Dr. Rajiv Chopra - Founder of Profound Medical and Inventor of the TULSA Procedure - YouTube

Location: Sanford Burnham Medical Discovery Institute Auditorium
Date: Third Saturday of June 2025
Facilitator: Aaron Lamb, Director and Meeting Facilitator

Meeting Overview

The June IPCSG meeting featured an exceptional turnout of newcomers - possibly the largest ever recorded. The meeting began with standard organizational updates and concluded with presentations on two cutting-edge technologies: the TULSA procedure for prostate cancer treatment and Artera AI's new diagnostic test.

Organizational Updates

Leadership and Volunteers

Current Leadership: Aaron Lamb continues as interim president and meeting facilitator, with Jean Van Vleet (director), Bill Manning (director/video editor), John Gotautlib (treasurer), Steve Pendergast (secretary/newsletter editor), John Tassy (webmaster), and Bill Bailey (librarian)
Volunteer Needs: The organization seeks volunteers for hotline support, newsletter editing, meeting setup, and a "big brother" mentoring program for newcomers
Backup Leadership: John Love will facilitate the July meeting as backup, demonstrating succession planning efforts

Member Demographics and Experience

The meeting featured a remarkable diversity of experience levels:

Newcomers: Largest turnout ever, with many referred by doctors, friends, or current members
Experience Range: From newly diagnosed (less than 1 year) to long-term survivors (up to 24 years)
Treatment Survey Results: Members reported experience across the full spectrum of treatments including active surveillance, surgery, radiation, ADT/hormone therapy, chemotherapy, focal therapies, immunotherapy, and newer treatments

Resources and Support

Website and YouTube: All meetings recorded and posted within a month
Newsletter: Available online, via email, or paper mail
Meeting Schedule: Third Saturdays monthly except December
Funding: 501(c)(3) nonprofit seeking donations to support website, video editing, advertising, and mailings

Upcoming Events and Meetings

July Meeting (July 19th)

Member roundtable featuring:

Richard Oppper
John Love
Mark Maguire

August Meeting

Tracy Roberts, registered dietitian from UCSD Moore's Cancer Center, presenting on diet modifications for prostate cancer patients.

PCRI Conference

Date: September 5-7, 2025
Location: Los Angeles
Cost: $30 registration fee
Note: Highly recommended by Aaron Lamb; discount code from previous year may still work

Main Presentation: Dr. Rajie Chopra on TULSA

Dr. Rajie Chopra, co-founder of Texas Prostate and inventor of the TULSA procedure, delivered a comprehensive presentation on transurethral ultrasound ablation. Key highlights included:

Technology Overview

FDA-cleared treatment for localized prostate cancer and BPH
MRI-guided procedure with real-time temperature monitoring
Outpatient procedure with minimal invasiveness
Can treat whole gland or focal areas depending on cancer location

Clinical Results

Five-year data showing sustained PSA reduction
21% retreatment rate (comparable to surgery/radiation)
Superior side effect profile for continence and sexual function
90% average prostate size reduction

Practical Considerations

Medicare coverage began January 2025
Available at ~30 sites nationwide, including UCSD locally
3-hour procedure under general anesthesia
7-10 day catheter requirement post-procedure
About 6-week timeline from initial contact to treatment

Eligibility Factors

Prostate size limitations (generally under 80-90cc)
Calcification considerations
Disease localization requirements
General anesthesia eligibility

Secondary Presentation: Artera AI Prostate Test

Gabby Caseris from Artera AI presented their new diagnostic tool:

Technology Features

AI-powered digital pathology analysis
24-hour turnaround time
Uses existing biopsy slides (no additional tissue needed)
Analyzes thousands of cellular patterns per slide

Clinical Applications

Risk Stratification: 10-year metastasis and mortality risk assessment
Treatment Personalization:
- Active surveillance candidacy for low-risk patients
- Short-term hormone therapy recommendations for intermediate-risk
- Aberadone necessity for high/very high-risk patients

Validation and Coverage

Included in NCCN guidelines with highest evidence level
Only predictive test recognized for intermediate-risk patients
Medicare fully covered, commercial insurance supported
95% of financial assistance applicants qualify for zero out-of-pocket

Key Benefits

Reduces overtreatment (2/3 of intermediate-risk men may not need hormone therapy)
Preserves tissue for future testing
Rapid results facilitate timely treatment decisions

Interactive Elements

Extensive Q&A Sessions

Both presentations featured robust question-and-answer periods, with members asking detailed technical questions about:

Treatment comparisons (TULSA vs. surgery vs. radiation vs. HIFU)
Retreatment possibilities and limitations
Technology availability and access
Side effect profiles and recovery experiences
Eligibility criteria and contraindications

Treatment Experience Sharing

The meeting facilitated peer-to-peer learning by identifying members with various treatment experiences, encouraging newcomers to connect with experienced patients for firsthand insights.

Meeting Atmosphere and Community Building

The meeting demonstrated the strong community aspect of IPCSG:

Welcoming Environment: Special attention to record number of newcomers
Educational Focus: Detailed, technical presentations balanced with practical advice
Peer Support: Emphasis on connecting new members with experienced patients
Hope and Optimism: Reinforcement that "there's no better time to get prostate cancer than today" due to expanding treatment options

Key Takeaways for Members

Expanding Options: Both TULSA and AI diagnostics represent the rapid evolution of prostate cancer care
Personalized Medicine: New tools increasingly allow treatment customization based on individual risk profiles
Quality of Life Focus: Newer treatments prioritize maintaining function while achieving cancer control
Community Value: The organization continues to provide crucial peer support and education
Accessibility Improvements: Medicare coverage and insurance support are improving access to advanced treatments

Volunteer Opportunities

The meeting highlighted several ways members can contribute:

Hotline support for urgent treatment decision assistance
Newsletter editing and production
Meeting setup and logistics
Mentoring program for newly diagnosed men
Backup meeting facilitation

The June meeting exemplified IPCSG's mission of providing patient-focused experience sharing, comprehensive education, and caring community support for men navigating prostate cancer treatment decisions. The combination of cutting-edge medical presentations and strong peer networking continues to make these meetings valuable resources for the San Diego prostate cancer community.

Dr. Rajiv Chopra Presents on TULSA: A New FDA-Cleared Treatment for Prostate Cancer

IPCSG June Meeting Summary

Dr. Rajiv Chopra, co-founder of Texas Prostate and inventor of the TULSA procedure, presented an in-depth overview of transurethral ultrasound ablation (TULSA Pro) to our support group in June. As the newest FDA-cleared technology for treating localized prostate cancer and BPH, TULSA represents an innovative addition to the treatment landscape that fits well into the modern continuum of prostate cancer management.

What is TULSA?

TULSA is a radiation-free and incision-free treatment that uses high-intensity ultrasound to thermally destroy prostate tissue. What makes TULSA unique is that the entire procedure is performed inside an MRI scanner, allowing the treatment team to monitor temperatures in real-time throughout the prostate gland with millimeter precision.

The procedure involves inserting a thin device through the urethra that contains 10 ultrasound transducers along its length. These transducers deliver energy that heats prostate tissue to 55 degrees Celsius, instantly destroying both normal and cancerous cells. The device is controlled remotely by a motorized arm, and the MRI provides continuous temperature feedback that automatically adjusts the energy delivery - similar to cruise control in a car.

A key safety feature is an endorectal cooling device that circulates room temperature water to protect the rectal wall during treatment, ensuring no thermal damage occurs to surrounding tissues.

Key Advantages

Dr. Chopra emphasized that while TULSA doesn't offer superior cancer control compared to surgery or radiation, it provides equivalent outcomes with significantly fewer side effects. The real-time MRI guidance allows for precise treatment boundaries, and the technology can be customized to treat either the whole gland or focal areas depending on cancer location.

Unlike radiation therapy, which requires multiple visits over weeks, TULSA is a one-day outpatient procedure lasting approximately three hours under general anesthesia. Patients typically go home the same day with minimal pain, though they do require a urinary catheter for 7-10 days post-procedure.

Eligibility and Considerations

TULSA is suitable for men with localized prostate cancer, particularly those seeking to minimize treatment side effects. However, there are some limitations:

Prostate size: Generally limited to prostates under 80-90cc, though this depends on cancer location
Calcifications: About 20% of men have prostate calcifications that can interfere with ultrasound energy, though these can often be removed in a separate procedure
Disease extent: Best suited for cancer confined to the prostate gland; not ideal for seminal vesicle involvement
General anesthesia: Patients must be eligible for general anesthesia

The procedure can treat various Gleason grades, including some high-grade cancers if caught early and with negative PSMA scans showing no spread.

Clinical Outcomes

Dr. Chopra presented five-year data from the pivotal TAC trial involving 115 men with mostly intermediate-risk prostate cancer. Key findings include:

PSA reduction: Sustained drops in PSA levels over five years for the majority of patients
Retreatment rate: About 21% of men required additional intervention within five years, comparable to surgery and radiation recurrence rates
Side effects: Significantly better preservation of urinary continence and sexual function compared to conventional treatments
Prostate shrinkage: Average 90% reduction in prostate size, which often improves urinary flow symptoms

Availability and Access

TULSA is now available at approximately 30 sites across the United States, including major academic medical centers and private practices. Locally, UCSD offers the procedure. A significant development occurred in January 2025 when Medicare began covering TULSA, dramatically improving access for men 65 and older.

Dr. Chopra's practice, Texas Prostate, has treated over 50 patients and is transitioning to a Medicare-certified hospital in Dallas, which will allow them to offer the procedure to Medicare recipients with minimal out-of-pocket costs.

The Treatment Experience

The TULSA journey involves several steps:

Preparation: Three days of bowel preparation similar to colonoscopy prep
Procedure day: Six-hour outpatient experience including pre-op, three-hour treatment, and recovery
Recovery: Catheter for 7-10 days, with most patients experiencing minimal pain
Follow-up: Regular PSA monitoring and imaging similar to other treatments

Dr. Chopra noted that the biggest patient complaint is typically the temporary catheter, not pain from the procedure itself.

Future Considerations

TULSA can be repeated if necessary and appears to be a viable option after radiation or surgery failure. The procedure preserves future treatment options since it doesn't build up toxicity that would complicate subsequent therapies.

Currently, the company is conducting a randomized trial comparing TULSA directly to radical prostatectomy, with full results expected in about two years. Early data confirms TULSA's advantages in blood loss, hospital stay, and recovery time.

Questions to Consider

For those interested in TULSA, Dr. Chopra recommends finding centers with experience (ideally 20-25 cases or more) and ensuring comprehensive pre-treatment evaluation including pelvic CT scans to check for calcifications and PSMA scans when appropriate.

As with any treatment decision, men should discuss TULSA with their urologist and consider getting a second opinion. The technology represents another valuable option in the expanding toolkit for treating localized prostate cancer, particularly for those prioritizing quality of life outcomes.

For more information about TULSA, visit tulsaprocedure.com or contact Texas Prostate for consultation. Dr. Chopra and his team are available for virtual or in-person consultations to discuss eligibility and treatment planning.

Artera AI Prostate Test: Precision Medicine for Treatment Personalization

IPCSG June Meeting Summary - Gabby Caseris, Artera AI

Following Dr. Chopra's TULSA presentation, Gabby Caseris from Artera AI introduced members to a groundbreaking diagnostic tool that's revolutionizing how we approach prostate cancer treatment decisions. This AI-powered test represents a significant advancement in precision medicine, helping men avoid both overtreatment and undertreatment based on their individual cancer characteristics.

Company Background and Development

Artera AI is a young precision medicine company founded just three years ago in the Bay Area through a unique partnership between a UCSF radiation oncologist and the former head of AI at Salesforce. The company's mission is to develop AI-powered tests that personalize treatment decisions for cancer patients, with their prostate test being the first to reach market.

The test has been commercially available for only about a year and available in California since November 2024, making it very new to the market. Despite its recent introduction, Artera AI has already achieved remarkable recognition in the medical community.

Revolutionary Technology: Digital Pathology Meets AI

What sets Artera AI apart from other genomic tests on the market is its innovative approach using digital pathology and artificial intelligence. While traditional tests require extracting RNA from tumor tissue (a process that takes weeks and can fail if insufficient tumor is present), Artera AI uses the same stained slide that the pathologist used for the original diagnosis.

This approach offers several key advantages:

No tissue consumption: The precious tumor tissue block is preserved for future testing needs
Zero failure rate: Since cancer cells are already preserved on the slide, there's never a result saying "insufficient tumor tissue for testing"
Rapid results: 24-36 hours from receipt of slide to results
Comprehensive analysis: The AI examines every single cell on the biopsy slide

The AI system was trained on thousands of patients from randomized controlled trials, learning to identify patterns by analyzing clinical information, outcomes, and images from biopsy slides. Each slide is divided into tens of thousands of patches, with each patch receiving a score that feeds into the algorithm to generate the final report.

Clinical Applications and Benefits

Prognostic Information (All Patients)

Every patient receives a prognostic assessment including:

10-year risk of distant metastasis
10-year risk of prostate cancer-specific mortality
Outcomes based on standard-of-care treatments for their NCCN risk group

Risk-Specific Insights

Very Low to Favorable Intermediate Risk:

Active surveillance candidacy assessment
Helps determine if watchful waiting is appropriate

Intermediate Risk - Short-term ADT Biomarker:

Binary yes/no recommendation for short-term hormone therapy with radiation
Critical finding: Validation studies showed approximately two-thirds of intermediate-risk men don't benefit from adding hormone therapy to radiation
This means most men can be spared the side effects and financial burden of unnecessary hormone treatment

High and Very High Risk - Aberadone Biomarker:

Determines need for aberadone (Zytiga) in addition to radiation and long-term hormone therapy
Recently presented at ASCO 2025 and selected as "Best of ASCO"
Key discovery: Only about 25% of high-risk men actually need aberadone addition
Supports the goal of minimizing overtreatment while personalizing care

Clinical Validation and Recognition

Artera AI has achieved unprecedented recognition for such a new technology:

NCCN Guidelines Inclusion

Included in 2025 NCCN guidelines with the highest level of evidence
Listed under "AI pathology" category
Unique distinction: The only risk stratification test for localized disease recognized to have predictive capabilities

Insurance Coverage

Medicare: Fully covered with zero out-of-pocket cost
Commercial insurance: Prior authorizations submitted as needed
Financial assistance: If non-covered amount exceeds $285, patients can access self-pay rate of $285
Outstanding coverage: Over 95% of patients applying for financial assistance qualify for zero out-of-pocket costs

Sample Reports and Interpretation

Intermediate Risk Report

The report provides a comprehensive visual display including:

Prognostic charts showing 10-year distant metastasis risk
10-year prostate cancer-specific mortality risk
Active surveillance candidacy indicator (circle moving along a continuum)
Short-term ADT biomarker: Binary positive/negative recommendation at bottom of report

High Risk Report

Similar format with:

Same prognostic information displays
Aberadone biomarker: Up arrow or down arrow indicating likely benefit from aberadone addition
Clear visual presentation for easy interpretation

Advantages Over Traditional Approaches

Speed and Efficiency

Traditional genomic tests: Several weeks processing time
Artera AI: 24-36 hours turnaround time

Tissue Preservation

Traditional tests: Consume tumor tissue from biopsy
Artera AI: Uses existing slides, preserves all tissue for future needs

Failure Rate

Traditional tests: Can fail due to insufficient tumor tissue
Artera AI: Zero failure rate since slides already contain preserved cancer cells

Data Foundation

Massive training datasets: Uses huge patient populations for model training and validation
Validated outcomes: Based on real patient results from major clinical trials

Impact on Treatment Decision-Making

The Artera AI test addresses a critical need in prostate cancer care: reducing both overtreatment and undertreatment through personalized medicine. Key impacts include:

Reducing Overtreatment:

Identifies intermediate-risk men who don't need hormone therapy (approximately 67%)
Determines high-risk men who don't need aberadone addition (approximately 75%)
Helps avoid unnecessary side effects and costs

Optimizing Treatment:

Confirms which patients truly benefit from intensified treatment
Provides confidence in treatment de-escalation decisions
Supports active surveillance candidacy assessment

Rapid Decision Support:

24-hour results enable timely treatment planning
Reduces delays in starting appropriate therapy
Allows for quick treatment adjustments

Future Implications

As precision medicine continues to evolve, tools like Artera AI represent the future of cancer care - moving away from one-size-fits-all approaches toward truly individualized treatment plans. The test's inclusion in NCCN guidelines and rapid insurance coverage adoption suggest it will likely become standard of care for newly diagnosed prostate cancer patients.

For IPCSG members, this technology offers hope for more precise treatment decisions that minimize unnecessary treatments while ensuring optimal cancer control. The rapid turnaround time and preserved tissue benefits make it an attractive option for men facing treatment decisions.

Member Questions and Answers

Note: The transcript indicates that due to time constraints, questions for Gabby were taken at the podium after the formal presentation rather than during a recorded Q&A session. Unfortunately, these individual conversations were not captured in the meeting transcript. However, members were encouraged to approach Gabby directly for specific questions about eligibility, insurance coverage, and how the test might apply to their individual situations.

General Questions Likely Addressed:

How to access the test through their physicians
Specific insurance coverage details
Timeline for receiving results
How the test integrates with existing treatment planning
Eligibility criteria for different risk categories
Comparison with other genomic tests they may have heard about

Members interested in learning more about the Artera AI prostate test should discuss it with their urologist or radiation oncologist, as the test requires a physician order and uses existing biopsy materials from their diagnosis.

For more information about Artera AI and their prostate test, members can visit the company website or ask their treatment team about incorporating this diagnostic tool into their care planning.

IPCSG June 2025 Meeting Summary