Transcription

• Speaker #0

  This podcast is created by Koelis.

• Speaker #1

  Dear prostate friends, welcome back to Prostate Talk. We are continuing our podcast series live from the heart of Europe’s largest urology congress, tackling the hottest topics in the field. It’s time to zero in on the prostate once again for the ultimate precision strike in men’s health.

• Speaker #2

  Prostate Talk.

• Speaker #1

  Today, I am thrilled to welcome Dr. Eduard Baco to the show. Dr. Eduard Baco is an academic researcher from Oslo University Hospital. He will help us shift our focus to diagnostic reliability. We all know the challenge. You have the MRI, you have the ultrasound, and you are aiming for that one suspicious lesion. But here is the reality: patients breathe, they move, and the prostate itself is anything but static. In the world of fusion biopsy, even a micro-movement can turn a bullseye into a miss. That’s why today we’re exploring how bridging the gap between imaging and biopsy isn’t just a technical challenge. It’s the key to a safer, more predictable patient journey. So sit back and relax, because even though the European Congress of Urology is in full swing just a few meters away, we found a quiet sanctuary in our home studio. We’re taking this time to dive into a crucial topic: the stakes of a successful fusion. Let’s get to the point. Dr. Baco, welcome to our podcast. I’m truly honored to welcome you to the mic today and to dive into why accurate fusion is so critical in the prostate cancer journey. Before we dive into prostate mapping, can you introduce yourself?

• Speaker #3

  Thank you. Thank you very much, Maude, for this kind invitation. Yes, my name is Dr. Baco. I am a surgeon, first a gastrointestinal surgeon, but I moved to urology 25 years ago. And for the last 10 years, I have mainly been doing diagnostic work and focal treatment of prostate cancer, working at Oslo University Hospital, a hospital specialized in cancer surgery. Its name is Radium Hospitalet.

• Speaker #1

  Thank you. You’ve been at the forefront of adopting new technologies to improve the patient journey. From your clinical perspective, how has the landscape of prostate biopsy changed since you first started your practice?

• Speaker #3

  It has changed completely, because we used to do transrectal prostate biopsies, blind biopsies, random biopsies — or random systematic biopsies, which were not really systematic. They were not registered. They were performed via the transrectal route, which eventually became dangerous because of resistance to the antibiotics we were using. Actually, we had a lot of infections and an increasing number of sepsis cases. At the time, we were doing 800 prostate biopsies in Oslo, and I can tell you that we had someone in the department with an infection almost every day. Every day? Yes, because of the numbers. With 800 biopsies per year, we had an 8% infection rate after biopsies. That means, practically, someone every day. And this was a really critical part of the evolution of prostate biopsy. The definitive change we observed came in 2017, when transperineal access was developed, and we started using this technology as the first in the world.

• Speaker #1

  You started right away, right after the event.

• Speaker #3

  I waited all that a long, long, long time. But it was impossible because technology doesn't exist.

• Speaker #1

  So could you explain why MRI ultrason fusion is becoming a gold standard for prostate cancer diagnosis today?

• Speaker #3

  The problem is that prostate cancer you cannot really see on ultrasound. You can see sometimes, but not every time. And that was the reason to have better imaging before, and the best imaging for prostate anatomy and the best imaging, we can see second best now for prostate cancer imaging, is MRI. Actually, we have PCM-HPCT, but at the time it was MRI. MRI that could show us where cancer is, but because we cannot see them all the time in ultrasound, we need something more. It was MRI plus fusion

• Speaker #1

  In simple terms, why is it so difficult to target a specific lesion in the prostate during a live biopsy compared to what we see on a static MRI?

• Speaker #3

  The problem is that prostate is organogemoose. It moves in all directions and the patient moves. And these two movements are impossible to do. coordinate using the needle which also moves and probe which moves. We are definitely dependent on technology which can follow up the prostate, follow up lesion in the prostate and can show us where we are and in the end the technology is a rigid location we say biopsy tracks in 3D volume and it was really game changer in precision of diagnostic of prostate cancer.

• Speaker #1

  All right so three dimensions of the prostate. plus Transparenal are now a part of the answer of the precision.

• Speaker #3

  It was a very, very important game changer and bring the biopsy from not precise procedure to precise procedure and biopsy from danger procedure to safe procedure. Actually, we are doing prostate biopsy in a precise manner and without infections.

• Speaker #1

  Very interesting. Can we say that high-quality fusion and help us avoid missing a cancer and repeat biopsies?

• Speaker #3

  Definitely, yes, because we cannot see all the tumors in the prostate on MRI. And if we have patients with clinical suspicion of prostate cancer, we have MRI which cannot show us we are still doing random biopsies, random systematic biopsies, and if some of them is positive, we can know where the location of cancer is, which is important. For escalation of treatment, we can do re-biopsy of the same place, which positive biopsies target. If this biopsy is really clinically significant, we are moving to treatment. If this biopsy is downstaged from, for example, 3 plus 4 to cancer 3 plus 3 or 3 plus 4, which is a percentage of Gleason 4, we can follow up the patients and monitor further as active surveillance patient.

• Speaker #1

  All right, thank you. So how does this MRI ultrasound fusion bridge the gap? between a standard diagnosis and a personalized treatment for each patient?

• Speaker #3

  That's it. We need personalized treatment now. Evolution is part of human evolution, and we have to evaluate in precision, and we cannot deal with standard methods as we had. We are definitely dependent on technology. We have technology which is precise, which is controlled, and which is retrospectively feasible to follow up what really happened in the prostate and where our biopsy tracks.

• Speaker #1

  Thank you. I would like to pivot now to a different aspect of this technology. Most fusion systems track the ultrasound based on the probe's position, but the prostate can shift or even deform, as we said before. What happens to accuracy if the target moves but the probe does not?

• Speaker #3

  You know, if you can see the target, the tumor, on ultrasound, it's not so big issue. to hit this target, even if you don't have MRI transfusion. But it's not always the case. But if you in case see the target, on your ultrasound, you are 100% dependent on MRI targets. Because prostate moves, patient moves, your needle moves, and your probe moves, you need to have something which do the correction between all these movements and show you where you are and where you should go with your needle in the target. There's a big challenge for systems which have not. Image. cross-fusion real-time system.

• Speaker #1

  Can we say this visual guidance gives you more peace of mind, especially when you're facing a complex case?

• Speaker #3

  Definitely, yes. We have sometimes two religions which are important to hit, and probably some of them is not early cancer, some of them is cancer, and using precise technology with registration of all biopsy tracks, we can, after results, stratify the patients on different treatments personalize the treatment patients according to findings.

• Speaker #1

  Interesting. And what about simple cases? What is the added value of image fusion for more routine or simpler cases?

• Speaker #3

  Simple cases is big tumor. Big tumor, you know, not really need precise image transfusion system. It's big tumors, we probably hit it even without fusion. But... Actually, we are in a period with PC screening. We will have more and more or less tumours coming. And in this case, we should be definitely precise and do diagnostic in the first biopsy and on repeat biopsy again.

• Speaker #1

  You touched on precision earlier. Can you explain the difference it makes to have a system that tracks the organ's deformation rather than just the probe?

• Speaker #3

  If you have the system which tracks only probe, your patient move, you are completely outside, sometimes outside the prostate and definitely outside the target.

• Speaker #1

  And you don't know?

• Speaker #3

  You don't know. It's scary because you have the biopsy reports and the biopsy reports will show you we have no prostate tissue in the biopsy. It's not really a good answer. But if you are using a fusion system which follow up the prostate, a follow-up reason, the prostate, our pressure level. It's completely different. And we can hit all targets in the prostate, any place is localized.

• Speaker #1

  Thank you. So better fusion and better samples mean better decision making. Do you feel more confident recommending watch and wait or active surveillance now that our 3D mapping is so much more precise?

• Speaker #3

  Definitely, yes. Because we have registration which is in the system. We can go back and look again. And if he not really hits the lesion, We can know that. That's the big, big, big advantage of MRI transfusion system with registration of biopsies in 3D volume.

• Speaker #1

  You're offering multiple solutions to your patients, from radical to focal prostatectomy. According to you, what's the added value of the precision of your fusion in the prostate cancer management workflow?

• Speaker #3

  It's very important because all decision-making we are doing now is based on cancer location. And if we know the location of this tumor is accessible by different focal treatment energies, we can choose focal treatment. Which is not accessible, it's not logical to use focal treatment for this part of patients. And the big tumors, as we discussed, we can also check what the situation around the capsula, if it's capsular infiltration, if it's perineumeral infiltration. It is important for decision-making, or we do prostatectomy, or we will go to radiation treatment. in some cases.

• Speaker #1

  Thank you. Very interesting. Following that point on accuracy, I'm curious, how does this technology change the learning curve?

• Speaker #3

  Because we can see retrospectively what we did. We progress in our precision from the start. Before the technology existed, it was impossible to look back, finally. That means if you did biopsy by wrong manner, you could continue by wrong manner a long, long, long time. Actually, we can see back all the registered and we can improve our technology. That means, I think, if you do 20-30 cases by good manner, it's sufficient to be a professional at a high level to do the biopsy.

• Speaker #1

  To conclude, let's talk about the patient experience. How does this early precision change the roadmap for the patient? Does a better start make their future care simpler and more effective?

• Speaker #3

  Definitely, yes, because the worst is you have the patients with negative prostate biopsy, you have MRI lesion, PIOS 4 or 5, and you have no cancer. It's a very, I would say, scary situation for patients and for urologists too, because you have probably cancer in the prostate, you have no diagnosis. That means you have to repeat the biopsy, which is not really part of the pleasure for patients. And if we do the biopsy, it should be done perfectly, one time, and precise.

• Speaker #1

  Thank you. Very clear. As we wrap up, everybody is curious. What your upcoming projects are? How do you hope to further evolve your practice to continue improving the patient journey?

• Speaker #3

  The most important part in neurology now is evolution of precision and new technologies, which are going to focal treatment in selected cases. And for that, we need good imaging, we need precise biopsies, and we need registration of biopsy location. After that, we can select the patient from different treatment strategies. Oxysurveillance, focal treatment, prostatectomy, radiation. It's very important. We can de-escalate the treatment strategy, as I said before. If we, for example, have glycine 3 plus 4, just a few millimeters, but a high percentage of glycine 4, probably the cancer was hit in the wrong manner. But if we have this registration in 3D, with ureter biopsy, I'm going from 3 plus 3. 3 plus 3, from 3 plus 4 to 3 plus 3, it changes strategy. We can continue follow-up. On the other side, if we have active surveillance patients with 3 plus 3, and we reheat the same location again in the second look biopsy, and we have 3 or 2, we have a high percentage of Glycine 4, we are moving to treatment.

• Speaker #1

  Okay, so more precision, more personalization.

• Speaker #3

  Definitely, yes, more precise treatment.

• Speaker #1

  Thank you. At the new Voice of Prostate talk, I've decided to start a new tradition to help us map out the future of theology. Doctor, if you had to describe the future of theology in just one word, what would it be?

• Speaker #3

  is the precision or registration of biopsy tracks.

• Speaker #1

  Thank you. A perfect word to summarize our talk. To wrap up on a lighter note, away from all the clinical talk, if this EAU26 would be a song, what would it be for you?

• Speaker #3

  Ah, excuse me. We are champions.

• Speaker #1

  Very good one. Thank you, Dr. Baco, for taking on the challenge and for sharing your vision with us today. It was a real pleasure.

• Speaker #3

  Thank you. Thank you very much for the invitation. And I wish you a lot of new technologies improvement, which is very important for us.

• Speaker #1

  Thank you. To wrap up, it's clear that in high-precision urology, the target is never static. By automatically compensating for patient movement and prostate deformation, we are no longer just performing a biopsy. We are creating a millimeter, high Q-rate, three-dimensions map of the patient's health. This isn't just a technical evolution. It's a new standard of care that eliminates guesswork and ensures we never miss a target, providing the most reliable path for... every patient's treatment journey. Dr. Baco, thank you so much for your time and for sharing your expertise with us today. It's been a pleasure. And to our listeners, remember, in the fight against localized prostate cancer, treatment is only as powerful as the detection is precise. We'll see you in the next episode of Prostate Talk. Let's keep getting to the point.

• Speaker #2

  Prostate Talk.