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 01:25 Why UCLA pursued micro-ultrasound 04:46 How micro-ultrasound works (high-resolution imaging) 08:20 PRI-MUS vs PI-RADS: scoring systems 11:30 Optimum Trial: design and purpose 21:25 Clinical implications and future uses 22:09 Q&A: training, variability & AI 25:08 Q&A: PSMA PET with micro-ultrasound 31:30 Q&A: biopsy safety, tract seeding & implants 36:40 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.

**Dr. Daniel Park from USC Keck Medical Center presents a comprehensive overview of prostate cancer diagnosis, treatment options, and cutting-edge surgical techniques.** 00:00 Introduction and Welcome 02:11 USC Urology Program Overview 07:10 Prostate Cancer Overview & Statistics 16:54 Risk Factors and Diagnosis 21:17 Biopsies 26:17 The Treatment Trifecta 31:00 Robotic Surgery 32:50 Video: da Vinci SP Robotic System (https://www.youtube.com/watch?v=TGjnb86HndU) 46:00 HIFU 58:15 Q&A **KEY TOPICS COVERED:** **Diagnosis & Detection:** - PSA testing limitations and the continued importance of digital rectal exams - The game-changing role of MRI in prostate cancer detection - MRI fusion biopsies vs. traditional random biopsies - how many cancers are missed - Gleason scoring (Grade Groups 1-5) and what the numbers mean - Why traditional biopsies are imperfect and often miss aggressive cancers **Treatment Options:** Dr. Park reviews the full spectrum of treatments including surgery, radiation, active surveillance, hormone therapy, and focal therapy. He emphasizes the treatment "trifecta" goals: cancer control, urinary continence, and erectile function preservation. **Active Surveillance:** - Appropriate for low-risk Gleason 6 (Grade Group 1) disease - Not "watchful waiting" - requires regular PSA, MRI, and biopsy monitoring - When to convert to active treatment **Robotic Surgery Revolution:** Extensive discussion of USC's single-port robotic surgery platform: - Evolution from open surgery to minimally invasive techniques - Single-port advantages: ~3cm incision, faster recovery, improved precision - Superior visualization and triangulation compared to traditional laparoscopy - Minimal scarring and quicker return to normal activities - USC's investment in cutting-edge surgical technology **Focal Therapy - HIFU (High-Intensity Focused Ultrasound):** Detailed explanation of this prostate-sparing treatment option: - How HIFU works: focused ultrasound energy heats tissue to ~194°F with millimeter precision - Two machines at USC: Sonicare and Ablotherm - Procedure takes 2-3 hours with real-time monitoring - Success rate: 80-85% based on USC's published research - Patient selection criteria: localized disease (T1-T2), Gleason 6-7, appropriate prostate size - Who should NOT have HIFU: advanced disease, high-grade cancer, certain medical conditions - Critical importance of post-treatment surveillance (annual MRIs, periodic biopsies) **Emerging Technologies:** - AI applications in surgical training and cancer detection - PSMA PET scans as next-generation imaging - Clinical trials: aquablation, nanopac injections, vaccine research - Future of robotic and AI-assisted surgery **Q&A HIGHLIGHTS:** Viewers ask about: - HIFU success rates and patient selection (honest discussion about 15-20% recurrence rates) - Managing PSA recurrence after prostatectomy (salvage radiation options, PSMA PET imaging) - AI's role in prostate cancer diagnosis and treatment - Post-HIFU follow-up protocols and aquablation for BPH symptoms - Active surveillance for newly diagnosed patients with pre-existing bladder issues - USC's focal therapy specialists: Dr. Andre Brew and Dr. Amir Lebashti - Insurance considerations and choosing high-volume treatment centers - Advanced treatments for metastatic disease showing improved survival rates **KEY TAKEAWAYS:** - MRI is essential for accurate diagnosis and treatment planning - Not all prostate cancers require immediate aggressive treatment - Multiple effective treatment options exist - choose based on individual circumstances - High-volume centers like USC offer latest technologies and expertise - Post-treatment surveillance is critical regardless of treatment choice - Support groups and patient education are vital - men need to talk about their health This presentation offers invaluable insights for newly diagnosed patients, those considering treatment options, and anyone interested in the latest advances in prostate cancer care. Dr. Park combines deep technical expertise with an approachable, patient-centered perspective. 📌 About Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and families affected by prostate cancer. We host online meetings on the 2nd and 4th Tuesdays monthly, with expert presentations on most 4th Thursdays. 💻 Connect With Us 🌐 prostateforum.org 📺 Subscribe for expert talks and community discussions 📧 Sign up for our newsletter at prostateforum.org ⚠️ Disclaimer This video is for educational purposes only and is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider donating or sharing with others who may benefit.

Dr. Elizabeth Zhang from Keck Medicine USC explores the "alphabet soup" of radiation oncology treatments for prostate cancer—including advances from 3D-CRT through IMRT, VMAT, SBRT, and the role of proton and internal therapies. Chapters and timestamps are included for ease of navigation. Chapters & Timestamps 00:00 – Introduction & About Dr. Zhang-Venten Brief welcome and overview of Dr. Zhang’s background. Keck Medicine’s expansion into Orange County and the motivation for demystifying radiation oncology acronyms. 02:43 – What is Radiation Therapy? Explanation of external vs. internal radiation, with a focus on External Beam Radiation Therapy (EBRT)—how LINACs work and the goal of precise targeting. 06:34 – External Beam: Machines, Beams, and 3D-CRT How a linear accelerator delivers EBRT, the evolution from 3D conformal radiation therapy, and historical context of “box” approaches and challenges for surrounding organs. 10:10 – Advances: IMRT & Inverse Planning Shift from “forward planning” to “inverse planning” using computers; describing IMRT and how modern machines allow fine dose modulation and better protection for healthy tissue. 15:48 – VMAT: Speed and Precision Introduction of Volumetric Modulated Arc Therapy (VMAT). Illustrates how VMAT enables rapid delivery using rotating machines that dynamically block and shape radiation in real time. 19:40 – Shorter & Safer: SBRT and Sessions Transition to modern fractionation schedules: From 44 to as few as 5 sessions with SBRT. Discussion of appropriate selection, role of rectal spacers, and patient-specific factors like prostate size and urinary symptoms. 24:10 – Proton Therapy Explained Comparing photon and proton radiation. Using patient-friendly metaphors, explores why protons offer a different dose profile, but highlights trial results showing similar quality of life outcomes for prostate cancer between modern photon (VMAT/IMRT) and proton therapy. 31:16 – Brachytherapy: Internal Radiation Explanation of internal radiation, using metaphors such as flashlights and glow sticks. Differentiates Low Dose Rate (LDR) “radiation to go” (permanent seeds) and High Dose Rate (HDR) “radiation for here” (temporary needles)—plus the risks, benefits, and technical notes on placement and migration. 33:50 – Modern Practice & Clinical Decision-Making How current advances shape patient decision-making—surgery vs. radiation for enlarged prostates, impact of hormone suppression, and quality of life factors. Dr. Liz shares recent studies, experience, and collaborations that guide patient care. 39:28 – Q&A & Live Discussion Open Q&A session addressing personalized patient questions: recurrence, oligometastatic disease, clinical guidance technologies, AI and imaging, risks with spacers, and the importance of expert placement. Dr. Liz offers advice on choosing centers of excellence and the significance of collaborative team care. 1:12:41 – Facility & Technology Overview Highlights of newest technologies in Orange County facilities, including TrueBeam machines and unique PET-guided linear accelerators at USC Newport Beach, plus the value of imaging integration for individualized care. Key Topics Covered EBRT: How external beam radiation is delivered and shaped for optimal safety Treatment advances: From “box” 3D-CRT to IMRT, VMAT, and SBRT Deciding on number of treatment sessions based on new techniques and patient factors Role and evidence for proton therapy in prostate cancer Brachytherapy (internal): LDR vs HDR methods, advantages, and practical risks Interpreting imaging, using integrated technology, and enhancing safety Q&A recap: Decision-making, recurrence management, technical guidance, and facility highlights Explore the chapters to learn about the latest prostate cancer therapies, hear patient-friendly explanations, and discover what advanced radiation oncology can offer today!. 📌 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.

In this Prostate Forum session, we welcome back Dr. Gary Ulaner, Director of Molecular Imaging and Therapy at the Hoag Family Cancer Institute and Professor of Radiology at USC. Dr. Ulaner is a national leader in prostate cancer molecular imaging and targeted therapy, and he returns to share important updates on PSMA-targeted imaging and therapy, with a focus on Lutetium-177 (Pluvicto) and its use alone or in combination with androgen receptor pathway inhibitors (ARPIs). Chapters 00:00 Introduction – Welcome and opening remarks 01:02 Molecular Imaging & Therapy Basics – How PSMA targeting works for imaging and treatment 05:15 Pluvicto and Clinical Impact – NEJM trial results, survival benefit, patient responses 06:04 Clinical Trials at Hoag – Actinium-225 PSMA (post-Pluvicto) and new Pluvicto ± ARPI trial (free medication provided) 11:16 Q&A: Practical Questions – PSA thresholds for PSMA PET, trial eligibility, out-of-state participation, side effects, quality of life Key Topics Molecular Imaging & Therapy Basics Dr. Ulaner begins with an overview of molecular imaging and therapy: cancer cells express targets such as PSMA (Prostate Specific Membrane Antigen), which can be bound by specially designed agents. When linked to imaging isotopes, these agents allow highly sensitive PET scans to detect prostate cancer. When linked to therapeutic isotopes, they deliver radiation directly to cancer cells, shrinking disease while sparing most normal tissue. Pluvicto and Clinical Impact The landmark NEJM trial established that Lutetium-177 PSMA-617 (Pluvicto) improves survival compared to standard care in metastatic castration-resistant prostate cancer. While not a cure, it significantly reduces tumor burden and extends life, with median benefit of about 4–6 months on average, and in some cases years of added survival. Dr. Ulaner emphasized that individual responses vary widely. Current and New Clinical Trials Two key clinical trials at Hoag are highlighted: • Actinium-225 PSMA trial: For patients who have already received Pluvicto and progressed. Actinium delivers alpha radiation (100x stronger than beta), often with fewer systemic side effects, though salivary gland toxicity (dry mouth) is more pronounced. This option may be preferable to chemotherapy for many patients. • Pluvicto ± ARPI trial (newly opened): For patients who have had one prior ARPI (abiraterone, enzalutamide, darolutamide, or apalutamide) and then progressed. Patients may receive Pluvicto alone or Pluvicto plus another ARPI. Importantly, Novartis provides the medication free of charge for participants. Practical Questions Answered The Q&A addressed: • When to order PSMA PET: After prostatectomy, a PSA ≥0.2 ng/mL usually qualifies. Post-radiation, thresholds depend on PSA rise above nadir. • Effect on treatment decisions: PSMA PET alters management in over 50% of biochemical recurrence cases, ~⅓ of high-risk newly diagnosed cases, and 10–15% of patients being evaluated for therapy. • Side effects: Pluvicto is generally well tolerated compared to chemotherapy. Actinium therapy has more dry-mouth issues but often less bone marrow toxicity. • Access to trials: Patients from outside California can enroll if they can travel to Hoag or to other sites nationwide as they open. • Hip replacements: Do not interfere with PSMA therapy or imaging. • Quality of life: Radioligand therapies usually provide “good months of life,” with relatively mild side effects compared to chemotherapy. Key Takeaways • Pluvicto is a proven life-extending therapy for advanced prostate cancer. • Actinium-225 PSMA offers a promising next step for patients progressing after Pluvicto. • New trials combining Pluvicto with ARPIs may improve outcomes, with drugs supplied at no cost. • PSMA PET imaging is transforming management, guiding both diagnosis and therapy selection. ============ 📌 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. 💻 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.

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.

How can AI transform prostate cancer treatment decisions? In this Prostate Forum fireside chat, Dr. Calvin Chao of Artera explains how their groundbreaking AI-powered test predicts outcomes and guides therapies like radiation, hormone therapy, and abiraterone. A must-watch for patients, caregivers, and clinicians seeking the latest in precision medicine. In this special session hosted by the Prostate Forum Advanced Support Group, we welcome Dr. Calvin Chao, Vice President of Medical Science at Artera. Dr. Chao shares exciting updates from the recent ASCO meeting, highlighting how Artera’s AI-driven prostate test is shaping the future of precision medicine in prostate cancer care. 00:00 Meet Dr. Chao 00:30 Q&A The discussion covers: • How the Artera AI platform uses digital biopsy slide analysis with machine learning to predict outcomes and guide treatment decisions. • The difference between prognostic risk assessments (likelihood of distant metastasis or mortality) and predictive biomarkers (who benefits from specific therapies like short-term ADT with radiation). • Results from landmark studies, including RTOG clinical trials and the STAMPEDE trial, showing how the Artera test can identify patients most likely to benefit from treatments like abiraterone. • Practical implications for patients considering active surveillance, radiation, or hormone therapy. Dr. Chao also answers audience questions about long-term outcomes, use of older pathology slides, PET imaging, and how the test applies in real-world decision-making. 📌 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.

In this informative and forward-looking presentation, Dr. Joanne Weidhaas introduces ProstoX, a breakthrough blood test that helps predict how likely a man is to experience moderate to severe side effects from prostate cancer radiation therapy. 00:00 Introduction 02:30 Dr. Weidhaas 25:57 Q&A 🔬 What is ProstoX? ProstoX is a simple, personalized test that analyzes six specific microRNA biomarkers from a blood sample. These markers give insight into how a patient’s normal tissues are biologically likely to respond to radiation—something traditional clinical factors (like age or radiation dose) can’t fully predict. 💡 Why It Matters: Men with prostate cancer often face difficult decisions about treatment. While radiation can be highly effective, it can also lead to lasting bowel, urinary, or sexual side effects. ProstoX gives men and their doctors an extra layer of personalized data to help make better, safer choices—whether to proceed with radiation, adjust the treatment plan, or consider alternatives like surgery or focal therapy. 📊 What You’ll Learn in This Video: • How microRNA biomarkers work in predicting radiation sensitivity • How ProstoX categorizes patients into low, intermediate, or high risk • Real-world patient examples where ProstoX improved outcomes • How to use ProstoX in treatment planning (and when to order it) • Where the test is available and what it costs • Ongoing efforts to expand access and insurance coverage 💬 Q&A Highlights: Dr. Weidhaas answers audience questions about: • Timing of the test (must be done before treatment starts) • Applicability to different types of radiation (SBRT, IMRT, brachytherapy) • Future use in other cancers • Scientific validation and clinical adoption 📍 Bottom Line: ProstoX brings the power of precision medicine to prostate cancer care. It helps identify men at higher risk of radiation toxicity—before treatment begins—so that decisions can be more informed, personalized, and patient-centered. ⸻ 👍 If you found this video helpful, please like, comment, and subscribe for more prostate cancer education and support. 🌐 Learn more about our mission: https://prostateforum.org #ProstateCancer #RadiationTherapy #ProstoX #PrecisionMedicine #MicroRNA #MenHealth #Oncology #ProstateForum #PatientEducation #CancerSupport #PersonalizedCare ==== About the Prostate Forum ====== Prostate Cancer? You are not alone. 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. 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. At the Advanced/Recurrent Group Group every 4th Tuesday, beginning at 5:00 pm Pacific Time, share your concerns and experiences, and find out what other Prostate Cancer warriors are saying and thinking. Learn about resources, advances, and breakthroughs - advanced treatment options are improving all the 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 are 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 Our website address is: www.prostateforum.org

Dr. Ali Afshar, a urologic oncologist at Cedars-Sinai and Providence St. John’s in California, presented an in-depth talk on focal therapy for prostate cancer using the Focal One HIFU (High-Intensity Focused Ultrasound) platform. This robotic, image-guided system allows targeted treatment of prostate tumors with fewer side effects than surgery or radiation. Overview of PSA and Diagnosis PSA is a protein produced by the prostate. Elevated PSA may signal cancer but is not definitive. Dr. Afshar emphasized looking at PSA trends, free PSA (unbound protein), family history, and MRI findings before recommending a biopsy. He uses transperineal MRI fusion biopsies, which are more accurate and safer than traditional transrectal ones. Understanding Risk Levels Prostate cancer is categorized by Gleason scores and PSA levels: • Low risk: Gleason 6 (3+3), PSA under 10 • Intermediate risk: Gleason 7 (3+4 or 4+3) • High risk: Gleason 8 or higher, or PSA over 20 Modern grading groups range from 1 (least aggressive) to 5 (most aggressive). Treatment Options • Active surveillance: Recommended for low-risk patients. Requires regular PSA checks, MRIs, and biopsies. • Radical prostatectomy or radiation: Effective but often lead to side effects like incontinence and erectile dysfunction. • Focal therapy: Targets only the tumor area, preserving healthy prostate tissue. It’s a same-day, non-invasive procedure with lower risk of side effects. HIFU with Focal One Focal One uses focused ultrasound energy to heat and destroy cancerous tissue. It integrates MRI and ultrasound imaging to precisely target the tumor. No incisions are made, and future treatment options remain open if needed. Ideal Candidates for Focal Therapy • Gleason 7 (especially 4+3) • MRI-visible lesion confined to one side • Prostate size under 50 grams • Good overall health and life expectancy • Those wanting to avoid surgery or radiation side effects Focal therapy can also be used for patients with local recurrence after radiation or surgery, depending on location and anatomy. Procedure and Follow-Up Patients undergo pre-treatment MRI and a bowel prep. The procedure is done under general anesthesia, followed by a catheter for 7–14 days. PSA is checked after 3 months and monitored regularly for 5 years. A follow-up MRI and biopsy are typically done at 1 year. Clinical Outcomes Studies show that focal therapy offers similar cancer control to surgery or radiation in well-selected patients, with lower rates of side effects: • Erectile dysfunction: approximately 21 percent • Incontinence: approximately 1 to 2 percent • Recurrence: around 20 to 25 percent (varies by cancer aggressiveness and location) Patients can still pursue other treatments if recurrence occurs. Audience Questions Participants asked about recurrence, insurance coverage (Medicare covers HIFU; PPOs may require authorization), and comparisons to other modalities like cryotherapy and nanoknife. Dr. Afshar emphasized that not all patients are suited for focal therapy, and treatment choice depends on cancer location, grade, and personal goals. Conclusion Focal therapy bridges the gap between active surveillance and more aggressive treatments. It offers a safe, effective option for select men and is growing in availability at major medical centers. ⸻ About the Prostate Forum of Orange County Prostate cancer? You are not alone. The Prostate Forum of Orange County is an all-volunteer organization that has been providing support, education, and community for prostate cancer patients and their families for more than 30 years. Our mission is to help individuals become informed, empowered partners in their treatment journey. We host monthly Zoom support meetings: • Newly Diagnosed Group: 2nd Tuesday at 5:00 PM PT – understand your diagnosis and explore treatment options. • Advanced/Recurrent Group: 4th Tuesday at 5:00 PM PT – share experiences, concerns, and emerging therapies. • Monthly Expert Presentations: 4th Thursday of most months – leading physicians and researchers present the latest on diagnosis, treatment, and quality of life. All meetings are free and open to anyone affected by prostate cancer – patients, partners, family, and friends. Visit www.prostateforum.org to: • Register for upcoming meetings • Learn the language of prostate cancer • Access treatment resources • Explore our library of expert presentations Let us help you become your own best advocate.