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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
00:11:05
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- [00:00]
A
This is Scott Becker with the Becker Healthcare Podcast. We're thrilled today to be joined by Dr. Art Rasnahad from Northwell. Dr. Rasnahad, could you take a moment and introduce yourself and tell us a little bit about what you do?
- [00:18]
B
I'm Dr. Art Rastenhat. I'm really excited to be here today. I'm the vice chair of urology here at Northwell at Lenox Hill. I'm also a dual trained interventional radiologist and a urologic oncologist. So you get two things in one package. I specialize in research and development and biomedical engineering new devices for prostate cancer care.
- [00:40]
A
And what are some of the trends you're watching in prostate care? And what percentage of men at some point have a prostate cancer issue of some sort?
- [00:55]
B
The data, what we're seeing is 1 in 8 guys, 1 in 7 men could have be diagnosed with prostate cancer within their lifetime. The best part about the trend we see today, that we're screening better than we've ever been before with the implementation of imaging. So no longer. If you have an elevated psa, should you have a biopsy. All the guidelines state that you should have some type of tool to risk stratify you. I prefer an MRI, which can look inside and see 100% of your prostate and help us decide where to biopsy or even if a biopsy is needed.
- [01:27]
A
Thank you. And so better and better screening, and then the survival rate for prostate cancer is really high, unless you catch it late or the in in a later phase. Tell us a little bit about what that looks like, and then I'd love to talk to you about some of your work and where you're most focused. Awesome.
- [01:48]
B
The prostate cancer does have a low mortality rate, which means not a lot of people die from it. There's a type of prostate cancer called Gleason grade group one. No one's ever died from. The problem is, how do we identify those bad players that are there? And the mortality rates for prostate cancer as the grade goes up, increases, of course. So, for example, grade group 2, which is one step above the one I told you that no one dies from, is about 3% at 10 years. And it doubles every gray group, essentially, as it works its way up the gray group 5. That's the easy way to look at it with respect to the aggressivity of prostate cancer. My dad tells everyone that he had prostate cancer. My grandfather had prostate cancer. I have other family members that have had prostate cancer. So this is a personal thing for me. With respect to the trends and what we're seeing, I think everything really changed in 2009, when urologists essentially were doing a really poor job screening, and they came out, don't screen at the same time. We knew there was a problem when I was working down at the nih and we said, hey, we think we can see inside the prostate to look at more aggressive areas and improve our biopsy. And that was the beginning of the new age of prostate cancer screening, diagnosis, risk, stratification, and the best part, new treatments. So in 2009, I'm working in a lab with Peter Pinto and Brad Wood, and we talked about doing focal therapy, where we treat a spot of the prostate using fusion biopsy technology. This was conceptual benchtop cadaver work. And the first time we tried it, we thought this was the coolest thing in the world. Like, no longer do we have to guess. We can see where the cancer is and we can treat it. We still did not have a commercial device on the market that help people do the procedure that do the diagnosis, which we call fusion biopsy. And that was developed and launched in Northwell, was the first site to validate this new technology in 2012. But patients come in, they're like, doc, so you can see it now. You can decide if I want a biopsy. You can biopsy the spot. Why do you have to take out my whole prostate if it's only in one area or two areas? And we're like, I understand that. But the data was still so new. But the concept was called focal therapy, and that's what I'm excited to talk about today with some of the new devices and the things that we have.
- [04:14]
A
Why don't you tell us about that therapy, that newer therapy that you're. That you're talking about?
- [04:19]
B
Right. Focal therapy is the idea that we just treat the spot in your prostate using some type of imaging merge with a treatment modality. The oldest one, the most consistent one we have, is cryotherapy, where we freeze the tumor. The interesting part about that is we just had a paper on this in 2025, talking about the use of these platforms of a platform that we developed at Northwell in collaboration with Philips, that we can just treat the spot under guidance. And we had a 94% success rate at one year with no cancer seen in the treated spot. But it's been a long, exciting journey to get here. We originally developed the technology in a nano for nanoparticle directed therapy, and that decreased our treatment times by 50%. So the procedure was really long back then. And we dropped that by 50% which was exciting. And then today we tested and published on this paper in the British Journal of Urology, it's international, showing that we can improve our targeting and outcomes in focal therapy above what most people are publishing. On number two, we tested the difference between a person that was an expert, which is me, if I am an expert, but I had a significant decade long experience in imaging and treatment. And I had a partner that had no focal therapy experience but was doing a lot of biopsies, Dr. Mike Schwartz. And we decided to look at what the impact of this technology was and, and we showed with proctoring three cases and using the technology, he could function at the level of an expert with the similar outcomes with respect to quality of life metrics like not leaking urine, good erections after the treatment, well as oncologic, with the same rate of essentially negative biopsies at one year. So it was really exciting that now we're bringing focal therapy technology to an everyday urologist that can now use this technology to improve the career care and a life for their patients.
- [06:13]
A
That's amazing. And where do you see that the takeoff of this therapy, how many urologists, what's the percentage of urologists are starting to get trained in this, that understand it, how quickly is it accelerating?
- [06:28]
B
To give you a similar perspective, fusion biopsy came out a decade ago and only exists in about 30% of the market today. Today, which is the idea of the biopsy with the mri, focal therapy is even a smaller group of that. And in the United States, every major academic institution has a focal therapy program now. And that growth has been really steep over the last three years. I don't know the exact amount of the penetration in the market, but in the world there we founded a society called the Focal Therapy Society, which started having meetings in 2008. And that has grown to a full society we founded in 2019 dedicated to training other urologists. And we have about 500 members worldwide. So it's still a small group, but it's growing. And some of the data we found that half of the patients that undergo surgery or radiation could be focal candidates. So you don't have to have your entire prostate treated if it's just in a few areas. And we treat this as a cancer control, we treat one spot, we monitor you. If something else pops up, we treat the spot. But the nice thing is these are treatments are all outpatient, same day procedures and you don't suffer the same risks of typical treatments, which is erectile dysfunction and leaking urine after the procedure. So that doesn't really happen in focal at the same rates as it does in whole gland treatment.
- [07:49]
A
So here's my question. You're sort of.
- [07:53]
Brilliant. Urology, oncology, what are the sort of big issues that you're watching in this overlap of urology oncology.
- [08:06]
In addition to focal therapy and prostate cancer? What, what's, what's interesting out there that people are focused on?
- [08:13]
B
My background is like dual, dual training, dual fellowship training, interventional radiology and urologic oncology. The trends today are all minimally invasive treatments for all sorts of urologic diseases. I do other things. One of the things that I do a lot of is called a varicocele embolization. So guys that have that, those veins that are a little swoll swollen on their testicles and have pain and sometimes have infertility, we're able to treat that through a pinhole. I do a little iv, I'm able to get inside the vein and I plug the vein. That's not working. So they don't even have to have surgery. The same thing is happening for men with big prostates. We can do a surgery called a prostate artery embolization all through a hole in the wrist or a hole in the groin. Like the cardiologist goes to the heart, I go to the prostate and I'm able to treat that and shrink it. So the trend is image guided, minimally invasive, outpatient same day treatments for many urologic diseases that we previously treated with some type of surgical approach. So the trend is having hybrid trained physicians that can understand the biology of the disease and provide these high cutting edge, high end treatments that are cutting edge on the, in the medical space today. And that's what we do, we're doing at Northwell Health. We have these programs, are really excited to bring this to our patients. I train other physicians here to increase the footprint, to help increase patient access. So it's something I'm proud of, to contribute to and I'm proud that Northwell has supported me in my career. I actually was a candy striper here, if you know what that is. Do you know what a candy striper is?
- [09:41]
A
Scott?
- [09:43]
I am old enough to know what a candy striper is. Yes.
- [09:47]
B
So I was a volunteer in the urology department with the candy. Medical volunteers wear candy striped vests. So I started as a volunteer in 2001 here at Northwell. I did my residency here, I did one of my fellowships here and I've been in attending here for God knows how long. So it's been an awesome adventure here with the Northwell team.
- [10:08]
A
Literally what a remarkable career and remarkable advances. You're really the best that we have. This kind of mix of research and science and great clinical medicine and leadership. I want to thank you so much for joining us today on the Becker Self Care podcast. Just a total pleasure to visit with you. Thank you very, very much.
- [10:28]
B
Thank you, Scott. It's great to talk to your audience. If you ever need me on again, I'm always available. It's been a real pleasure and I hope we can help change some people's lives together.
- [10:39]
A
It's a critical, critical issue in so many men. I thought it was more than 1 out of 8 suffer from prostate cancer, but really a huge percentage of people that struggle and need to figure out solutions and screening and treatments. So thank you so much for joining us.
- [10:54]
B
My pleasure. You have a wonderful day.