From PSA to Personalized Prostate Care

Transcript Generated by AI

Announcer: 0:00

Welcome to MedEvidence! where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Michael Koren: 0:11

Hello, I'm Dr Michael Koren, the executive editor of MedEvidence!, and I have a really neat guest today, Dr. Ali Kasraeian. Ali and I have known each other for a long time, working as physicians in the community here in Northeast Florida, and we've actually done some media stuff together. But this is a fascinating guy and I want to really introduce him to our MedEvidence! audience and talk about his inspiration to get him involved in clinical medicine, in media, in public health discussions, in scientific research and helping organized medicine stay organized. So, Ali, welcome to MedEvidenc! e and thank you for being here.

Dr. Ali Kasraeian: 0:50

Thank you for having me. It's an honor to be here and congratulations Such a wonderful, wonderful things that you always do and make us all be better at everything that we do.

Dr. Ali Kasraeian: 0:59

So thank you

Dr. Michael Koren: 0:59

Well again, thank you for being here. So tell the audience a little bit about your path. Where'd you grow up, where'd you go to school and then how you got interested in Urology and all these public health issues that you address.

Dr. Ali Kasraeian: 1:10

So I grew up here in Jacksonville, Florida. My parents are actually both originally from Iran and they came here and both trained my mom's a world-renowned breast pathologist, and my dad's a urologist, who I have the real amazing pleasure of working with and operating with. So that's been the greatest.

Dr. Michael Koren: 1:24

It's pretty good genes there.

Dr. Ali Kasraeian: 1:25

Yeah, I mean it's been an amazing highlight of my life and, interestingly, our parents never pushed us to go into medicine.

Dr. Ali Kasraeian: 1:32

But you watch how, what they did, you know, especially when the times of health care were not plagued with all the things that we deal with now, that we talk about in terms of health policy and those things, but you watched how they impacted people's lives, especially in that when I was younger you had no idea what they did, but you saw the appreciation that they had, and my brother and I only knew that my dad took kidney stones out of people and took kidneys out and did things of that nature.

Dr. Ali Kasraeian: 2:03

So there's all these things that my parents joke around. There are pictures of my brother and I drawing kidneys or walking around, cutting our dolls open and throwing things into them and taking them out, and then, as we got older, we kind of always had that in your back of mind as something profound to do, and anytime we had some kind of moment and opportunity to be a part of healthcare, it stuck. And so you know both my brother and I my brother's an orthopedic surgeon we both went in there and you know I went to become a pediatric surgeon.

Dr. Ali Kasraeian: 2:34

I didn't get the rotation, I got urology and you found that it was impactful and I went to Paris, did a robotic surgery, laparoscopic fellowship, and that's where a lot of things we'll talk about today inspired me in terms of a better way of looking at managing prostate cancer.

Dr. Michael Koren: 2:50

So very strong family ties to medicine, which was clearly an inspiration for you.

Dr. Ali Kasraeian: 2:55

Yeah, I mean it's the impact that you have on people's life at the time that they need it most, and that's one thing that I still remember. My parents always said if you can find something else to do that can make you happy, do that. If you can't, then medicine is a wonderful track to go into, although be prepared, it's long and hard. And they don't tell you that when you finish one thing, you expect that it gets easier the next time. It just seems like it gets harder at every step.

Dr. Ali Kasraeian: 3:20

but in a wonderful way,

Dr. Michael Koren: 3:22

Neat. So you went to Paris, you did some special training there and then you came back to work with your dad in practice

Dr. Ali Kasraeian: 3:28

Yep

Dr. Michael Koren: 3:29

Excellent. And so why don't you just fall into the pattern of being a great urologist helping people here in Northeast Florida? Clearly that wasn't enough for you. You needed to do some other things.

Dr. Ali Kasraeian: 3:41

Well, some people say it's an attention span thing, but I mean, you look at other things that you can do. For me, innovation is very interesting and in urology, one thing that's really interesting with urology is we're always you know it's a very cutting edge specialty. You know robotics, endourology, and for me, when I was in Paris, you know I saw some things that in the United States weren't being done the MRI scan. We partnered with a team in London when I was there, with a lot of research collaborations of using the MRI scan to look within the prostate and then look at targeted biopsies. And that blew my mind High-intensity, focus, ultrasound and cryotherapy to do targeted biopsies. So that was really inspirational to me and brought me back to what my mom's career path was with breast cancer. And then I went back and really looked at something I never thought about and realized how instrumental my mom's career path was with that fundamental switch from the lumpectomy or the segmental mastectomy to the big, you know, halstead mastectomy.

Dr. Michael Koren: 4:41

Sure.

Dr. Ali Kasraeian: 4:41

Where they removed everything, the big lymph node dissections,

Dr. Michael Koren: 4:43

much more targeted treatment

Dr. Ali Kasraeian: 4:46

yeah.

Dr. Ali Kasraeian: 4:46

And one of my mentors at the University of Florida was a guy named. Our chairman, was a big breast cancer surgeon who was part of that process as well. So you kind of looked at the similarities between that and where we were at the time with prostate cancer. Where could you be over-treating a lot of disease? And that really inspired me to potentially bring that into a process of my practice. And the wall for that was always, you know, it wasn't done in the United States how do you get it covered? You know, how do you do the research? To be a part of the research as a community physician, to be a part of that. And then I operated on a TV chef, had the opportunity to be part of media and opportunity to have a radio show for some years.

Dr. Michael Koren: 5:38

So you said a TV chef.

Dr. Ali Kasraeian: 5:39

Yeah, I had no idea. He was a TV chef. We're about a week or two before his operation. He was like can you come on my show to talk about prostate cancer? I was like I have no idea what you're talking about, but I'll be happy to, so he cooked some eggs.

Dr. Ali Kasraeian: 5:53

And next thing, you know we're talking about prostate cancer

Dr. Michael Koren: 5:55

That was a local show, yeah, in Northeast Florida.

Dr. Ali Kasraeian: 5:57

Yeah, channel 12.

Dr. Ali Kasraeian: 5:57

And then they asked me to come back and talk about other stuff. And then WOKV asked me to do a radio show and then that kind of stuck and I saw it as an opportunity to not only learn about things that weren't urology but to be able to talk about things, and there's a fun way to talk about healthcare in a different capacity. And then the Affordable Care Act.

Dr. Michael Koren: 6:20

So you did that regular radio show, yeah, and I was a guest a couple of times and we talked about some really neat things in health policy. And then, of course, covid was something that we talked about and I think you really serve the community by getting good information out there.

Dr. Ali Kasraeian: 6:33

I appreciate that it was fun and, for me, where it shaped another part of my career was when I was doing that. The Affordable Care Act was a big part of what's going on and several of my mentors - which for me mentorship seems to have been an underlying theme to a lot of things in terms of my path, where I saw things. I was interested, and I had the right mentors and the hand push me for opportunities. And Joe Tepas who was a prolific pediatric and trauma surgeon at UF, was a right very, very wonderful and strong leader at the American College of Surgeons in many capacities for quality, for health policy, would talk to me and guide me in terms of the positives and negatives of what was going on there. And Carolyn McClanahan, who's a close, dear friend, is very, very knowledgeable about the ins and outs of the Affordable Care Act, and you yourself. We'd have these amazing conversations on the show, so I'd always try to read as much as I could to be at least on par with the conversation with my guests, who are world-renowned experts, who are often on the conversations.

Dr. Michael Koren: 7:38

And you frequently refer to the world's greatest literature, whether it be Lancet or the New England Journal of Medicine and literally pulled it out during the radio broadcast and look at the data and make comments on it, which was fabulous, but it did it in a way that was very approachable even for the average listener.

Dr. Ali Kasraeian: 7:55

I mean, I think, simplifying the importance of data to our decision-making, especially as we see, as that past really 20 years have gone. Data is really impactful for what we do and it's worrisome when it's lost and you make decisions without data, and prostate cancer is something that we've learned over the past 20 years. The importance of data has made us better. Health policy, That becomes very important because a lot of decisions may or may not be made with the total amount of data and you can see how impactful that could potentially be and how dangerous it can be as well. So that got me involved.

Dr. Ali Kasraeian: 8:31

I got on a lot of legislative affairs committees with the AUA and American College of Surgeons and it's a wonderful way to potentially serve and be involved. You know the frustrations of what everyone feels, you see firsthand and you know hopefully it's a way to give back and help, although it is a very frustrating process because the solutions are not fast. But physicians, you know, do need to get more involved and we need to be there because we're all working, we're taking care of patients and the people that are involved and get more wins seem to be there a lot more with deeper pockets, and when we're not there, it impacts our colleagues and, most importantly, it impacts our patients.

Dr. Michael Koren: 9:13

Right, and this is a good segue to the fact that you're now the president of the Duval County Medical Society. So tell us a little bit how you got involved in that and why you decided to take that position, and how's it going so far.

Dr. Ali Kasraeian: 9:26

It's great. Duval County Medical Society is a wonderful organization and for the physicians listening, I would urge you to be involved. You know my big thing this year is to encourage people to think of the Duval County Medical Society as family.

Dr. Ali Kasraeian: 9:41

You know, I'm a big family guy three kids, I have a wonderful wife, I have wonderful parents and an amazing brother and his family and we as physicians historically acted like family our colleagues, our nurses, our patients. It was like family and we're kind of at a danger point where that relationship may be segmented by the way that the way medicine is practiced these days is moving towards potentially a more shift worker mentality. We're having teams that are a little bit more segmented and I think you know the team approach to health care is wonderful. I think it needs to be with physician leadership and I think we need to embrace that because I think it's a better way of taking care of patients. But it needs to be with this concept of family where we all take care of each other and then that's a better way of taking care of our patients.

Dr. Ali Kasraeian: 10:34

And I think the Duval County Medical Society is a great way to potentially do that, both in terms of the networking but also the resources that we can have and the advocacy at first is one of the biggest county medical societies with the Florida Medical Associations.

Dr. Ali Kasraeian: 10:48

We have a lot of passionate, wonderful people that work in that and our staff is amazing and we do a lot of fun things we give back to the medical students. We do a lot of things of that nature and I feel very blessed to be a part of it and honestly, frankly, it's been so many years that I've been involved I don't even know how I got started. My parents have been involved. My mom was in leadership for a long time and there's some really amazing history of profound things that have happened. A lot of you know big, big moves in mass casualty and things like that, where we're inspired by people at UF and trauma surgeons over there. Over the historical time, a lot of amazing other things have been done with surgeons and physicians here in Duval County. We need to celebrate the power of the physician leadership here in Duval County and this is a great organization to help us be great physician leaders for our patients.

Dr. Michael Koren: 11:39

Sounds terrific, very inspiring. Now I know you've also been involved in leadership positions and in committees on a national basis, so why don't you let the audience know a little bit about that work?

Dr. Ali Kasraeian: 11:49

So I've been very fortunate and it seems like all these things happen at the same time and I kind of joke around with my wife I recently got an MHA at UNF.

Dr. Michael Koren: 11:59

Wow.

Dr. Ali Kasraeian: 11:59

And it was really done. Because you go into C-suites with the hospitals to try to bring new technologies and things of that nature and it seems like you and your industry partners think this is the greatest thing since sliced bread and makes money for the hospital. It's great for the patients and they look at you like you've grown horns on and and. So I was like you know, obviously the people on the other side of the fence aren't malintended people, so maybe the conversation is different. So I thought this would be a good way to do it.

Dr. Ali Kasraeian: 12:26

It took a lot of effort and with kids it's difficult to do and you know I thank my wife for her support and patience for doing that. But along doing that, you know, everything seems to kind of work in terms of the ascensions with a lot of organizations. I'm the Legislative Affairs Committee, now called the Federal Advocacy Committee, which we're all chagrined by the anagram for that committee's name at the AUA, at the American Urological Association, a similar legislative committee for the American College of Surgeons. And what's great about that? It allows us to triangulate things locally and with the Florida Urologic Society so that we can potentially make efforts that physicians have a united voice for the things that matter to us, which ultimately help our patients, and I feel very blessed to be in those rooms to see how things are shaped locally, regionally and nationally.

Dr. Michael Koren: 13:16

Yeah Well, that's amazing. Wow, you've done a lot of things and congratulations and thank you on behalf of the physician community for all the stuff you do.

Dr. Ali Kasraeian: 13:24

I appreciate the opportunity.

Dr. Michael Koren: 13:25

So we're going to take a break here, but urologists are very famous for having a good sense of humor. I remember doing surgery and working with urologists and they were cracking each other up. I heard this one recently and you probably heard it, but I'll share it with the rest of the audience is what did the director of the urology program say to the star resident at the time of his acceptance into the urology program?

Dr. Ali Kasraeian: 13:52

I can only imagine.

Dr. Michael Koren: 13:55

He said you're in

Dr. Ali Kasraeian: 13:57

Now urology. It's interesting. Besides the amazing, amazing comedy of this show, one of the things that actually drew me to urology was, in fact, that I actually, like I was saying before I went to be a pediatric surgeon, I would always ask my dad I was like, of all the things you could possibly do, this is what you chose to do, and he'd be like you know, everyone's great the sense of humor. People are all wonderful surgeons and they have great sense of humor. It's a great lifestyle. You treat people or your patients get better.

Dr. Ali Kasraeian: 14:26

And at the University of Florida, when I was there, our third year clerkships where you go from the classroom to seeing patients was on a lottery system and you want the chairman's service so you can get the letter of recommendation for your residency applications, and then I put in to do pediatric surgery. I had a middle of the lot lottery said by the time I got there, all those spots were taking except one chairman spot, so I got that and then the only thing that was left was a urology and some other service that no one wanted. And I'm like, of all the things, it was this and I loved it. Everyone had a great sense of humor. Our chief resident at that time was, and still is, probably one of the funniest people I ever met.

Dr. Ali Kasraeian: 15:06

Every night, you know, back then you could go to drug rep dinners every night. We got all the pens we wanted. You could get pens at that time and our patients did better. We did big surgeries, we did little surgeries, you could shape you know all sorts for your day and it was like a nice mix of clinic and the operating room and everyone was happy. Back then I went to the general surgery side of things. It was a little bit of a different scenario. So I always kept it in the back of my mind. And here we are a million years later and I'm a urologist and couldn't be happier.

Dr. Michael Koren: 15:37

Beautiful. We're going to take a quick break here and then, when we come back, I want to focus on this controversy about prostate-specific antigen, PSAs. Certainly, I know that you've been keenly interested in this and have some views about it, and we'll jump into that discussion in just a moment.