and some years I call right, you know, even some, years, I got, yeah, know what I'm doing, but are we missing something? 10:33 So you, there's always room for improvement. 10:36 So what is so speaking, taking this kind of example into account, what are the. 10:42 Where do you get worried with PSA where you say, look, we know is not perfect, but look at this time we need to further evaluate. 10:47 Is there a number, I know it's age dependent. 10:50 What does that look like for you? 10:51 Yeah, you know, the way I look it more than anything else would be kind of an age appropriate PSa. 10:57 That's how I use it when I used it. 10:59 So I look at a guy, you know, maybe in his 50s, if it's PSA, You know maybe two, that's still less than four, but for a guys in 50's that kind of on the 11:07 higher side, and that is where I would think about, getting at least an MRI or something of that sort. 11:12 If it is less then one, I'm not so worried about things. 11:14 I think, using it as a single cut off that way, making sure you repeat it, If did go up, because that could save you a lot of the excess cost of MRIs and 11:24 other things that, once the PSAs goes back down. 11:26 But I think where I get worried about it is when we rely too much on it. 11:31 Where I look at it, is this should be the signal that you're looking to kind of just pick out guys that need to look more carefully. 11:40 But the way you look them more careful is not with some PSA derivative or doing another PSa. 11:45 This is where the biomarkers and the MRI really come in. 11:47 And they're not perfect either. 11:49 You know, but, there are definitely a lot further along than just making a biopsy decision on the PSA, because then you biopsie a lotta people you don't 11:57 need to, which ends up resulting in a lots of indolent cancer that you didn't even need And even if you manage to avoid the over-treatment, 12:05 they have the burden of just being on a surveillance protocol for something that's never, ever going to hurt them. 12:11 And you'd been better off not knowing about it, you know? 12:13 Right. 12:14 I always say ignorance is not bliss, but sometimes it is. 12:17 Like you don't want to find that Gleason 6 if don have it. 12:23 In pancreatic cancer, I guess, you wouldn't say that, but in prostate? 12:26 In prostate cancer. 12:28 That's right. 12:29 PSA density? 12:29 I find it valuable. 12:30 I found it really valuable in terms of differentiating between BPH and prostate cancers. 12:36 So for the audience, PSDensity is actually a calculation that's PSa over the size of your prostate that typically would come from an MRI and somewhere 12:45 around 0.15 is the cutoff. 12:48 Sometimes my cutoff, actually my caught off is 0.10 to 0 .15 depending on other factors. 12:54 I kind of, I want to keep it tight. 12:56 What are your thoughts on PSA density and how do you use it? 13:00 Yeah, no, I think that's a great point. 13:02 I, think of all the PSA derivatives that probably is the one with the strongest data behind it, because as you said, it kind of takes into effect the size 13:11 of the prostate potential BPH, which is one of biggest confounders in terms of what else could be causing the PSA to go up. 13:17 So yeah, there's value. 13:19 You know, use it with other factors that you're kind looking at, you know? 13:25 How did you get your PSA density? 13:27 Is it based on a DRE? 13:28 Well, then how accurate is that? 13:29 Probably not very accurate, right? 13:31 And then the ultrasound, if it's a trans-abdominal ultrasound again, you're probably not the most accurate. 13:37 Right? 13:37 So if you are talking about, um, a tritons rectal ultrasound to get that information, yeah, and that's good, but that is already, 13:44 your half way here in the invasive part already. 13:47 And if your talking an MRI to it, again very good. 13:50 But I would actually, I'd say the MRI itself. 13:53 will provide a stronger prognostic value than the PSA density, right? 13:57 So I do think it's helpful in terms of if you see an MRI that's negative and you know there's that 10 to 20% of people that can have a missed, 14:06 not so lethal cancer, but still significant that you may want to know about. 14:09 That's where I think PSD density helps you. 14:11 And that is where these biomarkers can be helpful too. 14:13 But PSAs density is one you get for free. 14:17 So if it is high, that may alert you to something that the MRI may be missing. 14:22 Right. 14:22 Right So then we have these, uh, non PSA based biomarkers, urine tests, which I've been very excited. 14:29 I use probably, I used it probably several times a day, just because it's easy. 14:33 And, and I like things that are not PSa based. 14:37 Uh, there are other biomARKers that PSAs based, but if we're saying that PSA is a problem, then all these other, re I don't know the algorithms, 14:45 But, they, have to be some level of a, problem too, particularly if they have a high PS a from BPH. 14:51 and i've seen so high scores in. 14:53 some of the other biomarkers, just my assumption is because the PSA is high from BPH, so a lot of false positives. 15:00 Non-PSA based, like XODX tests. 15:03 How do you use this urine test? 15:05 Tell us a little bit about it. 15:06 And so we have to make the assumption that no one knows what this test is or what it looks like. 15:11 So tell us little about and how you how use it in your clinic. 15:17 Yeah, so the XODX test is a urine-based test and it's a urinary collection that you actually do pre-DRE. 15:25 For a lot of urine tests, they actually require you to do a DRE first to kind of massage the prostate and get some prostate secretions into the urine itself.
PSA Density, MRI, and Biomarkers 15:33 Logistically, that can be a challenge because most patients don't like it. 15:36 A lot providers don' even like. 15:38 So this eliminates the need to do that. 15:41 And what they actually look for is unlike a midstream urine, which most patients are used to collecting, they want the first bit of urine because that 15:49 actually comes from the prostate. 15:50 So it's almost their way of doing that, getting that post-DRE prostate secretions without the DRE part. 15:56 Then it really centers around this concept of exosomes or what the call extracellular vesicles. 16:03 These are little tiny packages that every cell secretes. 16:08 for various purposes to communicate with other cells, to prepare the microenvironment they're in. 16:13 And we think that cancer cells secrete them about 20 to 30 times more. 16:17 So they secreted them into circulation, urine, plasma, anything. 16:22 You can actually identify them in there. 16:25 Localized tumors, unlike let's say CTCs or self-recirculating DNA, where you're only talking about very advanced tumors and mostly dead material, 16:34 right? 16:34 These are secreted by localized tumors and they're packaged in this like little semi permeable membrane. 16:41 And the importance of that is that means that all the RNA, the DNA, protein, and the fats that are in there are preserved. 16:47 So you can actually get these exosomes and get this material out. 16:51 The importance to this materials, I guess, is they serve as almost like cargo of the parent cell that secretes them. 16:58 If you're a tumor cell and you are secreting these things out, they are basically like a little repository of yourself. 17:06 So you can actually get them and extract the RNA, extract, the DNA, abstract the protein. 17:11 And there's a ton of biological data available to you that is coming from the tumor. 17:17 Now, we are used to kind of doing this in terms of tissue-based tests. 17:20 We were talking about decipher and things like that, where you're actually looking at the tissue, but most of that involves an invasive biopsy. 17:27 Now if you can get the same information from a urine or blood test or things like that, that's very powerful. 17:33 And I think what's cool about this exosome test is what they look at is just a couple genes. 17:38 They do what the call a PCR to kind of amplify some genes and they two particular genes known to be associated with prostate cancer and to see are they 17:50 expressed more. 17:50 So they're really looking for a very key prostate sensor signal. 17:54 But at its basic form, it's kind of a cruder version of an amazing technology because they have the ability to really interrogate the entire exosome. 18:04 I'm sure you get a lot of people talking about the future of medicine with AI and how all these other things will improve. 18:12 We're going to be having so much data, RNA sequencing, proteomics, metabolomics. 18:17 All of that coming from these little particles that are secreted from the tumor. 18:22 Just think about things we can learn about people's tumors, just non-invasively, serially. 18:27 So I am obviously excited about it. 18:29 It's incredibly exciting. 18:32 Now, and for many reasons, certainly from my end, as you know, I'm a natural doctor and holistic doctor. 18:40 Less is sometimes more for the principles and the philosophy of natural medicine. 18:45 But I do think that, the fact that ignorance is not bliss. 18:49 Some people come and they don't want to know. 18:51 You want know and then take action appropriately, whether it's no action. 18:55 And you know what's the deal is or, or do something, you that medical treatments or whatever it is that you need to do. 19:01 Even lifestyle changes requires people to be motivated. 19:05 You're a busy guy, You look very healthy to me. 19:08 you're very busy, guy with three children at home. 19:10 It's impossible for you to go exercise every single day. 19:14 Just the mere nature of your, what I assume is your schedule, because I know my schedule. 19:19 And if my scheduled is hectic, so is yours, right? 19:21 So it's very, but now when somebody has a diagnosis, they're like, oh yeah, no, this becomes priority, Right? 19:28 And so the diagnosis can even help whether to choose to be more aggressive with lifestyle or with medical treatments or both, 19:36 depending on what the situation is. 19:38 The cutoff for the ExoDX test is 15.6 at this point. 19:43 Meaning that if it's from zero to 15, I believe there's about a 91% chance that there is nothing there that we should worry about. 19:54 If it is above 15.6, we need to pay attention. 19:59 What's your cutoff? 20:01 Right? 20:02 Like if it's 17, are you going to say, oh, that's it, we need a biopsy? 20:06 What, you know, cause I, I I'm not exactly, and I've spoken to Dr. 20:11 Scott, the developer, uh, developer of this, of the test and a few other people. 20:16 And there's some, there a little bit of margin of error. 20:19 Obviously this 30 and above is a different story, but. 20:22 You know between one, between 15.6 and even 20, how do you go about that? 20:28 Yeah, great question too. 20:29 So I mean, you know, I think the cutoff you're going to use it depending on what you youre trying to do. 20:34 You know? 20:34 So, the way I look at it is, if I'm trying figure out if someone is okay and I don't need to worry about them, then like you said, 20:41 15.6 is great. 20:42 Cause if they're lower than that, they don t need any other evaluation. 20:45 The data is very strong and they've got validation studies proving that. 20:50 It's what happens if their above 15 point 6. Now, If they are above fifteen point six, does that mean they definitely need biopsy because they have cancer? 20:57 No. 20:58 And I think the cutoff you're going to use to decide what you do next is going depend a bit on what your doing next. 21:06 If what are you doing and all you have to offer is an invasive test like a biopsy, then you may choose a higher cut off. 21:12 And for me, I would say 30. So let's say I couldn't get an MRI somewhere to look for things. 21:17 Because a pacemaker or some other reason, although that's rare nowadays anyway. 21:24 Then I would probably use a cutoff of 30, because I will have a higher threshold to put someone through that type of thing. 21:30 But if the next test is an MRI, you know, which is not invasive, then I think 15.6 is a great place to start that conversation, 21:37 right? 21:37 And if I see something, yeah, we're getting the biopsy, but if don't see anything, that I probably wouldn't do the Biopsi unless that EXO test was above 30. 21:46 You know? 21:46 Because then, I'm worried that you fall into this bucket of guys, the cancer may not have showed up on the MRI. 21:51 And there is a good handful of guys that fall into that. 21:54 And that's where I think that test has value with a different cutoff. 21:58 Right.
ExoDx Testing and Active Surveillance 22:00 So this is, so the test is developed for people who want to know if they have the possibility of having prostate cancer that's significant, 22:08 probably higher than a Gleason 6 in their prostate. 22:11 And then to do the next thing, whether it's MRI, hopefully that, and then eventually if that shows something, biopsy. 22:17 For the last couple of years, I've done a little bit, something a bit different, or I added to that. 22:24 I'm super interested, right? 22:25 So my guys on active surveillance, once again, they had a biopsie. 22:29 And I know they oftentimes need a confirmatory biopsy a year later to just make sure. 22:35 Some of these guys are simply not doing another biopsies unless something drastically changes. 22:40 Even though most urologists are saying, look, we need one another a years later, right? 22:45 But then they disappear. 22:46 I don't want them to disappear! 22:48 Right? 22:49 The issues that I've seen with active surveillance or men on active surveillances is when they disappear for like decades, 22:54 come back, now their PSA is 100 or 200. Right. 22:58 So for me, to keep them in and to keeps them motivated, I try to do an EXO test on men, on Active Surveillance baseline, 23:07 and then do it every whatever, six to 12 months to see what that says. 23:10 And maybe that indicates, yep, you need either another confirmatory biopsy or even after a confirmitory biops you need one later on. 23:19 Also, selfishly, I guess, clinically I'm trying to say, man, i'm wondering if all these lifestyle modifications, very prescriptive, 23:26 every exercise, everything to E, certain supplements. 23:29 I wonder if that's doing anything. 23:30 i really don't have a way of measuring that. 23:33 PSA, you know, tends to stabilize actually very nicely, even decrease. 23:40 But if we're saying I can't bank on that, What if this exosome test tells me something? 23:46 So then I use it for those two purposes. 23:49 Why don't you take it away and tell me, Gio, you're absolutely doing the wrong thing. 23:54 I'm going to call the government on you because you utilizing this test the right way and you are harming people. 24:00 Or is there some value to the way I am utilizing on men on active surveillance? 24:06 Well, you know, I obviously think you're ahead of your time because I think most of us will probably be doing something like this as we get to the future. 24:12 And I. 24:13 You know in a way the, the tests somewhat need to catch up to where, where you are, so I there's a lot of truth to. 24:22 what you're saying, and as we know with prostate cancer, there's so much uncertainty about the biology, whether it's going to progress all these little things, 24:30 right? 24:30 And so any information that we can get that reduces the uncertainty is going help. 24:34 Like if you look at the elevated PDSA setting, we saw that MRI helped us reduce the number of biopsies we do. 24:39 If you add a biomarker, you get to do an even better job there. 24:43 So MRI and active surveillance, again, delaying some of the biopsy to reducing the number we need. 24:48 If you add a biomarker, I do think there'll be improvements there because what I think ultimately will happen is we're going to get AI that's going improve MRI. 24:57 We're gonna get a lot more information out of an exosome test because instead of just looking at two genes, they're entirely look at the entire panel of 25:06 prostate cancer related genes because it's not that expensive to do that anymore. 25:09 They're going to be looking at the proteins and the lipids that are secreted out of that. 25:13 And every six months to a year, you'll have a chance to look at how these things are changing and comparing it to all these other guys. 25:19 So I don't think we're that far away from having some app where you upload all this stuff to some cloud and metadata, AI tool feeds back to your phone 25:28 how your prostate cancer is doing. 25:30 And then you only need to do biopsies like, you know, very personalized. 25:34 You know? 25:34 Now I get it. 25:35 There's a lot that needs to be done before we get there, but you're, paving the ground for, what that's going to look like. 25:42 So I agree with you. 25:44 Now, I think you were involved in a study on active surveillance using that currently is currently ongoing. 25:49 Can you talk a little bit about it? 25:51 Yeah. 25:51 I mean, so, you know, they're doing exactly that. 25:53 They're looking at men that are newly diagnosed with prostate cancer and they are looking to see how did an exotest right before their next biopsy help 26:02 pick out who needed the biopsies, who was likely to have something worse there. 26:06 So I think it's going to be very good, because I do think we are going see that this does help us pick out men that may not be the best for surveillance 26:14 or men who are ideal. 26:14 I also think what's gonna be more interesting is as these men continue going on in their surveillance journey, if we're able to continue getting that urine 26:24 information on them. 26:24 Because like you said, a PSA is not the most helpful. 26:27 But if there's a serial noninvasive marker that we could follow that tells us a little bit about the biology of their tumors like this, 26:33 then it'll be a lot more useful to us as a non-invasive marker. 26:38 And we don't have a good one right now for surveillance, so it will be welcome. 26:42 All right. 26:42 Some final thoughts from you on where are we going? 26:46 And even where do you think we're going to go with diagnosis? 26:49 Do you there is a future? 26:52 without biopsy for prostate cancer diagnosis? 26:54 You know, it's a tough thing. 26:56 I think we're far from it if we ever get to that point. 27:07 But unless we get to a stage where our treatments don't cause as much side effects as they do, you know, then I think we're always going to need to know 27:15 for sure that we are doing the right thing and to help us select who needs that treatment, who doesn't. 27:19 You know if we find a way to give people a pill and it melts away their prostate cancer then maybe it won't, but we aren't there yet. 27:27 Dr. 27:27 Sinaj Poonen, thank you so much for being on this summit.
Future of Prostate Cancer Diagnostics 27:31 I think it's incredibly valuable information. 27:34 This is the one episode where we're really honed in on diagnosing prostate cancer at a higher level. 27:41 How can people find you if they are interested in being your patient? 27:45 I'm not as good as you, Dr Gio, in terms of all the social media stuff, but my Twitter is at sinajpoonin. 27:51 i'm at the University of Miami Health Network. 27:53 So you know, you can just Google my name and it'll pop up there. 27:56 Not a lot of other Sinaj punans doing biology. 27:58 So that's my favorite. 28:00 I did look that up. 28:00 And I was like, wow, there's not a, lot, Sanjay, many things there are a. 28:05 But not Sinanj punan. 28:09 Thank you so much for being on. 28:11 Anytime, Geo. 28:11 Look forward to catching up with you in person soon. 28:13 That's right. 28:14 Thank you everyone for coming along and watching yet this other episode, diagnosis of prostate cancer. 28:20 No one wants a biopsy. 28:21 I get it. 28:22 And there's enough tools out there currently and it's going to get even better to perhaps possibly one day avoiding one. 28:29 Thank for tuning in. 28:30 Look out for the next episode coming up next and much love. 28:33 Talk to you next time. 28:34 So long. 28:36 Thank you for tuning in to Doctor Talks. 28:38 We hope today's episode has enlightened and inspired you on your path to optimal health. 28:43 Each day is a new opportunity to make choices that empower your well-being. 28:47 For more insights and strategies, subscribe to our podcast and visit our website, www.doctortalks dot com. 28:56 Stay connected, stay healthy, and join us next time on DoctorTalks, real talks from real doctors on the issues that matter to you most.
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