2-24-22 Dr. Franklin Gaylis, MD - Urologist
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Indiana University, Bloomington *
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F303
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Medicine
Date
Feb 20, 2024
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docx
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2-24-22 Interview Dr. Franklin Gaylis Background:
https://www.linkedin.com/in/franklin-gaylis-md-8a3b8738/
Medicat Director + Urologist at Genesis Healthcare Partners (San Diego)
Dr. Gaylis’ research focuses on the use of He has developed clinical tools aimed at improving outcomes following radical prostatectomy
as well as reducing cost. Dr. Gaylis has also developed a urinary tract dilator instrument to facilitate the efficient removal of kidney stones. It has improved the safety of the procedure as well as significantly reducing costs
. Does acknowledge performs focal therapies
.
Who we are: Hello Dr. Gaylis! We wanted to first thank you for the time for agreeing to meet & talk with us. We are a group of UC Berkeley students in Berkeley’s Bio and Business program working on a Capstone project exploring urology and we are researching new focal therapies for prostate cancer as part of the capstone project & we just had a few questions we wanted to ask you.
Okay then I’ll start:
Interview Questions:
1) Are there any unmet needs
in the prostate cancer space that can be solved with emerging technologies?
Transcript: There are always opportunities to improve treatments, mitigate harms, and provide cost effective care. Unmet needs → there is a lot of technology available and we do a lot of active surveillance for low risk disease and you need to understand the type of cancer to apply different therapeutics. Need to stratify by risk. (NCCN characterization) Very low and low risk should be combined and the preferred management technique is active surveillance/conservative management. Broad category is not biologically well defined because many men that are “low risk” for progression are not necessarily low risk as paper with gleason of 6 behaved more like high risk. Differentiating slow growing versus more aggressive is
important. Even in low risk category, about 30 percent plus will progress; those patients ought not to be actively surveilled, this is where focal therapies
like HiFu or cryotherapy could be helpful (avoid radical prostatectomy or radiation therapy). Intermediate risk group is broken down into favorable and
unfavorable, certain treatments applicable for certain groups. High risk falls into the same category as unfavorable intermediate. Nidhi follow up Q: Why is gleason score of 6 high risk?
A: It is high volume and high risk. Gleason score is just a grading rubric. There has to be genetic predisposition to more aggressive behavior with two different patients both with score of Gleason 6.
2) What are some latest innovations in focal therapies for prostate
cancer and/or BPH have you heard of/have experience with?
- Transcript: I am not clinically practicing right now, more so in education and research. When he was practicing, HiFu was very experimental. He heard about a new tech as transurethral something, can ablate with heat or cold technique and HiFu is probably heat therapy. Cryotherapy is cold and laser therapy is hot. So many different ways to do a temperature change for prostate cancer. Can not combine BPH and prostate cancer because of different pathologies, BPH more of a functional issue. PAE is still experimental, not yet in routine practice. Had a friend who got it done, put catheters in major vessels and embolize the prostate, not convinced that it has caught on that well even though it has been a while. Eurolift and Resume
are two most popular right now, he used to do TRP and heat ablation for prostate. He used to use an electrode that would burn/coagulate the prostate. Data is not as convincing as he would like for a lot of focal therapies for prostate cancer, so always used surveillance and then if conditions progressed then did something more radical. Not used to be a big fan of cryoablation because you couldn’t get rid of the entire prostate, and did radical prostatectomy more. Challenge is if cure is necessary, is cure feasible? (and vice versa) Now a third of men die with prostate cancer that they did not
know about → active surveillance is very important now. Maybe better biomarkers and genetics that can better predict → has a paper with doctor catalonia (northwestern, one of world’s top cancer researchers) and can predict which men will progress with prostate cancer without treatment, and then what is the best treatment
New tech → cyberknife (body radiation therapy), can be applied to focal therapy. He would use this out of all focal therapies, but he knows others have
different preferences and there are no studies showing which tech is superior.
Index lesion visible by MRI or other imaging (clinically relevant).
-
(IF they don’t mention cryo/PAE)
: Have you had any experiences
with cryoablation or PAE? IF FAMILIAR with/MENTION cryoablation/PAE:
Should we ask this…. How many did u do in past?
3) How many cryoablation procedures do you do per month for prostate cancer? How many procedures do you perform per month for PAE related to BPH?
4) Why did you decide to utilize cryoablation for your patients’ treatment? (What criteria) Was it specifically requested? Why was it the best fit?
5) How do you expect the # of procedures for PAE/cryoablation to grow in the short-term and long-term?
6) Are there any major challenges or limitations that you are concerned about with cryoablation/PAE?
7) Do you see potential in any other promising focal therapies for prostate cancer such as HiFu, photodynamic therapy, and laser ablation?
IF NOT FAMILIAR with/MENTION cryoablation/PAE:
3) What sources do you use to learn about emerging technologies (like the ones you mentioned previously)? 4) How do you decide your patient’s treatment pathway? What factors are considered when choosing the best treatment for your patient.
4) How would you describe your comfort level when it comes to changing your current standard of care if there are better technologies? 5) What factors would you consider when evaluating whether you would implement a new technology over traditional treatment plans? What information would you seek to ease your hesitations over implementing new therapies?
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Urologist/Interventional Radiologist Relationship:
8) Urologist: When do you perform your own treatment procedures & when do you pass off treatment procedures to IR docs or other specialists?
Two competing specialities that can treat the same condition in different ways but good relationship. Vascular ablation new to IR. Very uncommon that a urologist will send a patient with BPH to an interventional radiologist. Almost never to pass to interventional radiologists for anything related to prostate.
9) Urologist: How do you choose which IR doctor to hand off your procedures to? (Do you personally have a good relationship with an IR Doc?)
11) How do you see the role that [IR docs/urologists/IO] evolving in the near- and long-term future?
ENDING QUESTION:
12) Last question: What do you personally think is lacking for urologists/IR docs and patients as a whole in the treatment space for prostate
cancer?
Get more precise ablation of prostate without causing functional harm (erectile dysfunction, urinary issues, etc.) → this is why they don’t treat low risk.
OTHER WRAP-UP Questions
12) How do you ease patient fears or approach patient hesitation when introducing treatment options?
13) Are there any other urologists or IR doctors you know who I can reach out to for more insights? [Last]
IFFY: :(
-
What are the typical patient responses to cryoablation/PAE? Do you tend to be more accepting or hesitant of the treatment?
-
What are your opinions on aggressive treatment and precision treatment in your field? -
Is there any you would prefer to certain prostate cancer/BPH patients?
-
Map out physicians’ prescribing decisions & processes & determine what drivers play a role such as reimbursement, product or clinical treatment mix; combination therapies?
-
What improvements would you incorporate to your treatment strategies?
-
Are you hesitant to try new therapies that are emerging?
-
What information would you like to ease such concerns?
-
Impacts of COVID on procedure numbers
-
Possible pivots that PAE/cryoablation could go into for different disease
indications?
-