Is HIFU Right for Your Prostate Cancer? with Dr. Matthew Cooperberg

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.com00:00 – 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___________________________________🌱 Partner OffersProLon 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/3TVehAxAG1 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 MembershipWant 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 — https://www.youtube.com/@DrGeoProstatePodcast🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm📸 Instagram → https://bit.ly/DRGEO-INSTA-YT📘 Facebook → https://bit.ly/POD-FB-DrGeo💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE🌐 DrGeo.com Website → https://bit.ly/43khht0___________________________________📣 Hashtags#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology___________________________________⚠️ DisclaimerThis 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 risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.