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This podcast is created by Coelis.
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Data and studies will help us finding out the optimal strategy for our patients to identify risk factors for progression disease and reduce complications and also long-term issues.
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Welcome to a new episode of Prostatalk. Where we are diving deep into the exciting world of data. But not just any data. Prostate care data. Now I know what you are thinking. How can numbers and spreadsheets about prostate be interesting? Well, hold on to your seats. Because the way data is collected and used in prostate care is nothing short of revolutionary. This is why we have invited today Dr. Trauman, a specialist in data collection and analysis. We'll explore how healthcare is evolving using mountains of patient data to better diagnose and treat prostate condition, making us wonder, is there anything data can't do? And don't worry, we are not just talking about nerdy algorithms. We'll also discuss how the machines behind all this tech are becoming so user-friendly that even your grandma could give them go. Also, hopefully she won't have to. From... easy-to-use interfaces to powerful diagnostic tool, we are witnessing a new age of prostate care that's as simple as pressing a button. So grab your headphones and let's explore the future of prostate health through the lens of data collection and some very fancy machines. Hi, Dr. Trauman. Thanks for having accepted to participate in our podcast, Prostate Talk. We are live at the GGU Congress in Germany. How are you and how the Congress is going?
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I'm very well. Thank you for having me here. And so far, the Congress is going really well. I've seen some interesting talks and I had a talk myself. And so I'm enjoying myself a lot here.
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We are really pleased to welcome you. Before starting the interview, could you please tell us who is Dr. Trauman?
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So hi, everybody. I am... Dr. Miriam Traumann. I was actually born and raised in Hamburg, Germany, and I am now currently working at the University Hospital in Frankfurt, Germany. And after my residency, which I started in Hamburg at the Martini Clinic, we probably all know the Martini Clinic, biggest cancer, prostate cancer center in the world. I continued at the University Clinic. in Hamburg. Afterwards, I spent a year actually in Marseille at an oncology center. After that, I worked at a smaller hospital as a consultant and attendant. And now I'm back at the university field and the university setting. I was my head of the department, Professor Chun, who I already know back from Hamburg.
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Thanks for this presentation. I heard. One here in Marseille. So does that mean that you speak a little bit French?
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Just un peu. Perfect.
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Better than my German. No worries. So let's not talk about prostate, but especially fusion biopsy. I have heard that you are interested in data collection, right? What kind of information do you collect precisely?
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Yes, so our department is very eager on data collection. That means we basically collect every data we can get. So prospectively searched or gained data is very important for us, as well as prompts. That means patient reported outcomes measurements. We send actually in very traditional, classic ways, questionnaires to patients. We try to do a follow up. We try to get every data, like I said, concerning the patient as well as. the cancer, the outcome, the diagnostics, and we try to collect as much as we can so we can actually squeeze the information out that might help us in the future.
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Concretely, how do you work with data in your daily practice? How do you use this data?
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So actually, we collect all the data, especially, for instance, for complication rates according to some complication classifications. That is really important to us. We have a lot of studious medical students as well as residents that... basically type in all the data in a sheet, in a work data sheet, very... a little bit conservative, but with all this data gained from our patient and also the diagnostics and we know a lot about everything and about our patients and the major concern is actually for us cancer detection rates, the screening. the imaging, the sensitivity and accuracy of biopsies and the outcome and also to have the best treatment or the best personalized therapy treatment for our patients and to guide them and to give them a good medical advice.
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And you mentioned the collect of the information. So how do you collect this information? Do you use a specific system? Any tools, particular tools?
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So we are using some kind of data collection system for PROMs, so the patient reported outcome system. We have a really big program for our perioperative and data of hospital stays, for instance. But we also use standardized questionnaires to follow up on patient and also what we're... Right now, working on is questionnaires during procedures for, for example, asking for pain and anxiety.
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And let's go back to the diagnostics stage about your fusion biopsy system. Since when have you been using it?
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So we already started using it in 2017. Back then I was at the smaller hospital, but also here in Frankfurt we used it. through the transrectal approach and we changed in 2023 so last year we changed to the perineal approach and we're still doing a lot of targeted fusion biopsies and what were your criteria of choice you mentioned the transparent approach but other criterias for once we chose the perineal approach because all the data and studies showed that they favor less infection. We don't need that much antibiotic prophylaxis anymore or not at all, actually. And we looked actually at our own data and we could confirm this. So we don't use any antibiotic prophylaxis anymore. And I think this is a very important step to reduce urinary infections or infection complications. And also it is very important because Some years ago, we didn't really know if MRI was a good tool to detect cancer. And with using more targeted and fusion biopsy, we can actually look at the imaging and see if it's good enough or if there are a lot of centers that do it better, specialized centers, and also re-evaluate our own data and the accuracy of.
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imaging and our biopsies and looking at the detection rates of prostate cancer which is actually clinical significant also so you already answer to my next question about the approach of prostate biopsy that are you using so could you explain us the workflow and how do you use the transparent approach in your daily practice maybe so in our hospital we do one day of
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biopsies and it's like in an outpatient setting. So the patient comes in, we do no antibiotic prophylaxis, then we'll do the perineal biopsy with local anesthesia. That means we'll have the superficial skin anesthesia followed by deeper periprosthetic block of anesthesia. I was surprised actually because Some years ago, we still did it under general anesthesia. And I was surprised that actually when you do a good local anesthesia, the patient will be okay with that. And he doesn't need general anesthesia. He just stays for maybe 30 minutes after the biopsy and then will leave the hospital on his own and go back to his home. So that's actually became a lot easier.
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Perfect. You mentioned that you changed recently, I mean, like one year, one year and a half, from transrectal to transperineal. Would you say it is easy to use the transperineal approach? Could you tell us more about the learning curve that involved this changing?
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I think for me it was a little bit harder to change to the perineal approach because I was so used to the transrectal approach. And I think this is what most people will tell you if they are really used to one approach and one technique. It's always a little bit tricky or harder to get used to another approach, to a different approach. But I really see the advantages of the transperineal approach because it's so much cleaner. and associated with less infections. And once you get it, and it will be quick that you learn it because you already know the imaging. And at the end, it's probably easier because you have a good exposition of the anatomy and also can compare it very well with the MRI eyes and do a good fusion. And you just have to get used to it. And once you've got this, it's actually, I think, maybe easier.
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Perfect. Thanks for your insights. Dr. Thurman, how do you see the future of prostate care? What will be the role of data?
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Data and studies will help us finding out the optimal strategy for our patients to identify risk factors for progression disease and reduce complications and also long-term issues because we all know that antibiotics resistances are a problem and we can avoid it by using no antibiotic prophylaxis. Also, maybe for the patient less biopsies when we figure out what are really the patients that we can pick out that have lower risk. Because every patient, and sounds a little bit cheesy, but every patient is an individual. His prostate cancer is also very different. So we have patients that are very low risk and you can do a perfect active surveillance, they will never die of prostate cancer. And then we have to really select those patients and see them early, those patients who are at risk of actually dying of prostate cancer. So I think this is very important and also to guide the patient in his disease.
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Thank you. I really like the way that you put the patients in the matter of your...
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practice and it's fabulous thank you talking about the future what are you currently working on we are currently working on our data concerning detection rate we already published some of our data but we want to compare it with the first so actually the learning curve we had and with the data now because since More than a year, we've already done over 300 biopsies. So I think, I hope we'll get better at that and that will lead to higher detection rates, I hope. Also, a topic that is really interesting is the use of verbal anesthesia and devices such as virtual reality devices. We actually are trying something out right now. It's just like... goggles where the patients look at a very very boring movie and it will help maybe to reduce the pain and also the anxiety so we are giving our patients um we let them choose between to use the vr device or not and we assess and anxiety and pain questionnaires actually yeah we want to look at those data further and also Always look at the complication rates, what we can improve, what we can, or also to identify those patients who are at higher risk for complications maybe.
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Thank you. So, Dr. Truman, I couldn't resist to ask you this next question. Urology is still a mal-dominated field. As a woman in this specialty, have you faced any specific challenge throughout your career and how? Have you navigated them?
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I think that's a really good question and a good topic to, I could talk about it for hours probably. But long story short, I think as a woman in this domain, you will face a lot of difficulties, but also a lot of advantages maybe. So as women, we should also feel strong to work in a male-dominated field. And at the end, we should try to network more together. I think that's maybe a little bit of a woman's weakness, if you can say it like that, that women don't do networking as well as men maybe. There are more because I think in my generations, there are a lot of women. But at the end, on the top, the head of departments are still pretty dominantly male head of departments. So I think in order to change that, we kind of have to stick together, overcome certain cliches also. But it's still a long way. But actually, I never really felt discriminated against because I'm a woman. because I have lovely colleagues and all the head of the departments I've worked with were really supportive. But I think also that women maybe underestimate themselves sometimes. So we have to learn also from our male colleagues that we can work at higher positions.
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Maybe you put a little nut in the mind of other women urologists to create this network, maybe a club or a social club. with all these fabulous women who are working in urology that can be a good idea.
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Yes, that's a really good idea and it's already in general surgery but also urology. There are some clubs or actually associations only for women and I don't want to exclude the men of course, they're really important for us as well but it's also important and we figured that out already that we have some networking. clubs or associations, especially supporting younger female colleagues.
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And do you feel it influenced your approach to the patient care to be a woman?
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I was surprised that for the most part, all of the patients didn't mind if I were a woman or not. Actually, everybody was really open. I think there are some patients that prefer maybe going to a male doctor. especially in neurology, but at the university hospital or at the clinic setting, that was actually never an issue. And I think some patients were really happy to have a female surgeon also because they felt maybe I was more sensitive, which I'm not, compared to my male colleagues. But I think it's... the end it doesn't really matter if you're male or female it matters how you treat the patient how you talk with them and i figured that you can do a surgery as well as anybody else and the end it's the way the patient feels about his disease and about the way he's been treated as a human being basically definitely and finally dr troman for any woman listening today
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who might be considering a career in urology. Do you have any advice or insight to share with us?
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As I said before, I think we have to believe in ourselves. I think the generations, the younger generation of women are a lot more independent and also confident about themselves. So I don't worry about the female future. Actually, in urology, I see a lot of young colleagues and they... doing research and they're doing everything that the male colleagues do. And I think they just have to believe that they can do the same, but also put the same effort into everything. Yes, that's my advice for the younger colleagues.
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Thanks a lot for the interesting insights. Before to finish our interview, I like to ask a special question. What is Dr. Traumat, your favorite song of the moment?
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My favorite song at the moment is probably Sara Perchettiamo. It's an Italian classic.
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Thank you a lot. Arrivederci. And I hope you like the exercise, Dr. Truman. Thank you for your participation.
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Thank you very much.
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