What if prostate cancer treatment weren’t months of daily radiation—but five ultra-precise sessions guided in real time by MRI? Today, Dr. Michael J. Zelefsky (Professor of Radiation Oncology, NYU Grossman School of Medicine) explains how MRI-LINAC and adaptive planning are redefining accuracy, reducing side effects, and personalizing care. A pioneer behind IMRT and image-guided radiotherapy, Dr. Zelefsky breaks down SBRT vs. IMRT, protons vs. photons, HDR brachytherapy, when to add hormone therapy, and how genomics + AI are shaping what’s next.

In this conversation, Dr. Zelefsky charts the evolution from long-course radiation to short-course SBRT with outcomes comparable to 7–9 week regimens—thanks to precision imaging and planning. He clarifies where IMRT ends and SBRT begins, why protons haven’t shown superiority over photons in prostate cancer, and where HDR brachytherapy (Ir-192) shines—especially as a boost in higher-risk disease. We dig into dose equivalence (why 5×8 Gy can match ~80–90 Gy long-course), risk-based treatment + ADT duration, and how Decipher/Artera scores can refine decisions. Most exciting: MRI-LINAC with continuous motion monitoring keeps the prostate in a virtual “bullseye,” enabling whole-gland treatment with focal boosts today—and potentially true focal therapy tomorrow as biologic imaging and AI mature.

Time-Stamped Highlights

00:00 – Welcome

02:00 – Why Dr. Zelefsky’s work is so respected; career arc and impact

04:00 – What changed: CT/MRI planning → 3D-CRT → IMRT → SBRT

12:45 – IMRT vs. SBRT: definitions, session counts, who gets what

19:10 – Energy sources overview: photons, protons, brachytherapy

20:30 – Protons vs. photons: evidence, indications, cost, access

24:00 – HDR brachytherapy (Ir-192) as a temporary “in-and-out” boost

28:00 – Dose logic: why 5×8 Gy (~40 Gy) ≈ long-course 80–90 Gy

29:30 – Risk groups (low/intermediate/high) and when ADT is crucial

33:00 – ADT durations (6–36 months): what trials actually showed

37:00 – Genomics (Decipher/Artera): resolving risk discrepancies

39:00 – What MRI-LINAC adds: real-time adaptive planning

43:00 – Continuous Motion Monitoring (CMM): beam stops if target moves

47:00 – Treat whole gland + boost the DIL (FLAME study approach)

49:00 – Toward focal therapy with better biologic imaging + AI

54:00 – How to choose: values, side-effects, lifestyle, comorbidities

01:01:00 – Final guidance: don’t be overwhelmed—multiple good option

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⚠️ Disclaimer

This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own

HIFU (high-intensity focused ultrasound) is one of the most talked-about focal therapies in prostate cancer—but who is it really right for? In this conversation, Dr. Matthew Cooperberg (UCSF)—a leading voice in urology, epidemiology, and integrative prostate cancer care—breaks down patient selection vs. energy modality, how modern imaging (MRI, fusion, RSI) drives precision, what genomics (e.g., Decipher) can and can’t tell us, and how salvage options compare after focal therapy vs. radiation. We also tackle lifestyle factors, trial design, and why midlife PSA screening (ideally <1 between ages 45–55) remains crucial.

👉 View more at DrGeo.com

00:00 – Welcome + episode setup (HIFU overview, aims of focal therapy)

04:10 – The real first question: Who is a candidate? (selection > modality)

05:10 – What “focal therapy” means (lesion-only, margin, hemi-ablation) + imaging progress

06:25 – Recurrence after focal therapy: targeting, dose, or biology? Follow-up biopsies

07:40 – Genomics (Decipher): predicting recurrence; how results change counseling

09:30 – Lifestyle & microenvironment: can diet/exercise influence outcomes?

11:00 – Salvage after focal vs. radiation: fibrosis, feasibility, quality of life

14:00 – Cryotherapy vs. HIFU: image guidance, control, and why HIFU advanced

16:00 – Imaging upgrades (MRI fusion, RSI, C-13 spectroscopy) and treatment constraints

17:00 – IRE (irreversible electroporation): role for apical tumors, early results

18:00 – TULSA, water/thermal concepts, focal radiation, partial prostatectomy: what’s known

20:00 – Smarter trials: active surveillance ± focal therapy for borderline cases

22:00 – The counseling hierarchy: decision first, technology second

24:30 – Proton vs. photon incentives; why advertising confuses choices

26:30 – UCSF’s program: mostly HIFU; where IRE fits; adding new machines prudently

28:30 – The real bottleneck: sub-millimeter targeting; AI-guided ablation future

33:00 – HIFU mechanics: probe size, apex/anterior reach, distance constraints

35:00 – “I want HIFU for Gleason 8”: agency, nuance, and when we advise against it

38:00 – A cautionary case: negative biopsy → later mets—what it teaches us

40:30 – Millennials, risk tolerance, and why PSA at 45–55 (<1 is ideal) matters

44:00 – Growth vs. spread: which high-grade tumors can we treat focally?

46:00 – How low vs. high genomic scores tilt decisions (and their limits)

47:30 – Where to find Dr. Cooperberg + parting PSA advice

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Can high-dose IV Vitamin C really support cancer treatment—even in men with prostate cancer? In this episode of the Dr. Geo Prostate Podcast, Dr. Geo welcomes Dr. Paul Anderson, one of the world’s leading voices in integrative oncology with 30+ years of clinical experience and NIH-funded cancer research.

Together, they unpack how vitamin C works differently when taken orally versus intravenously, what the latest research shows about IV vitamin C, and how it may impact the tumor microenvironment and immune response.

Listeners will also learn about practical approaches to integrative oncology, the role of detoxification and immune health, and what patients with advanced prostate cancer should know before seeking out IV vitamin C therapy.

✅ What You’ll Learn in This Episode:

• How oral vs. IV vitamin C behave differently in the body
• What the latest science says about IV vitamin C in cancer care
• Why the tumor microenvironment matters for long-term outcomes
• How IV vitamin C may support men with advanced prostate cancer
• Synergies with lifestyle therapies, immunotherapy, and sauna

💡 Don’t forget to subscribe, rate, and review the podcast! Every review helps us reach more men who want to thrive, not just survive.

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ProLon 5-Day Fasting Mimicking Diet — Enjoy fasting benefits with food. Supports cellular renewal, metabolic health, and fat loss. Special offer for our listeners: Get the ProLon kit for $148 → https://bit.ly/3TVehAx

AG1 by Athletic Greens — 75 high-quality vitamins, minerals, probiotics, and adaptogens in one daily scoop. Supports gut health, immunity, energy, and focus. Try it here → https://bit.ly/3mA2tVV

💪 Exclusive Membership

Want deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. → https://drgeo.com/membership

📌 Follow and Connect

📺 YouTube → Dr. Geo Prostate Podcast / @drgeoprostatepodcast

🎧 Listen to All Episodes → https://dr-geo-prostate-podcast.captivate.fm/

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⚠️ Disclaimer: This podcast is educational and not medical advice. Always consult your healthcare provider before making changes to your treatment.