In this episode of Pearls & Perspectives, Amy Pearlman, MD, speaks with Dan Sperling, MD, DABR, a board-certified radiologist and medical director of the Sperling Prostate Center (Florida, New York) and the Sperling Diagnostic Group (Florida). The discussion focuses on advances in prostate MRI, targeted biopsy, and focal therapies for prostate cancer. Sperling shares how his career evolved from traditional diagnostic imaging into prostate MRI after collaborating with large urology groups frustrated by the limitations of standard transrectal ultrasound-guided prostate biopsy. Early exposure to European innovators in multi-parametric MRI (mpMRI) and in-bore biopsy fueled his adoption of advanced imaging and eventually focal therapies. Although initially met with skepticism, mpMRI is now a central component of prostate cancer care, with MRI-ultrasound fusion biopsies widely adopted as a cost-effective and accurate option. The conversation highlights the infrastructure required for in-bore MRI biopsies, the evolution of targeted fusion approaches, and how patients often seek Sperling from across the globe for cutting-edge imaging and treatment. His patients, many of whom prioritize quality of life and minimal adverse events, are increasingly exploring focal therapies as alternatives to surgery or radiation. Sperling explains his use of 3 main focal therapy modalities—focal laser ablation, MRI-guided focused ultrasound, and TULSA (transurethral ultrasound ablation). He outlines factors influencing treatment selection, including tumor location, prostate size, presence of calcifications, and genomic risk. Adverse events are generally mild, with catheter use for a short period post-procedure. The episode also underscores the role of artificial intelligence (AI) in prostate imaging. Sperling uses multiple AI platforms to refine detection, reduce false positives, aid in targeting, and even help differentiate scar tissue from recurrence after treatment. He sees AI as a rapidly evolving tool that will reshape diagnosis, treatment planning, and surveillance in prostate cancer. For urologists, Sperling emphasizes the importance of close collaboration with radiologists, adopting MRI-guided diagnostic strategies, and staying informed about focal therapy research. He encourages open-mindedness toward these evolving technologies, which he believes represent an exciting new era in prostate cancer management. Chapters 1:17 Dr Sperling outlines his background 6:46 Barriers to adoption of MRI-guided biopsy 12:14 Decision making for focal therapy treatments 21:28 Who is the ideal candidate for focal therapy? 24:45 AI's role in Dr Sperling's practice 29:26 Urologist-radiologist collaboration

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