Latest / Becker’s Healthcare Podcast / Dr. Ardeshir Rastinehad, Vice Chair of Urology at Northwell’s Lenox Hill Hospital and System Director for Prostate Cancer at Northwell Health

Transcript

Dr. Ardeshir Rastinehad, Vice Chair of Urology at Northwell’s Lenox Hill Hospital and System Director for Prostate Cancer at Northwell Health · Becker’s Healthcare Podcast

• 0:00
  This is Scott Becker with the Beckers HealthCare
• 0:03
  podcast.
• 0:05
  We're thrilled today to be joined by doctor
• 0:07
  Art Rasnad
• 0:09
  from Northwell.
• 0:10
  Doctor Rasnad, could you take a moment and
• 0:12
  introduce yourself
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  and and tell us a little bit about
• 0:16
  what you do?
• 0:18
  I'm doctor r Rastinha. I'm really excited to
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  be here today. I'm the vice chair of
• 0:22
  urology here at Northwell at Lenox Hill.
• 0:25
  I'm also a dual trained interventional radiologist and
• 0:28
  a urologic oncologist, so you get two things
• 0:30
  in one package.
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  I specialize in research and development and biomedical
• 0:35
  engineering new,
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  devices for prostate cancer care.
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  And what
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  are some of the trends you're watching in
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  prostate care? And what percentage of men at
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  some point
• 0:49
  have a prostate cancer
• 0:51
  issue,
• 0:52
  of some sort?
• 0:54
  The data
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  what we're seeing is one in eight guys,
• 0:57
  one in seven men could have a be
• 1:00
  diagnosed with prostate cancer within their lifetime.
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  The best part about the trend we see
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  today that we're screening better than we've ever
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  been before with the implementation of imaging. So
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  no longer if you have an elevated PSA
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  should you have a biopsy.
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  All the guidelines state that you should have
• 1:15
  some type of tool to risk stratify you.
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  I prefer
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  an MRI which can look inside and see
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  a 100% of your prostate and help us
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  decide where to biopsy or even if a
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  biopsy is needed.
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  Thank you. And so so better and better
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  screening.
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  And then the the survival rate for prostate
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  cancer is really high unless you catch it
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  late
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  or the
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  in in a later phase. Tell us a
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  little bit about what that looks like, and
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  then I'd love to talk to you about
• 1:44
  some of your work and where you're most
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  focused.
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  Awesome.
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  The the prostate cancer does have a low
• 1:50
  morbid mortality rate, which means not a lot
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  of people die from it. There's a type
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  of prostate cancer called Gleason gray group one
• 1:57
  no one's ever died from. The problem is
• 2:00
  is how do we identify those bad players
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  that are there? And the mortality rates for
• 2:04
  prostate cancer
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  as the gray goes up increases, of course.
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  So for example, gray group two, which is
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  one step above the one I told you
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  that no one dies from, is about three
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  percent at ten years.
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  And it doubles every gray group essentially as
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  it works it way up the gray group
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  five.
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  That's the easy way to look at it,
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  with respect to the aggressivity of prostate cancer.
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  My dad tells everyone that he had prostate
• 2:31
  cancer. My grandfather had prostate cancer. I have
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  other family members that have had prostate cancer.
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  So this is a personal thing for me.
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  As with respect to the trends and what
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  we're seeing, I think everything really changed in
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  2009
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  when urologists essentially were doing a really poor
• 2:47
  job screening.
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  And they came out, don't screen.
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  At the same time, we knew there was
• 2:52
  a problem when I was working down at
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  the NIH. And we said, Hey, we think
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  we can see inside the prostate to look
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  at more aggressive areas and improve our biopsy.
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  And that was the beginning
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  of the new age of prostate cancer screening,
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  diagnosis,
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  risk stratification, and the best part, new treatments.
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  So in 2009,
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  I'm
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  working in a lab with Peter Pinto and
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  Brad Wood, and we talked about doing focal
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  therapy, where we treat a spot of the
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  prostate
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  using fusion biopsy technology.
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  This was
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  conceptual
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  benchtop cadaver work.
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  And the first time we tried it, we
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  thought this was the coolest thing in the
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  world. We're like, no longer do we have
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  to guess. We can see where the cancer
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  is, and we can treat it. We still
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  do not have a commercial device on the
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  market that help people do the procedure, to
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  do the diagnosis, which we call fusion biopsy.
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  And that was developed and launched, and Northwell
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  was the first site to validate this new
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  technology in 2012.
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  But patients come in, they're like, doc, so
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  you can see it now. You can decide
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  if I want a biopsy. You can biopsy
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  the spot.
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  Why do you have to take out my
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  whole prostate if it's only in one area
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  or two areas? And we're like,
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  I understand that, but the the data was
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  still so new, but the concept was called
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  focal therapy. And that's what I'm excited to
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  talk about today with some of the new
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  devices and the things that we have.
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  Why don't you tell us about that therapy,
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  that newer therapy that you're that you're talking
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  about?
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  Right. Focal therapy is the idea that we
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  just treat the spot in your prostate using
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  some type of imaging,
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  merge with a treatment modality. The oldest one
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  and the most consistent one we have is
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  cryotherapy where we freeze the tumor.
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  The interesting part about this, we just had
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  a paper on this in 2025
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  talking about the use of these platforms of
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  a platform that we developed at Northwell in
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  collaboration with Philips that we can just treat
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  the spot under guidance. And we had a
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  ninety four percent success rate at one year
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  with no cancer seen in the treated spot.
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  But it's been a long, exciting journey to
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  get here. We originally developed a technology
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  in a nano for nanoparticle directed therapy and
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  that decreased our treatment times by fifty percent.
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  So the procedure was really long back then.
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  And we dropped that by fifty percent, which
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  was exciting. And then today we tested and
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  published on this paper in the British Journal
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  of Urology
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  International
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  showing that we can improve
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  our targeting and outcomes in focal therapy
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  above what most people are publishing on. Number
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  two, we tested the difference between a person
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  that was an expert, which is me if
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  I am an expert. But I had a
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  significant decade long experience in imaging and treatment.
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  And I had a partner that had no
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  focal therapy experience but was doing a lot
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  of biopsies, Doctor. Mike Schwartz. And we decided
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  to look at what the impact of this
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  technology was. And we showed with
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  proctoring three cases
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  and using the technology, he could function at
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  the level of an expert with the similar
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  outcomes with respect to quality of life metrics
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  like not leaking urine, good erections after the
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  treatment, well as oncologic
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  with the same rate of essentially negative biopsies
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  at one year. So it was really exciting
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  that now we're bringing focal therapy technology to
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  an everyday urologist that can now use this
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  technology to improve the care and the life
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  of their patients.
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  That's
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  amazing. And where do you see that that
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  that take off of this therapy?
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  How
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  many urologist what's the what's the percentage of
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  urologist are starting to get trained in this
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  that understand it? How quickly is it is
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  it accelerating?
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  To to give you a similar perspective, fusion
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  biopsy came out a decade ago and only
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  existed about 30 of the market today, which
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  is the idea of the biopsy
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  with the MRI.
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  Focal therapy is even a smaller group of
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  that. And,
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  in The United States, every major academic institution
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  has a focal therapy program now, and that
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  growth has been really steep over the last
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  three years. I don't know the exact
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  amount of the penetration in the market, but
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  in the world
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  there, we founded
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  a society called the Focal Therapy Society, which
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  started having meetings in 2008
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  and that has grown to a full society.
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  We founded in 2019
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  dedicated to training other urologists
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  and we have about 500 members worldwide.
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  So it's still a small group, but it's
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  growing. And some of the data we found
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  that half of the patients that undergo surgery
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  or radiation
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  could be focal candidates. So you don't have
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  to have your entire prostate treated If it's
• 7:25
  just in a few areas and we treat
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  this as a cancer control. We treat one
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  spot, we monitor you. If something else pops
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  up, we treat the spot. But the nice
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  thing is these are treatments are all outpatient,
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  same day procedures, and you don't suffer the
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  same risks of typical treatments, which is a
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  dysfunction
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  and leaking urine after the procedure. So that
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  doesn't really happen in focal at the same
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  rates
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  as it does in whole gland treatment.
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  So here's my question. You're sort of
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  brilliant
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  urology
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  in oncology.
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  What are the sort of big issues that
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  you're watching
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  in this overlap of urology, oncology
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  in addition to focal therapy and prostate cancer?
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  What what's what's interesting out to the people
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  who are focused on?
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  My background is, like, dual dual training, dual
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  fellowship training, interventional radiology, and urologic
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  oncology. The trends today are all minimally invasive
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  treatments for all sorts of urologic diseases.
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  I do other things. One of the things
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  that I do a lot of is called
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  the varicocele embolization. So guys that have those
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  veins that are a little swollen on their
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  testicles and have pain and sometimes have infertility,
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  we're able to treat that through a pinhole.
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  I do a
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  We're
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  able to treat that through a pinhole. I
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  do a little I. V. I'm able to
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  get inside the vein and I plug the
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  vein that's not working so they don't even
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  have to have surgery. The same thing is
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  happening for men with big prostates.
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  We can do a surgery called a prostate
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  aryembolization
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  all through a hole in the wrist or
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  a hole in the groin. Like the cardiologist
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  goes to the heart. I go to the
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  prostate and I'm able to treat that and
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  shrink it.
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  So the trend is image guided,
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  minimally invasive, outpatient, same day treatments for
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  many urologic diseases that we previously treated with
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  some type of surgical approach. So the trend
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  is having hybrid trained physicians
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  that can understand the biology of the disease
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  and provide these high cutting edge, high end
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  treatments that are cutting edge
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  in the medical space today. And that's what
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  we're doing at Northwell Health. We have these
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  programs. We're really excited to bring this to
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  our patients. I train other physicians here to
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  increase the footprint to help increase patient access.
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  So it's something I'm proud of to contribute
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  to, and I'm proud that Northwell has supported
• 9:35
  me in my career. I I actually was
• 9:37
  a candy striper here, if you know what
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  that is. Do you know what a candy
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  striper is, Scott?
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  Yeah. I am old enough to know what
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  a candy striper is. Yes. So I was
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  a volunteer in the urology department with the
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  candy but medical volunteers wear candy striped vests.
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  So I started as a volunteer in 2001
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  here at Northwell. I did my residency here.
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  I did one of my fellowships
• 9:59
  here and I've been an attending here for
• 10:02
  God knows how long. So it's been an
• 10:03
  awesome adventure here with the Northwell team.
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  Literally, what a remarkable career and remarkable advances.
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  You're you're really the best that we have
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  this kind of mix of research and science
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  and great clinical medicine
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  and leadership. I I I wanna thank you
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  so much for joining us today on the
• 10:22
  Becker Self Care podcast.
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  Just a total pleasure to visit with you.
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  Thank you very, very much. Thank you, Scott.
• 10:29
  It's great to talk to your audience.
• 10:31
  If you ever need me on again, I'm
• 10:32
  always available. It's been a real pleasure, and
• 10:35
  I hope we can help change some people's
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  lives together.
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  It it it's a critical, critical issue in
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  so many men. I thought it was more
• 10:42
  than one out of eight suffer from prostate
• 10:44
  cancer, but but really,
• 10:47
  huge percentage of people that that struggle and
• 10:49
  need to figure out solutions and screening
• 10:51
  and treatments. So thank you so much for
• 10:53
  joining us. My pleasure. You have a wonderful
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  day.