Latest / Becker’s Healthcare Podcast / How AI Is Transforming Prostate Cancer Diagnosis and Treatment with Dr. David Albala

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How AI Is Transforming Prostate Cancer Diagnosis and Treatment with Dr. David Albala · Becker’s Healthcare Podcast

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  - Hello, and thank you so much for tuning
• 1:00
  - into the Becker's Oncology Leadership podcast.
• 1:03
  - I'm Elizabeth Gregerson,
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  - assistant editor here at Becker's. And today, I'm
• 1:08
  - talking to doctor David Albala,
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  - chief of urology at Crouse Hospital and a
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  - physician with the Associated
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  - Medical Professionals of New York. Doctor Albala, thank
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  - you so much for taking the time to
• 1:20
  - speak with me today.
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  - Well, thanks so much for having me. This
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  - is, I think, an important topic, and I'm
• 1:25
  - looking forward to our discussion.
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  - Perfect. And we... Before we dive into that
• 1:29
  - discussion, I would love if you could just
• 1:32
  - set the scene, share a bit about your
• 1:34
  - background, your role at Kraus, for our listeners.
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  - So just briefly, I spent, twenty one years
• 1:41
  - in academic medicine.
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  - I started my career at Loyola University,
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  - rose to the rank of professor, and then
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  - was recruited to Duke University
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  - where I had a tenured position and was,
• 1:54
  - the head of robotic surgery at Duke.
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  - And then I left Duke and moved up
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  - to Syracuse.
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  - I've been in Syracuse now for
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  - about fourteen years,
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  - obviously, treating prostate cancer
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  - in a variety of different ways. We have
• 2:10
  - a a very advanced prostate cancer clinic. So
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  - we see disease from localized disease to metastatic
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  - and castrate resistant disease.
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  - So I'm well versed.
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  - Just got back from a trip to India
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  - where I was doing robotic surgery in India.
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  - So Wow. It's worldwide.
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  - Absolutely.
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  - Well, outside of India, I'd love to kind
• 2:33
  - of narrow in on your vantage point. You
• 2:35
  - know, as both a surgeon and chief of
• 2:37
  - urology,
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  - I'd love to talk about, you know, one
• 2:40
  - of the biggest topics in health care right
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  - now, and that's AI.
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  - But I'd like to hear where you are
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  - seeing AI
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  - actually make a real difference across the prostate
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  - cancer care pathway. I know there's lots of
• 2:53
  - shiny objects out there, lots of big headlines,
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  - but it's always nice to hear from someone
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  - who's, you know,
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  - on the ground using it where you've seen
• 3:00
  - it make a real difference.
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  - Well, it's interesting. You know, when I first
• 3:05
  - trained,
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  - the way we diagnose prostate cancer
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  - typically was with a rectal exam and a
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  - PSA test.
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  - And then those patients would eventually get an
• 3:14
  - ultrasound done and a biopsy. And we've seen
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  - a a significant rise in the use of
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  - MRI imaging
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  - to try to pick up prostate cancer earlier.
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  - MRI is a a great diagnostic tool. It's
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  - a radiological,
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  - tool that allows us to pick up these
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  - cancers
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  - much earlier on in the
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  - course of the disease.
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  - And
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  - with that
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  - increased sensitivity in picking up the disease,
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  - we then are faced with multiple choices on
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  - how we can treat patients.
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  - We can do active surveillance.
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  - We can do surgery. We can do radiation.
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  - There are focal therapies.
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  - So there's a lot of tools out there
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  - to treat prostate cancer,
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  - but AI has now come into this area
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  - of cancer care
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  - and has helped us
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  - be much more accurate in making the diagnosis
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  - and understanding
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  - the prostate cancer disease process.
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  - For example, there's a a product down the
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  - market
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  - called Unfold AI, which is essentially a,
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  - AI assisted,
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  - platform
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  - that helps the clinician,
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  - you know, one, educate patients on their disease.
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  - It helps us make treatment decisions,
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  - and we can use it intraoperatively
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  - to help us make decisions in in the
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  - operating room and when we're administering
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  - focal therapy.
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  - So this tool is is a really neat
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  - tool.
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  - It
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  - it provides personalized medicine,
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  - allows patients to develop what we call a
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  - cancer estimation map, which is color coded, and
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  - it can tell us accurately where the disease
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  - is much more accurately
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  - than what we see with the imaging that's
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  - currently on the the the marketplace today.
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  - Perfect. Yeah. And I know a lot of,
• 5:06
  - the discussion around prostate cancer care treatment these
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  - days is coming down to, you know, active
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  - surveillance versus treatment, surgery versus other options.
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  - You know, what
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  - often I've come across is kind
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  - of... Is it can... Is it a cancer
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  - diagnosis? Are we waiting and watching? Kind of
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  - what is the strategy there? Are AI tools
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  - kind of changing the way,
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  - you and your patients are weighing all of
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  - those choices?
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  - Yeah. We have a number of tools that
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  - can help us. Obviously, once a patient gets
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  - a biopsy,
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  - we look under the microscope and the diagnosis
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  - of cancer is made.
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  - And in the past, decisions have been made
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  - based on the aggressiveness of the tumor or
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  - what we call the Gleason score. So we
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  - look under a microscope and look at the
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  - cells that are present.
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  - And
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  - what... Based on those cells, we can make
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  - treatment recommendations.
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  - What...
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  - The beauty of artificial intelligence is that it
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  - allows us to be much more accurate than
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  - using standard of care or using the pathology
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  - that we see. We can use genomic markers,
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  - actually look at the genes that make up
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  - a particular tumor
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  - that was popularized
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  - initially in women with breast cancer and now
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  - can be extended into men that have prostate
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  - cancer.
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  - But with artificial intelligence,
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  - we can get a really accurate assessment
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  - of of the cancer map, and we can
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  - actually predict success
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  - on how a treatment may be,
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  - you know, with surgical intervention
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  - or with focal therapy.
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  - And and that's the thing that's important. And
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  - the the
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  - the the benefit that I like
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  - is once
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  - you you
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  - use artificial intelligence and develop a cancer estimation
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  - map,
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  - you can show the patient where their disease
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  - is,
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  - understand is the disease very close to the
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  - margin
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  - that's gonna be excised,
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  - What's the chance of having a positive margin?
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  - And that may actually alter the surgical therapy
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  - and treatment that's rendered to that particular patient.
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  - So it's a very accurate tool to predict
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  - extracapsular
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  - extension.
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  - There's some studies that have been done looking
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  - at seminal vesicle invasion,
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  - but the sensitivity
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  - is is really quite nice and the specificity
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  - with artificial intelligence. And in fact, it actually
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  - can change
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  - treatment decisions in one out of three urologists.
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  - Well, speaking of urologists, you know, I'd love
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  - to
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  - kind of shift from that, you know, patient
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  - facing treatment decision perspective
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  - to the perspective of, you know, someone who's
• 7:53
  - working in the health care industry
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  - from a physician's perspective.
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  - Health systems
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  - leaders are constantly being pitched
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  - AI tools, you know, AI system software.
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  - Some of it's integrated, some of it's not.
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  - You know, what
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  - makes these tools genuinely worth adopting, and have
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  - you come across, you know, any red flags
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  - that leaders
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  - should watch for before they, you know, shift
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  - their strategy or start committing resources to this
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  - technology?
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  - Sure. You know, one of my roles is
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  - to be the the... I'm the editor for
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  - the journal of robotic surgery, and and and
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  - if I were to tell you the number
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  - of papers that are being submitted to our
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  - journal
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  - with artificial intelligence is just mind boggling. I
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  - mean, the... This area has totally exploded. But
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  - I think for health care systems, obviously,
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  - where you're gonna spend your money and how
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  - you're gonna spend your money is really critical.
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  - And and to me, there are a couple
• 8:51
  - things that I think are important.
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  - Number one is you wanna make sure that
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  - that
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  - the system has been studied appropriately and it
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  - does have FDA clearance.
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  - You wanna look at the review articles that
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  - have been published. Are they peer reviewed articles?
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  - What types of journals?
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  - And how will artificial intelligence
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  - change workflows?
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  - I think that's really important for the physician
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  - to understand that. And health systems need to
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  - understand that as well because,
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  - you know, how patients flow through the clinic
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  - and how you manage these patients is gonna
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  - be critical
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  - to the happiness of the physician and the
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  - success of the health system.
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  - And then I think, also, there has to
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  - be some reimbursement for these artificial intelligence tools.
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  - Now the beauty of Unfold AI is this
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  - was FDA cleared in 2022.
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  - Actually, it's interesting. It it won the FDA
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  - breakthrough device in 2021,
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  - and there is now a specific CPT code
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  - for Unfold AI. And it's the only artificial
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  - intelligence platform that I'm aware of in prostate
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  - cancer at the present time that has FDA
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  - clearance and a specific code.
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  - So
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  - what's nice about
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  - this system is it changes the behavior of
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  - treating physicians
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  - in thirty three percent of the time.
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  - And it also... For patients that undergo
• 10:17
  - focal therapy, and and that's where you might
• 10:19
  - use devices like high intensity focused ultrasound.
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  - There's new devices called the Tulsa device.
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  - A variety of less invasive procedures.
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  - This actually... Using this system can reduce,
• 10:35
  - treatment failures in about seventy two percent of
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  - patients across the board.
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  - So this is a really nice system.
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  - Patients, you can use it to educate patients.
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  - It helps in the treatment guidance and choosing
• 10:49
  - a particular treatment, and it helps intraoperatively
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  - on how you're gonna be successful in rendering
• 10:56
  - that treatment to the particular patient.
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  - So I think the the future is really
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  - bright.
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  - You know, artificial intelligence is here to stay.
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  - We're gonna integrate it in our workflows.
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  - And I I like this system because I
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  - think it gives me
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  - information that I can't glean from just a
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  - histology report or a pathology report.
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  - It gives me more information
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  - and allows me to also educate my patients
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  - so they understand their disease and understand why
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  - I'm thinking of doing this versus that.
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  - Perfect.
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  - Well, you touched on where I'm going with
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  - my last question, and if anyone's listened to
• 11:35
  - one of my interviews on the podcast before
• 11:37
  - they know, I always
• 11:38
  - love
• 11:40
  - asking leaders what gives them hope about the
• 11:42
  - future, especially when it comes to cancer care
• 11:45
  - and the health care industry at large. I'd
• 11:47
  - love to hear your perspective.
• 11:49
  - Well, you know,
• 11:51
  - things have changed so much in prostate cancer
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  - over the years. When I first trained,
• 11:56
  - you know, the only two options we had
• 11:58
  - were surgical intervention with an open prostatectomy
• 12:03
  - or possibly radiation.
• 12:05
  - Now,
• 12:06
  - you know, we have multiple opportunities.
• 12:09
  - We... The the robot has come into this,
• 12:12
  - space.
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  - It's really been a game changer.
• 12:15
  - Patients now were doing outpatient
• 12:18
  - prostatectomies.
• 12:19
  - Patient will come in in the morning,
• 12:21
  - will take their prostate out, do the anastomosis,
• 12:25
  - and these patients will leave the hospital the
• 12:27
  - same day.
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  - I believe as we look to the future,
• 12:31
  - you know, artificial intelligence is making us better
• 12:34
  - surgeons.
• 12:35
  - We're giving better treatments and getting better results.
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  - But I I look... I think as I
• 12:41
  - think about where we'll be in ten years,
• 12:44
  - you know, the technology is changing so rapidly
• 12:48
  - that, you know, surgeons, we may not be
• 12:50
  - doing surgery anymore.
• 12:51
  - Patients may come in, sit under some specialized
• 12:54
  - X-ray device,
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  - get a type of treatment
• 12:58
  - that will be successful,
• 13:00
  - without making incisions,
• 13:02
  - or
• 13:03
  - having any kind of risk associated with with
• 13:06
  - the treatments.
• 13:07
  - So I think the the future is really
• 13:09
  - bright.
• 13:10
  - It's been fun, you know, living these years
• 13:13
  - treating patients with prostate cancer and seeing the
• 13:16
  - developments.
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  - And and I'm very, very optimistic
• 13:20
  - that, you know, hopefully, in my lifetime, we're
• 13:22
  - gonna be able to get cure rates down
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  - to,
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  - you know,
• 13:26
  - almost a hundred percent for localized prostate cancer.
• 13:31
  - Amazing. Well, I'm excited to... For that future
• 13:34
  - as well. So I thank you for, you
• 13:36
  - know, taking the time to come on the
• 13:37
  - podcast and sharing your insights, with our audience.
• 13:41
  - Well, Breca, thanks for having me, and,
• 13:44
  - it's a pleasure to to talk about prostate
• 13:46
  - cancer care, and I'm optimistic that all our
• 13:49
  - patients are gonna really benefit in the future.
• 13:52
  - Perfect. And thank you to our listeners for
• 13:54
  - tuning in to Becker's Oncology Leadership Podcast.
• 13:57
  - I invite you all to check out even
• 13:58
  - more of Becker's health care podcasts at beckerspodcast.com.
• 14:03
  - Thank you again to doctor Albala for joining
• 14:05
  - me today and to our listeners. Have a
• 14:07
  - great day.