Here's a paper from 2005. I quoted it at the PCRI meeting in L.A. one time when you were
up there. I said that — here's the quote that was in this paper... I think it was in a series
et al, Margolis was one of the authors in 2015, it said—and we touched upon this, I just want you to
make one more comment—"some potentially important cancers, 15 to 30 percent, are MRI invisible,"
and I thought, that 30 that's close to one-third. Can you explain to the audience now,
are you bringing that number down? So part of the Achilles heel we've mentioned is that sometimes
MRI misses significant tumors, but it seems like that number is dropping, am I right or wrong?
So, as good as MRI is, there will always be some tumors that just don't show up on MRI.
Even if they're a significant size that we would expect to see them because they don't
have the typical features of a cancer cell. They don't induce a basal reaction; they have more
cytoplasm, more fluid content than other kinds of cancer cells; they may not induce blood flow
the same way other cancer cells do. So, there will always be outlier cancers that we just can't see,
and this is true of any medical imaging technique, but we're bringing that number down to around
five percent of cancers that are big enough for us to target, and a lot of the data are based on
studies of men that have gone for surgery—so we cut out the entire prostate—and we look to see of
all the tumors in the prostate can we find all of them, and you might think, "well what do you mean
tumors?" You're not going to leave a tumor in the prostate and wait for another one to grow;
you're going to take it out as soon as you find a prostate cancer, but prostate cancer is very
often multifocal meaning that there's more than one that we find when we cut the prostate out,
and sometimes there'll be one big one and that's the one that we found and then there'll be a few
small ones, and sometimes there'll be a big indolent cancer—so grade group one,
or the kind that undergoes active surveillance—and sometimes there'll be another small one that's
very aggressive, and sometimes we will think it's all one big tumor when the pathologist will say,
"No these are different tumors," and we'll think, "Well but they're next to each other," and the
pathologists say, "No, you called one; we see two; you missed one." Like, but it's this— whatever.
Other times, we will describe the main tumor and then there'll be something else in the prostate,
and we will think, "Well this isn't going to affect the surgery; it's not near the edge
of the prostate; I don't want to make the report overly lengthy and bore the surgeon,
so we're going to describe the important thing and you know these other things aren't going to drive
the management," and then the pathologists say, "Well, you missed this three-millimeter cancer
that's in the middle of the prostate." I say, "Yes, yes we did," but there are cases where there
is an obvious tumor and the pathologist will say, "Here is the tumor Dan, what does it look like on
the MR?" and I can't see it, and we've gotten that down to where it's about five percent of cases,
and that may be where we stay until we improve the technology a little bit more.
I mean — that's why I said it, "that people quote these older statistics," but it's moving
in a direction of progress.
Yes.