Herbert Lepor, MD, on Focal Cryotherapy, 1000 Procedures, and Andre De Shields
Herbert Lepor, MD, discusses NYU Langone's 1000th focal cryotherapy procedure, Andre De Shields' case, and why prostate cancer treatment is at a turning point.
In this episode of The Moonlight Shift, Gina Mauro sits down with Herbert Lepor, MD, who serves as the Martin Spatz Chair of Urology at NYU Langone and one of the most recognized prostate cancer surgeons in the country, to discuss the milestone that reframed how he thinks about everything he has built: the 1000th focal cryotherapy procedure at NYU Langone, and the Broadway legend who made it famous.
The Family Story and the Brother's Scar
The episode begins further back than the operating room. Lepor's grandparents escaped Russia for Romania and eventually the United States, where they worked in sweatshops and opened a luncheonette in Brooklyn, New York. He was the first in the family to become a physician — a path set in motion at age 6, when he watched his 3-year-old brother Norman survive one of the first open-heart surgeries in San Diego, California. He was fascinated by the scar. Norman became a cardiologist. Both brothers attended UCLA and Hopkins.
Patrick Walsh, 7000 Cadaver Sections, and the Nerve Nobody Could See
At Hopkins in the early 1980s, Lepor worked under Patrick Walsh—whose portrait still hangs directly behind his chair at NYU—to trace the nerves mediating erection during radical prostatectomy. The work required making 7000 microscopic sections through cadaver specimens to locate nerves invisible to the naked eye. The resulting nerve-sparing approach was a major advance, though not a complete solution. After more than 5000 surgeries, Lepor's own outcomes data told a more complicated story: persistent erectile dysfunction, incontinence during the recovery period, and in 20% of men, penile shortening or curvature. Then MRI arrived.
The Andre De Shields Moment
The 1000th patient was Andre De Shields—Tony and Grammy Award winner, 80 years old—who told Lepor directly that surgery or radiation were not options because he had a Broadway revival to open. He asked to be the first case of the day because of a Playbill interview the following morning. He was back at rehearsals for Cats: The Jellicle Ball in 2 days, and his PSA at the time of filming had decreased by approximately 80%. That outcome, while notable, reflects the program's broader results: 996 of 1000 cases were outpatient procedures, with no recorded cases of incontinence and 80% of men reporting erectile function comparable to pretreatment levels at the 2-year mark, vs approximately 30% after radical prostatectomy.
Freeze, Cut, or Wait?
The episode's game segment presents five clinical prostate cancer scenarios. Lepor calls for active surveillance in a low-risk 58-year-old, focal cryotherapy for a well-localized intermediate-risk tumor in a 65-year-old, and surgery for a 50-year-old with aggressive disease across both sides of the prostate. The segment's most resonant moment comes at the end, when asked what he would do in the patient's position: "I will not answer that question because what I would do shouldn't reflect what they would do."
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