Bill Klaproth (Host): This is Outer Banks Health. I'm Bill Klaproth. With me is Dr. Amanda Pond, a urologist, and Dr. Charles Shelton, a radiation-oncologist, as we talk about advancing urology care on the Outer Banks. Dr. Pond and Dr. Shelton, welcome.

Amanda Pond, MD: Thanks for having us.

Charles Shelton, MD: Thanks, Bill.

Host: You bet. Looking forward to talking with you both about this. Dr. Pond, let me start with you. What inspired you to bring new urology procedures to the Outer Banks?

Amanda Pond, MD: For me, it's fun to do new things. It's important for me to stay on top of my field, which is constantly changing. That's one great thing about urology, is it's always evolving into less invasive procedures. And we're always doing research on cancer and prostate cancer and urology and how to improve patient outcomes and increase quality of life and decrease mortality. You know, a lot of people don't know about urology, but it's a really fun and exciting field. And we get to do a lot of different things. But it's fun for me, and patients appreciate it too. I think there is a little bit of a stigma in the Outer Banks that we don't do anything new and we don't have, you know, a lot of services, but I'm doing my best to try to change that impression, at least in the field of urology.

Host: Well, these are good advances for our community, so we're glad that you're bringing them to the forefront. You mentioned less invasive procedures, better patient outcomes. These are all good things. Can you talk a little bit more about that, how these advancements have improved patient care and outcomes in our community?

Amanda Pond, MD: Yeah. One thing with respect to prostate cancer that I've recently switched to is a transperoneal approach for prostate biopsies. So, historically, they have been done through a transrectal approach. One of the biggest, most serious side effects of that is infection. And so, by switching to the transperoneal approach, the risk of infection is much lower. I'm also doing those under anesthesia, which really increases patient comfort and patient satisfaction.

Host: I love it. And so good that we do podcasts like this for the community to learn about these advancements and new technology. Are there any other minimally invasive procedures that you now offer that makes what you do there unique that you can share with the community?

Amanda Pond, MD: Well, in our office, we have a minimally invasive procedure called Bulkamid, and it is a great procedure I do for my ladies who suffer from stress incontinence. What's great about it is it's done in the office, so there's no anesthesia. I do it in women from ages 30 to 90. There's no contraindications. Any woman can have it done. So, that's great, and I've had great results with that. It's a quick outpatient procedure. It's very safe and very effective. For my men who suffer from BPH symptoms, I do a UroLift in the office. Again, no anesthesia. And I know some people are afraid of anesthesia or maybe have too many comorbidities that put them at risk for anesthesia. And also, for my guys with prostate, we are working on getting aquablation approved. That's coming very soon. So, we're also very excited to start offering that.

Host: Absolutely, Dr. Pond. Thank you for that, Dr. Shelton. Let's bring you into the conversation. I know that you do a lot of work on prostate cancer patients as well. Can you share your thoughts on some of the new innovative approaches that are available?

Charles Shelton, MD: Sure, Bill, thanks. And thanks, Amanda. I just want to say how much this collaboration has been a game-changer for us in the Outer Banks. So in the world of cancer, cancer, as you can imagine, is very complex. And care is constantly evolving and it often requires continuous coordination of care, often between many supportive providers.

And in fact, you know, most, if not all, of our patients have to leave the Outer Banks for one component of their care. As a rural provider, we'll never be able to do everything in the Outer Banks. But by having this collaborative partnership with Dr. Pond by deliberated care coordination and collaboration with facilities that we partner with that offer the services we expect for our patient population, we can really make that care seamless and complete.

Host: I love it. And the collaboration really is important for our community. When it comes to prostate cancer specifically, can you share something you're working on or something either you're proud of a new procedure you're offering?

Charles Shelton, MD: Sure. So, I'll talk about what Amanda alluded to. So, you know, before Dr. Pond came here, and by the way, we did not have a urologist for many years, so all men had to leave the area for everything urologically. So, thank you for being here.

But one of the things Dr. Pond has changed for us, really in the last few years in particular, is just improving the patient experience. So, it's hard for us to talk about this as men. When we have exams, men don't like to have finger exams up their rectum to feel their prostate. Men don't like to have probes up their rectum to do biopsies and to look at the prostate gland size.

And so, what Amanda's done, which I love, is she's introduced a process where we can do this in the operating room under conscious sedation, much like what you'd envision with a colonoscopy or another outpatient procedure. You get sedation, you feel comfortable, you're able to tolerate somebody doing something that may not be a procedure you'd like to have done in the office. And so, that's something that we've changed in the last few years, which I really think puts the focus on the patient. So, we've also, because of that, transitioned from doing a lot of the biopsies in the office, which can be very uncomfortable, to offering biopsies now in the operating room by Dr. Pond as an outpatient surgical procedure that has not only allowed us to do, I think, a more effective biopsy for a patient, but it allows us to also combine some technologies. For example, we have the ability to take imaging that can be done at other hospitals, like an MRI, for example, of the prostate, which is a new modality that we offer in the Outer Banks. Those images that really show the cancer can be then fused at the time Dr. Pond is doing her biopsies to see exactly where the needle needs to be stuck in that patient while that patient is sedated. That allows us to get a more efficient biopsy of where the disease is located in that patient, which is more meaningful for that patient's treatment.

And she alluded to this earlier, instead of doing the biopsy through the rectum itself, which is not a clean area to do a biopsy, which can be associated with infections, she now does the biopsies through the skin underneath the scrotal area, which is done transperoneally, we call that, which is a much more sterile procedure. It's much more comfortable with the patient being done under anesthesia. And I think it's a much safer approach where we eliminate some of those risks of infection. And people don't think about this, but when you're an older man and you get a prostate infection, it can be very serious and often life-threatening in some of our 80 plus year old gentlemen. So to be able to do this in a manner that's much safer and much more patient-centered, I think, is a huge win for us, thanks to Dr. Pond.

Host: Again, that's the reason we do these podcasts. This is great information. Thank you for that, Dr. Shelton. Let me ask you this, for men that do have prostate cancer, does this procedure help protect patients during radiation therapy?

Charles Shelton, MD: Great question. Thanks, Bill. That leads right into what I do. So, I'm a radiation therapist by training. And one of the modalities that we offer outside of surgery for prostate cancer is radiation therapy. And radiation therapy is not without toxicities. I'm very transparent with patients, and I tell them some of the risks with radiation therapies, it can cause damage to the bladder or it can cause damage to the rectum, which are tissues that are very close by a man's prostate.

What Dr. Pond has done for us in the last year has been a game-changer. She now does some things to make the radiation more, not only more effective, but better targeted by putting something in the prostate after she's determined that that patient has cancer. Dr. Pond could put in little markers, they're called gold seeds. And what they are is almost like little fiducial pieces of metal that are placed very carefully within the gland to show me, as a radiation therapist, where do I want to point that beam when I treat that patient with radiation therapy. So, we can be much more targeted, which means we can shrink the radiation to just the area that needs to be treated, thereby eliminate some of the toxicities.

And then, over the last six months or so, we've also added an additional safety measure where Dr. Pond can interpose a gelatinous material behind the prostate and in front of the rectum, creating a little more space for my radiation to kind of skirt behind the prostate and avoid damaging the rectum, which is super, super helpful for patients. So, that's a safety benefit that we've derived from her being here just over the last year.

Host: Great information. And Dr. Pond, it sounds like this teamwork between you and Dr. Shelton and your specialties, it seems like it really has improved the patient experience. Would that be right?

Amanda Pond, MD: Yeah. I'm, as you know, the only urologist out here. So, it can be tough being a single provider, so it's really great to have Dr. Shelton and our oncologist, Dr. Spiritos, to collaborate on patients, especially some of these with more aggressive, high-risk disease.

Host: Absolutely. So, this has really been great information. Before we wrap up, I'd like to ask, each of you the same question. So, Dr. Pond, let me start with you. So looking ahead, what excites you most about the future of urology care on the Outer Banks?

Amanda Pond, MD: Well, as Dr. Shelton mentioned, you know, unfortunately, we are a rural area. And we often have to send people out for something. Something else that's coming to us. Aside from surgery, one of the other things I have to send people out is a specific PET scan for our advanced prostate cancer patients. It's a PET scan that's specific to prostate cancer that we don't currently have at the beach. But we are working on getting that done here locally. So, that will also be great. You know, since I've been here, we didn't have prostate MRIs when I got here. We now can do that locally. We're going to get PET scans here locally. So our goal is really to try to minimize the trips that our patients have to make off the beach. But I'm confident that, you know, Dr. Shelton and Dr. Spirito that we'll continue to stay on top of prostate care and be able to offer everybody the latest in treatment.

Host: Thank you so much for that. And, Dr. Shelton, thoughts from you on what excites you looking forward?

Charles Shelton, MD: Yeah. Having a urology provider like Dr. Pond here is a game-changer for us in the outer Banks. She's very humble and would probably not brag about herself, but I would tell you that her presence here has changed the patterns of care tremendously here. Before she was here, all men had to leave the area not only for their diagnosis, but also for a majority of their treatment. As you can imagine, Bill, that's distances that people had to travel typically to Virginia, to Greenville. And that has all changed dramatically over the last few years since she's been here. So, I can't say enough thanks for that. So now, the majority of men really can be diagnosed locally and treated locally. To me, that's a huge win for our population because they can stay home and receive the majority of their care. And I'll brag about her just because I know the data.

As a system within the East Carolina University Network, mRIs are the new thing for prostate cancer, and they've been around for several years, but they're not well-implemented in rural areas. Dr. Pond did 250 MRIs of men with prostate cancer last year. The system only did a thousand. So, Amanda, as one provider in a rural area, did essentially 25% of all the MRIs for men with prostate cancer in Eastern North Carolina, which tells you, A, she's busy, but B, she's much more tuned in to the relevance of modern imaging for diagnosis of prostate cancer.

So, we're really a leader of that as a small community within Eastern North Carolina, which is huge. And what I'd like to see for the vision of our future is we're really thinking about this cancer as a great way to be focused on precision medicine. So, precision medicine is a term you'll hear commonly in the world of cancer when you can identify something unique to the patient where the patient has genetic markers that are relevant for how their tumor is, what it is and why they have cancer. Or you can use precision imaging like the MRIs or like the PET scans that Dr. Pond's talking about. Those are things that historically we did not offer in the Outer Banks, which we offer now. And ultimately, when you're doing the right care for the patient. For each patient that we diagnose locally, that tends to translate into better odds of beating that cancer in the long run. So, I'm very excited about how we've embraced all the new modalities for prostate cancer, among other cancers as well.

Host: Yeah, that is good news. So last question for you, Dr. Shelton, before we wrap up. I know Outer Banks Health was awarded an $80,000 American Urological Association grant to address the needs of an aging population. Dr. Shelton, I know you led the grant effort. And then, Dr. Pond, you're carrying the work forward. Dr. Shelton, what does this grant make possible and and how will it impact patients locally moreover, what we all talked about in this podcast?

Charles Shelton, MD: So, I think it really iterates these same points that we've been talking about today about trying to bring home quality care to our communities. And so, part of what we're doing with this grant is we're looking at disparities in rural America. As you may know, Bill, North Carolina is the second largest state in America for its rural population. And we are a rural provider. We do cancer therapy well. And what we want to be is a model of how rural care can be done, just like it would be done in urban America by models like this, where we collaborate and we discuss patient care as a team.

So, our hope is to translate what we've done locally through the efforts of Dr. Pond and Dr. Spiritos and our nurse navigators. We actually have urological navigators now. We would like to share that information with the rest of ECU health system and to duplicate this model elsewhere within Eastern North Carolina.

Host: Well, I love that mission. I love that goal. Thank you for that, Dr. Shelton. This has really been insightful and informative and really important for men and for women to hear as well, because we all know men don't like to go to the doctor sometimes and it takes their wives to go, "You're going." So, good for everybody to hear the information on this podcast today. Dr. Shelton and Dr. Pond, thank you so much for your time.

Charles Shelton, MD: Thank you, Bill. Appreciate it. Thanks, Amanda.

Host: Absolutely. And once again, that is Dr. Amanda Pond and Dr. Charles Shelton. And for more information, please visit outerbankshealth.org/services/urology. And if you found this podcast helpful, please share it on your social channels. And please visit outerbankshealth.org/podcast for more podcasts just like this. This is Outer Banks Health, the official podcast of Outer Banks Health. Thanks for listening.