1. Prostate Cancer Crisis: Imaging is the Solution Faina Shtern, MD President, AdMeTech Foundation

2. Prostate Cancer Crisis: Imaging is the Solution AdMeTech Foundation’s Mission: To End the Era of Blind Prostate Cancer Care: To Create a Future of Image-Guided, Minimally-Invasive Diagnosis & Treatment

3. Courtesy of: Thomas M. Wheeler, MD, Baylor College of Medicine

4. Prostate Cancer Crisis Prostate Cancer Epidemic “Blind” Diagnosis & Treatment Patient Care Crisis Socioeconomic Problem

5. Prostate Cancer Epidemic Most common major cancer: –1 in 6 men is diagnosed –A new case – every 2.5 minutes –A man dies of prostate cancer every 18 minutes In 2007:  30,000 men died  70,000 had treatment failures  230,000 new cases  1.5 million men had biopses

6. Prostate Cancer Epidemic & African American Men Greater risk (by 60%) Younger Men More Virulent & Lethal Disease Higher Mortality (>100%)

7. Imaging Technologies & Transformation of Prostate Cancer Care “If prostate cancer is caught at a time when it is confined to the prostate, generally it can be cured by radiotherapy and surgery” Professor Alan Horwich Royal Marsden Hospital, UK

8. Unnecessary Biopsies: Patient Care Crisis & Socioeconomic Impact  230,000 new cases  1.5 Million men have biopsies  1 Million men per year have unnecessary biopsies with related fears, trauma and costs  Costs for Healthcare:  Over $2 Billion per year

9. Unnecessary Biopsies: Patient Care Crisis & Socioeconomic Impact –20 million men who had biopsy –2 Million men live with prostate cancer –18 million men had unnecessary biopsies: Cost to Healthcare: $36 billion

10. Potential Cost Savings with Imaging Per Year  Cost of Unnecessary Biopsies:  $2.00 billion  Potential Cost of Imaging for Additional Screening and Diagnostic Procedures:  $600 million  Savings with Improved Imaging:  $1.4 billion (assuming cancer yield of only 25%)

12. Current Diagnosis and Treatment is Blind There are no accurate, affordable and accessible imaging and other diagnostic tools to guide: Early Detection Biopsy Treatment

13. Experimental MRI Shows Large 2 cm Mass Missed with Biopsies

14. Experimental MRI- Guided Biopsy Large 2 cm Tumor: Aggressive, virulent prostate cancer (Gleason Score: 8 & 9)

15. CT Imaging Shows Multiple Metastases

16. Rising PSA Multiple negative biopsies Experimental MRI - demonstrated tumor –Image-guided Biopsy showed virulent cancer –Metastases to lymph nodes Treated with chemotherapy & radiation Case Study: 53 Year Old Man with Negative Standard Biopsies for 5 years

17. Blind Prostate Cancer Treatment: Complications 50 – 80% of impotence 50-60% of incontinence

18. Mitchell Schnall, MD, PHD University of Pennsylvania Pioneer of Prostate-Dedicated MRI “What was the most devastating experience for my father… and what kept him embarrassed, ashamed and isolated from our family was his inability to control his bowels”

19. Treatment Failures: Prostate Cancer Crisis Efforts to Reduce Treatment Failures should be a clinical and public health priority

20. Barry Bostwick: Leading Man of Prostate Cancer Barry’s Diagnosis – at the age of 52 Barry Selected Radical Surgery –Diapers for Quite a While –Challenges with Intimacy –Shots and Viagra

21. Barry Bostwick: Leading Man of Prostate Cancer Barry’s Father - Diagnosis at the age of 81 Barry’s Father Selected Active Surveillance –No related problems or surgical complications

22. Barry Bostwick: Leading Man of Prostate Cancer “Was surgery really necessary?”

23. Prostate Cancer Care: Fundamental Dilemma To Treat or Not to Treat?

24. Socioeconomic Impact 2 million men live with prostate cancer 18 million have had unnecessary biopsies: –($36 billion) Treatment costs $8 billion per year –at least $2 billion is unnecessary Lost Lives Lost Quality of Life

25. Framing the Need for Prostate Imaging: Patrick Walsh, MD, Johns Hopkins Pioneer of Radical Surgery “The most critical pieces of information…are the precise location and extent of cancer within the prostate. I can’t think of anything more important. Right now, there is no proven method… we need that desparately. ”

26. Prostate Cancer Crisis: The Solution is Imaging Potential Annual Reduction of Health Care Costs with Imaging: –$1.4 billion (unnecessary biopsies) –$1.6 billion (unnecessary treatment) –$2 billion (minimally-invasive treatment) –Total Reduction: $5 billion

27. “…but you have to demand it to get it." “”