KATZ'S CORNER 033124 Guest: Jonathan Haas, MD. Radiation Oncologist at NYU Langone Hospital - Long Island

CredentialsPositions

• Clinical Professor, Department of Radiation Oncology at NYU Grossman Long Island School of Medicine
• Chair, Department of Radiation Oncology at NYU Grossman Long Island School of Medicine

Board Certifications

• American Board of Radiology - Radiation Oncology, 1998

Education and Training

• Residency, University of Pennsylvania School of Medicine, Radiation Oncology, 1997
• MD from Washington University-St Louis, 1993

Episode Transcript

(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Gone Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range

(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven ten WOOR. It's theChairman of Urology at NYU Land Gone Hospital,
Long Island. Here is doctor AaronKatz. Well, good morning everyone,
and welcome again to Kats's Corner hereon wr iHeartRadio. So glad you

(00:42):
could join me this morning. Andfor those that are celebrating Easter today,
a very happy Easter to all ofyou, and we have a wonderful show
for you today. A guest thatis quite familiar with all of you if
you are an active listener of Katz'sCorner here, Doctor Jonathan hass is here
today. He is the Professor andChairman of the Department of Radiation Oncology at

(01:04):
the NYU Land Gone School of Medicine. The Grossman Long Island School of Medicine,
I should say, and the NYULand Going Health System out here on
Long Island and sees patients here inMineola, New York City, as well
as on the eastern part of LongIsland out in patch Hog. And we
are here today to discuss a lotof the new things that are going on

(01:26):
in prostate cancer for patients that areconsidering or have had radiation. And if
you've been listening to the show andknow our program of cyber Knife, which
is clearly an expert center of excellencefor prostate cancer, and doctor has is
the leader, he's here this morning. Good morning, John, and I
know you just got back from Chicagoin an exciting meeting and want to talk

(01:49):
to you about all that this morning. So thanks for joining us. Yeah,
of course, thanks for having me. You know this is my favorite
way to spend a Sunday. Youmake me sound like the Rolling Stones.
Right, I'm on tour. Iwas in Chicago, got east in Manhattan
and Minneola. Yeah, t shirtsright. You catch House House Live.
Well, you know I do applaudyou because you know, not only do
you take the enormous amount of energyand time to be a radiation oncologist and

(02:15):
to take care of so many patients. But I know that you're also very
dedicated family man. You take timealways for your kids. You're always sending
me wonderful pictures of them or whereverthey're going and whatever they're doing, as
well as taking care of yourself.I know that you're, you know,
in terrific shape. You're an activerunner, you work out, and so
I do applaud you. You reallyhave done an enormous job and really something

(02:39):
for all of us, not onlyfor patients to look up to, but
for also your your colleagues here atn YU. So I just want to
I want to put that out.Yeah, that's really nicey. I mean
I have a theory, right ifwould you go to like a dentist with
horrible teeth or a barber with horriblehair? So if you can't really take
care of yourself, right, howcan you like you take care with someone

(03:00):
else? And granted I know somefantastic positions who are like mildly over eight,
and that's fine, but you haveto be able to look in the
mirror and say, how can Itell you to eat healthier? Like you
opened my eyes with holistic die withthe murdera tran dye. Right, So
if I'm not going to follow that, how can I tell my patients to
do the same? Absolutely? Right, you know? And if yeah,
you're right, and then it's withhorrible teeth, that's an image, you

(03:21):
know, or bad breath. Gosh. So I know you just came back
from this meeting in Chicago, andyeah, you really had a number of
presentations there. Again, congratulations toyou and your team. Maybe you can
tell us in the list you know, all the listeners about this meeting and
some of the research that you presentedthere. So it's called the Radiosurgery Society
meeting. It's the largest SBRT meetingin the world. SBRT. We've discussed

(03:45):
multiple time stands for stereotactic body radiationtherapy and really we have thought leaders from
all over the world. Meeting thisyear was in Chicago. I'm on the
scientific committees, which is, youknow, really nice. I get to
help, you know, kind ofshape the agenda. We brought I think
seven eight people from my department.We had a couple of neat presentations,
one of which was looking at patientage and who proceeds on to cybernife for

(04:10):
SBRT. And you know, historically, and we've had this discussion, right,
surgery has felt to be for youngerpatients and radiation was for older patients.
So we looked at a five yearseries of our patients and there were
probably five thousand patients that we lookedat during that five year cohort, and
we've kind of split them up fromage less than sixty, age sixty to

(04:32):
seventy, and age seventy and above. And we found predictively that you know,
the older patients went ahead, youknow, more frequently than younger patients.
It was probably greater than seventy percentof the older patients went ahead.
It was like sixty five percent ofthe patients of the middle age, but
interestingly more than half the patients thatwere under sixty. So these young patients

(04:53):
opted to proceed on with SBRT.So really we know this, right,
we published on the UNI that SBRThe doesn't really care what age you are,
nor does a surgical scalpel, rightor a bovie. So we're now
able to prove that across all agecohorts that SBRT you know, in our
hands a CyberKnife, but with otherplatforms is an effective way to treat prostate

(05:14):
cancer patients. So that was kindof super neat to present that. JOHNA.
Shock presented an abstract on looking onpre treatment colonoscopy and if they had
procedures before and let's say they hada poll removed, is that impact on
treatment? We found that not tobe the case, and we were actually
able to close out the entire session, so they have a kind of a
closing session, right, and ourwhole department led it. It was the

(05:36):
one session of the meeting and theywere probably like twenty or thirty sessions.
That was all NYU Long Island PearlMutter Cancer Center doctors, and we had
an entire section on SBRT for gynecologicmalignancies, and Eva Challis, who's our
physician director, was there, DeepRanks, Matt Whitten, my chief of
physics, and we moderated it.So it was a nice way and really

(05:58):
an honor to close out the entiremeeting with just NYU Long Island physicians.
I was kind of looking at onstage, I'm like, this is really
kind of nice. I'm proud ofour department and everything we've come and it's
nice to be recognized even on thatglobal level where they asked us to kind
of close it out as a department. Terrific, congratulations, you know,
and you're mentioned gynecological malignancies. Youknow, for in the prostate area,

(06:20):
patients are either going to choose tohave radiation or surgery. And there are
some patients that need radiation after surgery, thankfully not that many. But for
the SBRT, the cyber and ife, are you going to choose that or
you're going to choose surgery for thegynecological malignancies, Is it the same like
you're either going to have radiation oror surgery or is it not to the

(06:43):
same extent? Not right so soso it's it's really more rigid as far
as treatment option by stage. Butoftentimes when you have what's considered above an
early stage two cervical cancer, forexample, right what we call is stage
two B, which means that there'sgross server disease, those patients really are
often treated with a combination of chemotherapyand radiation, and the radiation typically consists

(07:09):
of two parts, the pelvic radiationmuch like we do for our high risk
prostate cancer, and then break etherrapy, which you also know about by putting
radioactive sources into the cervix and uterus. But there's a subset of patients that
for anatomic reasons or for medical reasonscan't have the break etherrapy part. So
for fifteen years we've done SBRT onthe CyberKnife as a boost in lieu of

(07:32):
the break etherrapy instead of the breaketherrapy, and it's considered a novel,
newer way to do it, andwe kind of led the session on that.
So let's say you have a threehundred pounds morbidly obese woman that you
just can't take to the operating themto do the break etherrapy. So historically
these patients would get regular radiation asa boost, and we discussed a really

(07:54):
nice trial that came out of theUK where they looked at patients that had
that done and essentially more than halfthe patients failed, and the majority patients
failed within the cervix. It wascalled a central recurrence because you can't get
enough dose in there. But bydoing SBRT, by doing cyber knife in
our hands, we can escalate thedose to do essentially the same thing as

(08:15):
breaking therapy, similar to what we'redoing with prostate cancer. Right, we
didn't make up the prostate cancer doses. They came from high dose rate break
etherrapy data. So we're just mirroringa treatment and a dose that we know
works and just doing it in amore elegant and non invasive way. So
similarly, we did that with ourgyn patients and we found that it worked.
It's still not yet considered standard ofcare because breaking therapy just has a

(08:39):
longer track record, but it's interestingand a really good tool to have in
our armamentarium for those patients that cannothave break etherrapy, and we're hoping to
be honest with you that eventually itbecomes a substitute for breaking therapy for this
malignancy. Yeah. You know,it's fascinating when I'm just listening to you
talk about all of the research andthe breakthroughs that are going on and how

(09:01):
you and your team and here atNYU are able to be on the forefront
of that. Here you're being askedto lead a session at a major radiation
oncology meeting, and people all overthe world are coming to you to learn
from you, to do what youdo, and to mirror what you do,
which is really phenomenal thing. AndI'm just also wondering for patients out

(09:22):
there, how do patients keep upwith all of this research? How do
they yeah, and have a greatthrough this process? So a lot of
it, I mean, you seeback in the day, you have to
on a certain level. You haveto trust your physicians, right usually when
I first started, right, youknow, and you and are contemporaries,
you know, when this is mytwenty seventh year, and to keep adding

(09:43):
years. I was a general radiationon collegist. I kind of did it
all. I did head and neck, I did pediatrics, I did gyn,
I did prostate, I did lung, I did brain and because it
was just a broader field. Butyou see it in neurology. I certainly
see it in radiation on colleg Youhave to kind of sub specialize, right,
It's impossible to stay up on allthe literature and all the different specialties.

(10:07):
You know. I can't stay upon all the pancreas literature, I
can't stay up in all the pediatricradiation literature. I can stay up on
the vast majority of the prostate literature. And you know urology too, right,
you you are the world's pre eminentcriosurgeon and the active holistic doctor in
the world in my opinion. Butyou know, I don't know how comfortable
you would feel doing an efrectomy forrenals. You become an expert in your

(10:30):
field, so you have to answeryour question. I think it's the patient
has to really kind of research theirdoctors to see what are they specializing.
Are they a generalist or they aspecialist. You have the option to go
to someone that really kind of subspecializes, and we give patients data you know,
we have you know, we havepackets of our own data, you
know, stuff that we've published,and we can point them in the direction

(10:52):
of other data. This is youknow, this is prostate CAM to these
other radiation options. This is thedata in you know, our hands here
at NYU Island, and we're nowworking in parallel and conjunction with our friends
in Manhattan. Also, this iswhat we publish in our hands. You
know, this is what John hasshas published, is what you know,
John Leshock is published, you know, Todd Carpenter is published. Now we're

(11:13):
working with our colleagues like the MichaelZeleski, Andrew Evans, David Mune,
all these wonderful people in Manhattan whenwe're combining forces with them. So it's
really really nice. But I thinkit's on the patient number one to go
to an NCI designated cancer center.And we've talked about that, because you've
already been screened to have the highestlevel of quality. Make sure that if
you have the option, try togo to a specialist that only does prostate

(11:35):
cancer, only does g y N, or only does head and neck,
and we have that in our departmentas well. And then ask for data,
you know, ask what you cantranslate into laypersons terms, because you
know, most of our patients areno physicians, you know, and explain
it to them. No, you'reyou're right. And I had on the
show a couple of weeks ago,you know, you know doctor Alec Kimmelman
who's now taken the leadership here atour promoter Cancer Center. And as you

(11:58):
mentioned, we're one of the fewcomprehensive cancer centers that are designated by the
National Cancer Institute. And I thinkwhat you're saying is true, that you
know you need to go, especiallywith cancer, and as you know,
and many of us realize that thefirst the first treatment of the cancer should
be should be the best and shouldbe the right one for you and in

(12:20):
the right hands. And sometimes thatsometimes that doesn't always include just one doctor.
It may include like yourself, aradiation oncologist, with a medical oncologist,
with maybe another either urologist or agynecological surgeon. So being part of
this comprehensive cancer center here, andthose words were really true. And I

(12:43):
was talking to doctor Kilman a coupleof weeks ago here on the show,
and his vision for our new inhis new position as the leader of the
promo or cancer center is just justexactly in line with what you're saying,
John. That and the research that'scoming out to day seems, you know,
just at a faster paced doesn't itdoesn't. It seem like the things

(13:05):
are evolving very quickly. Now wehave immune therapy, now, we have
combinations therapy, Now we have youknow, radio surgery that we didn't have,
you know, the Cybernie that you'retalking about, that wasn't even he
is fifteen years ago. You know, maybe you know, maybe it was
just starting. Yeah, that's exactlyright. I mean, you know,
you know, and Alex has beengreat. I mean, he and I've
worked together for over five years nowand he's he was my counterpart, meaning

(13:28):
the chair, and he still isthe chair at Parmetter Cancer Center in Manhattan.
But he's so wonderful, you know. He was, you know,
kind of now made in chart ofthe entire cancer center overseeing the radiation on
collegist, the medical oncologists, thesurgical oncologists, the research. Yeah,
you know, so it's it's reallynice to have number one, a great

(13:48):
person, a great researcher, andselfishly radiation oncologists in that position. He's
been great on every level, andhe's got a vision to you know,
to kind of marry the research andthe clinical side of it. And he's
been very supportive and you know thisof all the research that we're doing in
our department and all departments and tryingto translate that from you know, into

(14:09):
the clinics so patients benefit. Youknow, we can talk about some of
the neat studies that you and Ihave done that we've had opening but that's
with the support and blessing of Promutter. Yeah, and we're going to get
to in just a moment. Butif you just tune it in and here
in the morning, We're talking withdoctor Jonathan Hast, the Professor and Chairman
of Radiation Oncology at the NYU LandGoing Medical Center out here on Long Island,

(14:30):
and doctor has CyberKnife. The centeris available both in New York City
here in Minneola and now you're alsoseeing consults out east. I understand John,
is that right out at the LongIsland I go to Patchog once a
month. Doctor carpenters once a month. So we're trying to trying to make
that you make the initial consultation easierfor the patient, trying to make the

(14:52):
follow ups easier for the patient.You know, they're still coming to Mineola
for treatment, but it's only youknow, Patchog's only an hour away.
But if we can kind of makethe rest of it much more easy for
the patient from a convenience purpose,we're doing that. That's really terrific.
And I know that you're probably thinkingin the future maybe even having a cyber
knife out there, and we'll seein the future. Yeah, absolutely,
I mean we're looking to kind ofwe want to make a convenience on all

(15:15):
levels. We'll eventually have a fullthickness radiation oncology and parlmeter cancer department in
Patchog and we've had discussions about that. Yeah. Sure, And just before
the break, you were mentioning aboutso many of the wonderful clinical trials that
you're doing. It just maybe insummary, could you tell us some of
the ones that you're a most excitedabout. I know that. Yeah,
well, the one that you andI been doing for years, the one

(15:37):
that you and I've been doing foryears, which is Intrepid, So you
know that one's been a home run, and you were kind of at the
ten yard line about getting that completelyacross with all a cruel right, So
that one I love. That's patientsthat have you know, kind of higher
intermediar's prostate cancer, randomizing them toeither lupron, which is a medication that
patients don't love, versus dereludamide,which has less sexual side effects, and

(16:00):
we're integrating genomics, you know,the RNA test into that to kind of
really personalize and tailor of the radiation. So that one's been on for years.
We started, as you know,our two fraction cyber night protocol last
summer, instead of going from fivedays now going down to two. So
we're now in the low double digitsfor treating that. I think we have

(16:22):
about ten patients that have completed thatand we're now seeing them back in follow
up. So I just saw acouple last week and they're doing as well
as the five fraction, which iswhat we want to see. You we're
not trying to we already have greatoutcomes with five if we can replicate that,
and we think we can and wewith early follow up, are you
know, have the patients I'd ratherthan spend time with their family than with

(16:44):
John Has, right, So nowinstead of spending we kind of turned them
away from spending forty five days withJohn Has down to five days, right,
So now if we can have themspend just two days with me,
that's a benefit. And we've beenable to show that with early follow up.
Again, we're going to continue that. That trial needs to kind of
accrue more patients and have longer followup, but with short term follow up

(17:04):
and I nuncie patients, you know, add about six months, they're doing
great. A neat trial that we'reopening up with. I'm just ask you,
I'm sure that people are you know, if you're thinking, wow,
forty five days now, I'm fivedays now you can go down to two
days. That's dramatic. Am Igoing to be getting during those two days
a very high dose of radiation thatwould lead to more side effects? That

(17:29):
is that? No, absolutely not, and that's a great question. Quite
the opposite. So you know,you know, we do something called radiobiology
that determines the doses that we giveand the doses that we protect the normal
anatomy too, So it's when youdo the math of it as a conversion
factor, it ends up being equivalenteven slightly a little bit more to the
cancer and equal to the to thenormal anatomy. And we've had radio biology

(17:53):
talks, although I'm happy to gointo that that prostate cancer, in contrast
to many of the other cancers thatwe treat, responds better to larger fractions
giving over a shorter period of time. So we're just moving further along that
spectrum. But to be fair tothe patients since it's a newer dose,
that's why we do it on theauspices of an IRB approved protocol, meaning

(18:15):
that we've gone to the senior doctorsat the cancer center and say, hey,
this is a protocol that makes sensethat we believe it's safe based on
this data. And if you remember, I told you how the five fraction
data was replicated from the high doserate Brickie therapy data. We're not making
up the doses. So similarly,there's two fraction data that's been well established

(18:36):
and safe, so we're just replicatingthat. But to be fair, the
IRB and as it should, needsto sign off to say this is a
safe study both for the patient mostimportantly and also has the potential for the
betterment of cancer patients in general.So it checks both of those boxes.
So it took us oh gosh likeyears to get this protocol through and it's

(18:59):
test into doctor Shock's hard work,my hard work, you know, your
hard work to support it, andso we think it's going to be a
home run. But it's still earlyon study. But to answer your question,
we think it's perfectly safe. Wethink it's perfectly effective. We're not
making up the doses. They comefrom safe doses established elsewhere. That's great,
And you know things that we weretalking about earlier about how you move

(19:22):
science into the clinic and how youmove the research forward, and with all
these developments, it has to comethrough clinical investigations like the ones that you're
doing. I mean, we wouldnever have known that we didn't have protocols.
Right, Let's we be treating patientsof leeches. You know, if
you like the dark ages of medicine, right, you have to ask questions.

(19:44):
You have to be thoughtful about it, you have to be safe about
it, but you have to askthe questions. If you don't ask the
questions, medicine never advances. Right. You don't have robotic surgery, you
just have all open surgery. Youdon't have immunotherapy, you have kind of
carpet bombing chemo therapy. You don'thave genomics to tailor therapy. You have
one size fits all radiation. Soyou have to ask these questions otherwise medic

(20:08):
doesn't advance and patients can't do better. Yeah, and I've been thoroughly impressed
with this new oral pill that we'reusing in combination with the radiation instead of
the injection, which as you mentioned, gives men much more side effects due
to the lowering of the testosteron.This newer pill is just targeted to the
cancer cell itself. The testosterone levelsstay the same, the PSAs go way

(20:30):
down, and I think it's justit's going to be a home run.
Where as you mentioned, we're almostdone with the trial, but we've we
participated and entered more patients in anyother center in the United States. So
congratulations again on that, and I'msure that that paper will come out very
shortly. So okay, so we'vegot now we're going from from the five
day fraction where we're doing a clinicaltrial with two Any other trials that you

(20:55):
think that are coming up that you'reexcited about. Yeah, we're going to
be opening up one surely with myfriend, my colleague, my mentor,
doctor Michael Zelefski, who's been onyour show, where we're looking at taking
the patients with the higher intermediaris prostatecancer, the patients with the gleasi in
four plus three, randomizing those patientsto ADT, which men hate versus no

(21:17):
ADT, and we're going to furthersub stratify it by genomics. So when
I first started CyberKnife back in twothousand and five, really none of our
patients had ADT. You know,we had a thought that we would be
escalating the dose so high that wecan overcome you know, the hormone the
hormone effects, but it was neverreally proven in kind of a phase three

(21:40):
trial, which is the best wayto do radiation. So Michael, to
his credit, to listen, whydon't we try to prove that? So
you know, we know there's abenefit of hormones with kind of the standard
doses of radiation, but we're givinga radiobiologically higher dose when we integrate the
SBRT or use the SBRT. Soand we prove that what we think is
a possibility, meaning that you know, not all men need hormones. Can

(22:04):
we prove that with you know,with an elegant organized phase three trial and
just for the listeners, you aphase three trial, in my opinion,
is the best way to do research. You know, if you're taking a
group of patients, let's say there'sone hundred patients, to keep the numbers
round, and you're randomizing them.Half the patients get treatment A, which
is the standard and in this casethe hormones. The other half of the

(22:26):
patients get the question of the experimentaltreatment, which in this case is the
no hormones. And you know,there's science to support that, and the
genetics will or the genomics will furthersubstratify that. But if we can prove
you know that in a significant percentof patients you don't need the hormones.
That's a win, right because patientsdon't love having zero testosterone for six months.

(22:52):
But again it's on us to proveit. You know. It's interesting
what you're saying, and you know, the between the two clinical trials is
that we're they're both similar in theway that we're de escalating. You know,
with the first trial, we're givinginstead of the five treatments, we're
now going to two. In thissecond trial, we're going to give you
know, maybe patients a subset ofpatients instead of using the standard hormones,

(23:15):
no hormones at all, exactly,you know, and you wonder, I
guess it's through our own research andlearning, as you mentioned, with the
genomics more about the biology of thesetumors, that maybe not everyone needs to
be treated with a big sledgehammer.Let's say that you need, you need
some treatment, but we can deescalate and not give so much and reduce

(23:38):
the side effects and yet give youthe same cancer outcomes. Is that would
you say that that's true? Youhit the nail, Yeah, you hit
the nail, and it's beautifully articulated. What you just said so when I
was a resident. I trained atthe University of Pennsylvania and it's one of
the largest pediatric radiation coality departments inthe world. It's Children to Hospital of

(23:59):
Philadelphia. And one of my mentorswas a gentleman named Dan Dangio, like
the finest, one of the finestmen you'll ever meet. And his his
whole mantra was cure is not enough, right, and especially when it came
to the kids, because you know, do you want to give a five
year old, you know, bigdoses of radiation, big doses of chemotherapy
where you're going to stunt their growthand you're going to you affect their IQ.

(24:25):
So the pediatric you know, oncologypeople have been doing this for decades
where they take a treatment and ratherthan add intensity, they the the the
intensifies therapy. They lower radiation doses, they lower radiation fields, they decrease
cycles of chemotherapy, and you know, oftentimes more often than not it works

(24:45):
because you're asking these thoughtful questions withwith background of prior studies, and and
they're not doing they say, wellthat you know, this makes you know,
we're just going to throw spaghetti onthe wall. And see what hits
and sticks. They're doing this ina thoughtful, organized fash and and so
we're now you know, in mymindset, you know, we do this
with the kids, why can't wedo this with the adults. So cure

(25:06):
is not enough, right, meaningthat we want to cure patients, but
that's not enough. If we canlimit side effects, if we can limit
intensity, if we can limit treatmentduration, provided that there's equipose, right,
provided that the treatments are equivalent,then that's just a home run on
every level. But again, wehave to prove it so that you're exactly
right, you know. So we'redoing you and I are doing this together.

(25:27):
We're looking to less you know,less toxic you know, or less
you know, morbid hormones and tryingto prove that. And you know,
we can tell internally with what we'vealready seen on the study that that appears
to be the case. You know, we're trying that. We've already done
that with radiation. We were oneof the first to go from nine weeks
down to five days, and thatshowed better lifestyle for the patients and we

(25:48):
get them back with no compromising curerates. Again, you said it correctly.
We're looking to do that with twofraction, we're looking to do that
with hormones. We're looking to thatwith omitting hormones. So that's exactly right,
and it's a beautiful way to sayit. If we can kind of
get patients back to their life withfewer side effects and fewer time, that's
just a win. Well, thankyou so much, John, It was
really educational for me, and I'msure for all the listeners and if you

(26:11):
are listening out there, and Iwould like a consultation to see doctor has
and the Radiation on collegey department orone of his colleagues. They are throughout
Long Island, and as you heardus in the city as well. You
can certainly look him up online atthe NYU Land Going website or at the
Promoter Cancer website. And thank youso much, John, it was great,
and I know you wanted to talkabout so many other things as well,

(26:33):
but we'll get you back on theshow to talk about artificial intelligence all
the other wonderful things you and yourcollege are do in the department. I
love that, so, thank youso much, of course, my pleasure.
Well that's the end of the show. If you want to have a
great day. Enjoy the day,and we'll see you next week here on
kancers Corner. Every Sunday, tunein. This is doctor Aaron Katz.

(26:53):
You've been listening to Cancer's Corner.Come back every week to hear more straight
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