The Dr. Geo Prostate Podcast Is HIFU Right for Your Prostate Cancer? with Dr. Matthew Cooperberg
HIFU (high-intensity focused ultrasound) is one of the most talked-about focal therapies in prostate cancer—but who is it really right for? In this conversation, Dr. Matthew Cooperberg (UCSF)—a leading voice in urology, epidemiology, and integrative prostate cancer care—breaks down patient selection vs. energy modality, how modern imaging (MRI, fusion, RSI) drives precision, what genomics (e.g., Decipher) can and can’t tell us, and how salvage options compare after focal therapy vs. radiation. We also tackle lifestyle factors, trial design, and why midlife PSA screening (ideally <1 between ages 45–55) remains crucial.
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00:00 – Welcome + episode setup (HIFU overview, aims of focal therapy)
04:10 – The real first question: Who is a candidate? (selection > modality)
05:10 – What “focal therapy” means (lesion-only, margin, hemi-ablation) + imaging progress
06:25 – Recurrence after focal therapy: targeting, dose, or biology? Follow-up biopsies
07:40 – Genomics (Decipher): predicting recurrence; how results change counseling
09:30 – Lifestyle & microenvironment: can diet/exercise influence outcomes?
11:00 – Salvage after focal vs. radiation: fibrosis, feasibility, quality of life
14:00 – Cryotherapy vs. HIFU: image guidance, control, and why HIFU advanced
16:00 – Imaging upgrades (MRI fusion, RSI, C-13 spectroscopy) and treatment constraints
17:00 – IRE (irreversible electroporation): role for apical tumors, early results
18:00 – TULSA, water/thermal concepts, focal radiation, partial prostatectomy: what’s known
20:00 – Smarter trials: active surveillance ± focal therapy for borderline cases
22:00 – The counseling hierarchy: decision first, technology second
24:30 – Proton vs. photon incentives; why advertising confuses choices
26:30 – UCSF’s program: mostly HIFU; where IRE fits; adding new machines prudently
28:30 – The real bottleneck: sub-millimeter targeting; AI-guided ablation future
33:00 – HIFU mechanics: probe size, apex/anterior reach, distance constraints
35:00 – “I want HIFU for Gleason 8”: agency, nuance, and when we advise against it
38:00 – A cautionary case: negative biopsy → later mets—what it teaches us
40:30 – Millennials, risk tolerance, and why PSA at 45–55 (<1 is ideal) matters
44:00 – Growth vs. spread: which high-grade tumors can we treat focally?
46:00 – How low vs. high genomic scores tilt decisions (and their limits)
47:30 – Where to find Dr. Cooperberg + parting PSA advice
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⚠️ Disclaimer
This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.