So, I had a urologist call me before I did this interview and he said—and I don't care
if this is a conflict or not, you can defer it. I don't think that you should. He said,
"Well, you know, has Klotz told you about the TULSA data and TULSA?" I said, well, you
know, I dabble in a lot of things. I spent a lot of time in prostate; I really haven't
looked at TULSA, and I took a look at it. There's a video—you give a talk on it—from
last year on YouTube and can you explain to the audience why you talk about TULSA? What
TULSA means on a grander scale or just any commentary because I—
Sure.
very few people know what TULSA means except a city in Oklahoma.
It's interesting that the—I think a lot of the company is actually based in Tulsa
although that's not why they called it that. So, this is another way to deliver energy
to the prostate to destroy the tissue and it was just approved recently by the FDA for
tissue ablation. So, it's not actually approved for prostate cancer, but actually, the FDA
hasn't approved any new device for treatment of prostate cancer in something like 40 years
including the robot. It's too hard to demonstrate effectiveness against cancer with that disease,
so it's the same concept as HIFU (high-intensity focused ultrasound) but it's done in the MR
core and the MR nowadays gives the capability for what is called real-time thermal mapping.
So, you get a map of temperature in the prostate. Now, under normal circumstances that is useless
because everyone's temperature is, you know, 98.5, 37 degrees centigrade throughout your
body, but if you are using an energy-based technique to heat tissue then it becomes very
powerful because it tells you exactly what the temperature is in every little region
in every pixel. So, and it's a closed-loop system and this came out of my institution.
I've been involved with this technology for something like 12 years. We did about 40 dogs
along the way; we did the first in human, and now we've just completed and just accepted
for publication the pivotal trial that led to registration—about 115 patients. So,
it works. It's a transurethral transducer. It basically generates microwave energy that's
controlled by the temperature mapping, so you see the tissue heats up on the MRI.
Can you explain transurethral first and why this is interesting?
It goes in the—It's like a urethral sound. It's about seven millimeters in diameter,
so the urethra accommodates this quite easily. It's done under anesthesia. So, it's just
like putting a cystoscope if some of the people in the audience know what that is. Same idea,
but it's got these 10 ultrasound transducers that are 5mm long each, each one individually
controlled. So, it's an amazing technology, and the system, the temperature map, controls
how much energy is delivered. So, that's the advantage; it's very automated. The disadvantage
is, it's quite complex and, so, so far it still takes quite a while to do it although
the actual heating time is quite short. So, it's something new. It's now being kind of
promoted around the world. I think it still needs to be validated, but the preliminary
results look really promising.
So, when can a person get it if it's working? I mean, when does it become an option here?
So, this is not for grade group 1 in my opinion. This is for mainly grade groups 2 and 3. So,
particularly partial-gland ablation, the sweet spot is the guy who has got a solitary lesion
on MRI that's a grade group 2 or 3, and the rest of the prostate doesn't have anything
or it has a little bit of grade group 1 which you don't worry about and so you just zap
like half of the prostate. So, for that, it is gorgeous and the appeal of that is really
minimal or no long term side effects.
And when and where can I get it?
So, there's a few guys in the states who are now doing it. We are planning to start doing
it probably sometime in the next few months. So, it is now available and I think probably
if you go online and search for it—TULSA—you'll find the guys who are doing it.
T-U-L-S-A, right?
T-U-L-S-A, yeah.
Yeah, the only advertisements I've seen for TULSA are like, "Come to Tulsa, Oklahoma"
or something. I haven't seen anything ads, but I think that at a later time—I don't
know—you can give me a timeline, this is interesting. So, I looked it up, I think we
should do an interview for thirty minutes that primarily revolves around the pros and
cons of it and how it compares to other—you call this a focal therapy, right?
Well, it can be used for either. Like the trial we just completed and published was
whole-gland.
But why, I guess what I'm missing is we have all these therapies, these focal ablative
therapies, that think they're the greatest thing since sliced bread or sliced bagels,
you know, all that stuff...
It is for the right patient.
...Or sliced tomatoes if you're into lycopene. Why the pursuit here? What was missing out
there that made you want to pursue this angle?
Precision.
It's all about precision. So, with HIFU, for example, which I also do. I've been doing
it for more than a decade. It's a good technology, but you don't actually know what the tissue
effects are. Like, you map out an area where the cancer is and you treat that, but you
really have no way of knowing did the tissue all get treated to the kind of lethal level
and so on. With this, you can see it, so you know if you've got a cold spot, you can see
it. You know, there's no guesswork involved. So, I think, you know, the technology that's
going to win is the one that offers the greatest precision. It's also gotta be, you know, practical.
It can't be too expensive. It can't be too time-consuming, and, you know, it's going
to take us 20 years to find out which one is the best.
You used the word—my last question on it—I was always looking for catches, you know,
I'm like "where's the catch, what's going on here? This looks interesting; urologists
are fascinated" And then I listen to your lecture and this is why you can tell I have
no life, I listen to the entire lecture. You know how we normally just scan things? I listened
to the entire Klotz lecture on TULSA.
I'm sorry for you.
I know, it was good. This is good. I mean, we are all bidirectional learning. You kept
coming back to the word calcifications. Can you tell me what having a calcification in
your prostate even means? Because people think about it when it comes to the arteries, not
the prostate, and why did you keep bringing that up?
Well, so you get calcifications, basically small stones, so the prostate has ducts, it's
full of ducts, and you can form stones in these ducts and they can grow, and the problem
is the calcification displaces and reflects the ultrasound energy. So, the tissue beyond
the calcification is not going to receive any ultrasound energy and therefore won't
get heated. So, in the study, we found that actually, the presence of calcification larger
than 1cm was one of the strongest parameters predicting for failure of the treatment, persistence
of cancer. So, but most patients have small calcifications which don't seem to matter
that much. It's the larger ones that are the problem, so that's going to cut out maybe
5 or 10% of patients from having this.
That's really interesting. So, okay, you saw I wore my Toronto shirt, you promised me another
interview on TULSA and something else.
I'm happy to do that.
When do you want to do that TULSA interview? The next few months?
Anytime.
Anytime?!
You just made a mistake