UCLA urologist Dr. Wayne Brisbane explains how micro-ultrasound compares with MRI for detecting prostate cancer, based on the Optimum Clinical Trial published in JAMA. This talk is ideal for men with rising PSA, newly diagnosed prostate cancer, or those considering biopsy, MRI, or active surveillance. Learn how micro-ultrasound works, what the research shows, and what it means for real-world decision making. ⸻ Chapters 00:00 Welcome & introductions 01:21 Why UCLA pursued micro-ultrasound 04:36 How micro-ultrasound works (high-resolution imaging) 09:42 PRI-MUS vs PI-RADS: scoring systems 12:58 Matching images to surgical pathology 18:02 Optimum Trial: design and purpose 22:52 Trial results: detection, accuracy & non-inferiority 26:42 Cost savings & workflow advantages 29:48 Clinical implications and future uses 31:59 Q&A: training, variability & AI 33:36 Q&A: PSMA PET with micro-ultrasound 34:58 Q&A: biopsy safety, tract seeding & implants 36:40 Q&A: negative MRI but rising PSA; availability 38:10 Closing comments and community updates ⸻ Summary Micro-Ultrasound Overview Dr. Brisbane explains UCLA’s work with high-resolution micro-ultrasound, which images the prostate at ~70 microns—far more detailed than conventional ultrasound. This allows clinicians to visualize abnormal duct patterns associated with prostate cancer, offering MRI-like detail in real time and without the limitations caused by metal hip implants or MRI scheduling delays. How Micro-Ultrasound Compares With MRI Micro-ultrasound can reveal structural changes in prostate tissue that correlate with Gleason patterns. Dr. Brisbane compares micro-ultrasound and MRI images of the same gland, demonstrating how higher resolution can help identify suspicious lesions. Unlike MRI, micro-ultrasound is performed directly in the clinic, with no claustrophobia and no ferromagnetic interference. PRI-MUS vs PI-RADS The PRI-MUS scoring system parallels PI-RADS for MRI. Using acoustic features—duct patterns, density, and shadowing—it helps categorize lesions from low risk to highly suspicious. UCLA continues to refine PRI-MUS to improve accuracy, including AI-assisted interpretation. Correlation With Pathology UCLA developed a specialized process to align micro-ultrasound, MRI, and whole-mount pathology from prostatectomy specimens. These comparisons validated how well micro-ultrasound can map tumor location and characteristics, forming the foundation for the Optimum Trial. Optimum Trial Findings The randomized Optimum Clinical Trial compared three approaches: micro-ultrasound alone, micro-ultrasound with MRI, and standard MRI-fusion biopsy. Results showed that micro-ultrasound was non-inferior to MRI for detecting clinically significant prostate cancer—and even trended slightly in its favor. Grade Group 2 and higher-grade cancers were detected at similar rates in all arms. Cost & Practical Benefits Replacing MRI-guided biopsy with micro-ultrasound can save roughly $445 per patient, reduce radiologist workload, and streamline scheduling. Micro-ultrasound may be especially valuable when MRI is not possible or not definitive. Clinical Applications Potential uses include: • Combining MRI + micro-ultrasound for improved targeting • Reducing the number of biopsy cores when both modalities identify the same lesion • Supporting active surveillance by tracking lesion changes • Improving diagnostic accuracy for men with rising PSA but negative MRI Audience Q&A Highlights Dr. Brisbane addresses: • Training challenges and the role of AI • How PSMA PET compares with MRI and micro-ultrasound within the prostate • The extremely rare risk of biopsy tract seeding • Advantages for men with hip replacements • Where micro-ultrasound is available in Southern California ⸻ About Prostate Forum of Orange County Prostate Forum is a patient-focused nonprofit serving Southern California and beyond. We meet online via Zoom on the 2nd and 4th Tuesday of each month at 5 PM Pacific, including during the holidays. Meetings feature presentations from leading urologists, oncologists, radiologists, and prostate cancer experts. If you’re watching this on YouTube, visit ProstateForum.org to sign up for our email list and receive links to upcoming programs. ⸻ Support Our Work Prostate Forum relies on community support to keep these educational programs free. You can contribute via: • PayPal • Personal donations (even $5 helps) • Qualified charitable distributions from IRAs • Vehicle or property donations through our partner program Your support helps us continue providing trusted, expert-led prostate cancer education.

What’s new in prostate cancer care in 2025? Dr. Matt Cooperberg of UCSF shares the latest updates on screening, active surveillance, focal therapy, and treatment decision-making. An essential talk for patients, caregivers, and clinicians looking to understand risk, avoid overtreatment, and benefit from the newest advances. 00:00 Introduction & About Dr. Matt Cooperberg (UCSF) 00:55 Prostate Cancer Today: Screening, Incidence & Mortality 15:45 Active Surveillance vs Watchful Waiting — Who Qualifies? 32:30 Focal Therapy Explained: HIFU, Cryotherapy & Beyond 38:56 Key Takeaways & Audience Q&A Key highlights include: • 📊 Screening trends: How PSA guidelines have swung over time, the risks of over- and under-diagnosis, and why smarter screening is critical. • ⚖️ Risk stratification: Understanding the spectrum from indolent “snails” to aggressive “rabbits,” and how tools like the CAPRA score improve decision-making beyond traditional NCCN categories. • 👀 Active surveillance: Why surveillance—not immediate treatment—is the standard of care for most low-risk cancers, and how MRI, confirmatory biopsies, and genomic tests refine monitoring. • 🔬 Focal therapy: The promise and limits of approaches like HIFU, cryotherapy, and laser ablation, and why they should be viewed as complements to surveillance rather than replacements for surgery or radiation. • 🧪 Genomic and AI testing: Where tools like Decipher, Polaris, and emerging pathology AI fit in—and where they don’t—when guiding patient choices. • 🏥 Second opinions & centers of excellence: Why outcomes vary widely, and the importance of seeking subspecialist expertise before choosing a treatment path. Dr. Cooperberg also emphasizes the urgent need to reduce racial disparities, personalize treatment decisions, and support men living with prostate cancer long after initial therapy. 👉 Whether you are newly diagnosed, considering active surveillance, or exploring focal therapies, this talk offers practical, evidence-based insights into today’s rapidly evolving prostate cancer landscape. ==== About the Prostate Forum ====== 📌 About the Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and their families affected by prostate cancer. We host online support groups on the 2nd and 4th Tuesdays of each month, and feature presentations from medical experts on the 4th Thursday of most months. Our goal is to provide reliable information, expert insight, and a welcoming community where patients, survivors, and caregivers can share experiences and learn together. 💻 Learn More & Join Us 🌐 prostateforum.org 📺 Subscribe to our YouTube channel for monthly expert talks and fireside chats. 📧 Sign up for our free newsletter via our website to receive meeting updates. ⚠️ Disclaimer The information presented in this video is for educational purposes only. It is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider supporting the Forum through donations or by spreading the word to others who may benefit.

Advancing Precision Medicine: EpiSwitch PSE Prostate Cancer Screening Test Designed to confirm the presence of prostate cancer, the EpiSwitch Prostate Screening test, known as the PSE, confirms the presence of prostate cancer—whether symptoms are present or not. This technological advancement empowers urologists with important information when deciding if a patient should undergo a biopsy or opt for continued monitoring via active surveillance. Sections: 00:00 Introduction 01:00 Dr. Heaton - EpiSwitch 21:20 Q&A The Prostate Forum of Orange County (prostateforum.org) is an all- volunteer organization that has been providing support to prostate cancer patients for more than thirty years. Our goal is to listen, to inform, and to educate, so that people learn to advocate for themselves and become active collaborators with their medical teams in managing their own treatment. The Forum hosts monthly online support meetings (via Zoom) on the second and fourth Tuesday of most months, beginning at 5:00 pm Pacific Time. You are not alone. At the Newly Diagnosed Group, every 2nd Tuesday at 5:00 pm Pacific Time, get help understanding your Prostate Cancer diagnosis. Learn what it means. Talk about your options. Advanced treatment options are improving all the time. Share your concerns and experiences. Find out what other Prostate Cancer warriors are saying and thinking. Learn about resources, advances, and breakthroughs at the Advanced/Recurrent Group Group every 4th Tuesday, beginning at 5:00 pm Pacific Time. Monthly Presentations Experts in the treatment and management of Prostate Cancer share their knowledge and experience with us on the fourth Thursday of most months. All meetings are free, and open to anyone affected by prostate cancer – patients, family, friends. Visit the Prostate Forum website: prostateforum.org to: • Register to receive notices of meetings • Advocate for yourself: learn the language of prostate cancer. • Find resources for learning and treatment • Explore a library of a hundreds of expert presentations COME TALK TO US. WE'VE BEEN THROUGH IT.

Dr. Metzger reports on recent large-scale, encouraging studies on the effectiveness of Active Surveillance in managing a prostate cancer diagnosis. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

Dr. Metzger reviews the Clinical Practice Guidelines from the NCCN, containing recommendations for the prevention, diagnosis, and management of prostate cancer across the continuum of care. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

"This is not Your Father's Prostate Cancer." Dr. Marks talks about the revolutionary advances in detection of prostate cancer, and the target biopsy program at UCLA and elsewhere. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

Dr. Scholz describes the prostate cancer treatment options for intermediate risk prostate cancer, including Active Surveillance, current forms of radiation treatment, and surgery, and gives an overview of their effectiveness, risks, and side effects. The presentation is hosted by the Prostate Forum of Orange County (PFOC), a Prostate Cancer Support Group in Southern California. The Prostate Forum holds online support meetings twice each month for men with prostate cancer, their families and friends, and once a month the group hears from expert speakers in the diagnosis, management, and treatment of prostate cancer. You can find a calendar of meetings and presentations, along with a video library of previous presentation, at the PFOC website, www.prostateforum.org.