Becker’s Healthcare Podcast

Guest: Dr. Ardeshir Rastinehad, Vice Chair of Urology at Northwell’s Lenox Hill Hospital
Host: Scott Becker
Date: December 7, 2025

Episode Overview

This episode delves into advancements in prostate cancer care with Dr. Ardeshir Rastinehad, a dual-trained interventional radiologist and urologic oncologist. The discussion covers the latest trends in prostate cancer screening, the evolution and promise of focal therapy, minimally invasive treatments, and the importance of hybrid expertise in modern urologic care.

Key Discussion Points & Insights

Dr. Rastinehad’s Background & Focus

• Dual-trained as both an interventional radiologist and urologic oncologist.
• Vice Chair of Urology at Lenox Hill, Northwell; leads prostate cancer system efforts.
• Dedicated to research, device development, and biomedical engineering for prostate cancer care.
  [00:18] Dr. Rastinehad: "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."

Prostate Cancer Prevalence & Improved Screening

• Approximately 1 in 8 men will be diagnosed with prostate cancer in their lifetime.
  [00:54] Dr. Rastinehad: "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."
• Shift to improved screening using imaging (notably MRI), moving beyond PSA-only approaches and random biopsies.
  • MRI allows for targeted biopsies or even avoidance if unnecessary.
    [00:54] Dr. Rastinehad: "No longer, if you have an elevated PSA, should you have a biopsy. All the guidelines state...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..."

Prostate Cancer Types, Risk, and Mortality

• Discussion on Gleason grade groups, with Grade 1 considered non-lethal; mortality rates rise with higher grades.
  • Example: Grade Group 2 has a 3% ten-year mortality; risk roughly doubles with each grade.
• Personal connection: Dr. Rastinehad’s family members have had prostate cancer, fueling his dedication.
• Key pivot in 2009: Better screening and biopsies with imaging (fusion biopsy); launch of focal therapy concepts. [01:48] Dr. Rastinehad: "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?"
• Northwell was the first to validate fusion biopsy technology in 2012.

Focal Therapy: Targeted, Minimally Invasive Prostate Cancer Treatment

• Focal therapy targets only cancerous spots, sparing the rest of the prostate and reducing typical side effects.
• Oldest and most established focal therapy: cryotherapy (freezing tumors).
• Northwell, in partnership with Philips, developed a platform yielding a 94% success rate (1-year, no cancer in treated spot). [04:19] Dr. Rastinehad: "Focal therapy is the idea that we just treat the spot in your prostate using some type of imaging merge with a treatment modality...We had a 94% success rate at one year with no cancer seen in the treated spot."
• Innovation: Nanoparticle-directed therapy decreased procedure times by 50%.
• Recent publication (2025, British Journal of Urology International): Technology allowed non-expert urologists (with minimal proctoring) to achieve expert-level outcomes for both oncological and quality-of-life metrics (e.g., continence, erectile function). [05:07] Dr. Rastinehad: "...with proctoring three cases and using the technology, he could function at the level of an expert...not leaking urine, good erections after the treatment, well as oncologic, with the same rate of essentially negative biopsies at one year."

Adoption and Expansion of Focal Therapy

• Fusion biopsy has ~30% market penetration after a decade; focal therapy lags behind but is rapidly growing.
• Every major US academic institution now offers some focal therapy program.
• Focal Therapy Society: Founded in 2019, now ~500 global members.
• About half of patients who would otherwise undergo surgery or radiation may be focal therapy candidates.
• Significant benefits: Outpatient procedures, same-day recovery, drastically reduced risks of erectile dysfunction or incontinence compared to standard treatments. [06:27] Dr. Rastinehad: "...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...these are treatments are all outpatient, same day procedures and you don't suffer the same risks..."

Broader Trends in Urology-Oncology: Minimally Invasive Interventions

• Dr. Rastinehad’s hybrid expertise allows for cutting-edge, less invasive treatments for various urologic conditions:
  • Varicocele embolization: Pin-hole procedure for varicose veins in the testicles.
  • Prostate artery embolization: Minimally invasive procedure for enlarged prostate, performed through a small puncture as with cardiac interventions. [08:12] Dr. Rastinehad: "The trends today are all minimally invasive treatments for all sorts of urologic diseases...The trend is image guided, minimally invasive, outpatient same day treatments for many urologic diseases..."
• Importance of hybrid-trained physicians (e.g., in both interventional radiology and urology) to fully harness new technologies and tailor care.

Personal Journey & Commitment to Northwell

• Dr. Rastinehad started at Northwell as a volunteer “candy striper” in 2001.
• Completed residency, fellowship, and now leads advanced programs at Northwell. [09:47] Dr. Rastinehad: "I was a volunteer in the urology department with the candy. Medical volunteers wear candy striped vests...It's been an awesome adventure here with the Northwell team."

Notable Quotes & Memorable Moments

• [00:54] Dr. Rastinehad: "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."
• [04:19] Dr. Rastinehad: "Focal therapy is the idea that we just treat the spot in your prostate using some type of imaging merge with a treatment modality."
• [05:07] Dr. Rastinehad: "...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."
• [08:12] Dr. Rastinehad: "The trend is image guided, minimally invasive, outpatient same day treatments for many urologic diseases..."
• [09:47] Dr. Rastinehad: "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..."

Timestamps for Key Segments

• 00:18 – Dr. Rastinehad: Background, expertise, and role at Northwell
• 00:54 – Prostate cancer prevalence, improved screening techniques
• 01:48 – Gleason grades and mortality; family connection
• 03:47 – History and early development of fusion biopsy and focal therapy
• 04:19 – Deep dive into focal therapy innovations and outcomes
• 06:27 – Growth, adoption, and broader impact of focal therapy
• 08:12 – Broader trends: Minimally invasive & hybrid treatments in urology
• 09:47 – Dr. Rastinehad’s journey from volunteer to leader at Northwell

Conclusion

This episode highlights how emerging imaging and targeted treatment technologies—especially focal therapy—are transforming prostate cancer care. Dr. Rastinehad’s dual expertise and passion for innovation are helping to drive minimally invasive, patient-friendly treatments, pushing urology toward a future with better outcomes and fewer side effects.

Host Scott Becker closes the conversation by expressing gratitude for Dr. Rastinehad’s work and leadership in advancing patient care.