Transcription

• Speaker #0

  This podcast is created by Koelis.

• Speaker #1

  Dear prostate friends, Welcome back to another episode of Prostate Talk. As we mentioned in our last update, the mic is changing hands. I’m Maude, and I feel honored to be your new host. I’m here to continue our journey and dive even deeper into the world of prostate cancer care. Together, through innovation and expertise, we will keep shaping the future of urology. We are launching Season 3 with a fresh perspective. As your new female host, I’m especially proud to open this new chapter by welcoming our very first female guest on the show — a brilliant and incredibly promising voice in the field of urology. Joining me today is Dr. Rocio Roldan-Testillano, an expert at the forefront of urological innovation. Today, we’re diving into her specialized work on transperineal image fusion biopsies under local anesthesia — a technique that is significantly improving diagnostic accuracy while focusing on patient well-being. The landscape of MRI-ultrasound prostate fusion biopsy is evolving. With new reimbursement codes being introduced in both France and the United States, the clinical value of the transperineal approach is no longer just a preference — it’s becoming the gold standard. Healthcare systems are also pushing for a leaner patient journey, prioritizing local anesthesia and shorter hospital stays. That’s why now is the perfect time to revisit this evolution. We are recording live from the EAU Congress — the European Association of Urology — a true crossroads for medical and pharmaceutical innovation. The event is in full swing, and I’m taking a short break from the buzz to dive into a real paradigm shift: how we’re finally taking the “ouch” and the uncertainty out of the patient journey. Hello Dr. Roldan-Testillano, we are thrilled to have you with us here at EAU, just a few steps away from all the action. It’s great to welcome a new female voice to discuss the latest trends in prostate care. How are you today?

• Speaker #2

  I'm doing great, thank you for the invitation. It's really exciting to be here at the European Association of Urology Congress and to talk about this major shift happening in prostate cancer diagnosis today..

• Speaker #1

  Thanks. To kick things off, for those who may not be familiar with your work, could you please introduce yourself? We’d love to hear about where you practice and what your specific areas of expertise are within the field of urology.

• Speaker #2

  Sure. I’m Rocio Roldan-Testillano. I’m originally from Spain, and I’m currently based at the McGill University Health Centre in Montreal, where I’m completing a fellowship in uro-oncology. During my first year, which was mainly research-focused, I worked on prostate cancer diagnosis using transperineal fusion prostate biopsies, as well as focal therapy.

• Speaker #1

  Great, thank you for this introduction. Let’s now talk about prostate cancer diagnosis. We are moving from blind biopsies to precision detection. What does this modern pathway look like for a patient coming into your clinic today?

• Speaker #2

  Well, today, the era of blind biopsies is essentially over. As guidelines recommend, when a patient comes to our clinic with an elevated PSA, the first step is usually a prostate MRI. If the MRI shows a suspicious lesion, we then perform a targeted plus systematic fusion biopsy. In addition, as the PRIME trial has recently shown, high-quality biparametric MRI, when interpreted by experienced readers, can achieve excellent diagnostic performance, further simplifying the imaging pathway. This approach allows us to sample the prostate much more precisely and significantly improve the detection of clinically significant prostate cancer.

• Speaker #1

  Very interesting. Taking a closer look at fusion-guided targeted biopsies, we see the transperineal route taking over. Why is that? What makes it better for both the practitioner and the patient?

• Speaker #2

  Well, there are several reasons. The most recent trial, TRANSLATE, provided two important findings. The first is that the infection risk is significantly lower. With the traditional transrectal approach, infection rates can reach around 5 to 7%, with sepsis occurring in up to 1 to 3% of cases. With the transperineal route, the risk is extremely low because we avoid passing the needle through the rectum. Secondly, the transperineal approach allows for much better sampling of the anterior and apical regions of the prostate, which improves the detection of clinically significant prostate cancer.

• Speaker #1

  All right. And looking back at your own experience, what motivated your transition to this method? Were there specific clinical benefits or patient outcomes that convinced you to choose the transperineal approach?

• Speaker #2

  Well, I first encountered the transperineal approach when I started working at McGill University. Not only do we achieve better sampling and a lower infection rate, but we are also more efficient, as we save operating room time and anesthesia time. This helps reduce the pressure on available resources. Moreover, at McGill, we have a large focal therapy program, which is an important part of the prostate cancer treatment options we offer to patients. The transperineal route helps us better select patients and plan treatment. I definitely intend to continue using the transperineal approach under local anesthesia in an outpatient setting in my future practice.

• Speaker #1

  Healthcare systems in France, Japan, and the US have recently evolved to better recognize the value of fusion-guided and transperineal procedures. How do you interpret this shift toward smarter biopsies, and what does it tell us about the new global standard of care in urology?

• Speaker #2

  Well, I see very positive developments. What we are now seeing is that healthcare systems are catching up with the evidence. By recognizing these procedures, countries are helping to accelerate the transition toward a more accurate, safer, and patient-centered standard of care in prostate cancer diagnosis.

• Speaker #1

  And beyond the clinical benefits, there is also a strong economic argument. Hospitals are increasingly looking for more cost-effective models. Could you tell us more about how the transperineal approach, especially under local anesthesia, helps hospitals reduce costs and optimize resources compared to traditional methods?

• Speaker #2

  Well, in our practice, we perform around seven prostate biopsies per day, all in the clinic, in an outpatient setting, and under local anesthesia. This means we avoid the costs and time associated with the operating room and general anesthesia. To give you an example, in the operating room, a procedure like a prostate biopsy may require up to seven people, including an anesthesiologist. In the clinic, we usually work with a team of three. The urologist administers the local anesthesia, which makes the process much more efficient for the hospital while maintaining a very good patient experience.

• Speaker #1

  Well, thank you very much. And beyond avoiding the risks associated with general anesthesia, how does this approach impact the overall patient experience?

• Speaker #2

  From my point of view, the most important aspect is that the urologist is comfortable performing the procedure under local anesthesia and knows how to administer it properly. When done correctly, patients usually tolerate the biopsy very well. The procedure is quick, recovery is almost immediate, and most patients go home shortly afterward. Overall, this significantly improves the patient experience.

• Speaker #1

  Yes, absolutely. Comfort is a key factor here. Could you tell us about your anesthesia protocol? How do you keep patients relaxed and pain-free during the procedure?

• Speaker #2

  Our anesthesia protocol combines both superficial and deeper local anesthetic blocks. First, we perform a superficial infiltration of the perineal skin. Then, under ultrasound guidance, we administer a deeper block targeting the apical periprostatic area, including the levator ani muscle and branches of the pudendal nerve. We use 1% lidocaine, typically between 40 and 80 milliliters, depending on the patient’s weight. When performed properly, most patients tolerate the procedure very well and remain comfortable throughout the biopsy..

• Speaker #1

  And do you perform this biopsy on all your patients, or is there a specific profile that benefits most from this approach?

• Speaker #2

  In our practice, we use this approach for almost all patients. Interestingly, those with more comorbidities often benefit the most, as it allows us to avoid general anesthesia. Only in rare cases, when a patient cannot tolerate the procedure under local anesthesia, do we perform it under general anesthesia.

• Speaker #1

  I’d like to start a new tradition on this podcast. To help us map out the future of urology, if you had to describe it in just one word, what would it be?

• Speaker #2

  I would say precision, because we are moving toward more targeted diagnosis and treatment, and we need to adapt to each individual patient.

• Speaker #1

  Such a perfect word — very interesting. We always like to finish with a non-clinical icebreaker. What’s the one song that never fails to get you in the right headspace?

• Speaker #2

  Well, one song that always puts me in the right mindset is Viva La Vida by Coldplay. It has great energy and always gives me a boost before a busy day.

• Speaker #1

  That makes me want to dance now! That was very inspiring. Thanks again, Dr. Roldan-Testillano. I hope you enjoyed the exercise.

• Speaker #2

  Thank you so much for the invitation. I really enjoyed the conversation — it was a pleasure.

• Speaker #1

  Thank you. As we close this episode, it’s clear that the gold standard in prostate biopsy is constantly evolving. Dr. Rocio Roldan-Testillano has shown us where urology is heading — a future where stress and discomfort are replaced by true precision and better care. As she perfectly illustrated, shifting toward the transperineal approach and local anesthesia is more than just adopting a new technique. It’s about future-proofing your practice in a digital, patient-centered era. It’s about reaching a standard of care where clinical uncertainty is replaced by precision, and patient anxiety is replaced by comfort. With a push for leaner, walk-in, walk-out pathways, we are seeing that what is best for the patient experience is also what is most efficient for hospital workflows. Dr. Roldan-Testillano, thank you for sharing your expertise with us today. And to our listeners, the landscape is shifting, and the pursuit of precision in men’s health starts in your clinic. We’ll see you next time on Prostate Talk. Stay precise — and let’s get to the point.

• Speaker #3

  Prostate Talk.