Scott Webb (Host): Today, we're going to learn about the ExactVu ultrasound system that's being used at Summa Health for prostate screenings, and how it's benefiting patients in terms of earlier diagnosis and treatment for prostate cancer. And joining me for the fourth time is Dr. Joseph Dankoff. He's a physician and urologist with Summa Health.

 This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about prostate health and I'm a man, a guy in his mid to late 50s-- don't need to be specific. But I'm really excited to learn more about ExactVu, how it's making early detection, easy, all that good stuff. And I know that Summa's Urology Department started using ExactVu recently. So let's just talk about that. Like what is it, what is it for, and how is it helping?

Dr. Joseph Dankoff: Standard recommendations are that men age 50 and above get annual prostate cancer evaluation. And that includes getting a PSA blood test. So, men that have elevated blood tests have to go potentially for a biopsy. So since the 1990s, we've had technology that allows us to do an ultrasound in the rectum to identify areas of abnormality and then to pass biopsy needles through the rectal wall into those areas inside the prostate.

So, what ExactVu has done for us is it is taken a much more precise view at the ultrasound. Imagine if you had an Instamatic camera from the 1970s and you could find some film, you could take a picture of somebody. But if you had your own iPhone, you could take 100 times better picture under much better circumstances.

Host: Yeah. And I get that reference having been born in 1968. I totally get that reference. Maybe some of our listeners are too young, but I get it. An old timey camera versus our iPhones today. Amazing. So, let's talk about then the, like, positive impacts of prostate cancer screening, prostate health is seeing overall because of ExactVu.

Dr. Joseph Dankoff: Back in previous era when we were using the old style ultrasound machine, we had a positive biopsy rate, roughly 37-40%. And that was what the national average was. With our current imaging capability, our positive biopsy rate is above 50%. And in certain patient groups, it's as close as 90% positive. So, the cancers that had previously been undiagnosed, because we missed them because we didn't see them, now we're not missing them because we are seeing them.

Host: Right. Yeah. So, it's not that more people are suffering from or being diagnosed with prostate cancer, it's that you're diagnosing more folks, right?

Dr. Joseph Dankoff: That's right.

Host: Yeah. That's great. So then, let's talk about the actual procedure. I know that that's maybe what holds folks up sometimes from going for colonoscopies. So just in general, what can patients expect from the ExactVu procedure?

Dr. Joseph Dankoff: So, the way we do our biopsy procedure at our ambulatory surgery center in Medina is that the men come in, and they're going to a surgery center. They're going to be put to sleep. They're going to be under general anesthesia for about 10 to 15 minutes. The older style biopsy technique involved passing the biopsy needle through the rectal wall. We don't do that. We do what's called a transperoneal prostate biopsy. So while the imaging ultrasound is in the rectum, the biopsy needle itself passes through the skin between the scrotum and the anus. So since the needle never goes through the rectal wall, the risk of infection almost drops off to nothing. There are people around the world that do this biopsy procedure with no antibiotics whatsoever. We'll still give a single dose of antibiotics, but our infection rate is much, much, much less than it was back when we did transrectal biopsies.

Host: Sure. Yeah, it sounds pretty amazing. It sounds like music to my ears, as someone who may, you know, be recommended to have this procedure done, right? So, let's talk about the improvement in patient care. How are patients just benefiting overall from this?

Dr. Joseph Dankoff: Probably the most important factor is that I have inherited patients that have gone to every other urologist in Northeast Ohio who have specifically told their family doctors after having been through one of the older style biopsies in the office, awake, laying on their side, probed in the rectum, needle passing through the rectal wall, and they've been told, "I'm never going back there ever again. If I ever have to have that procedure done, I'd rather die of prostate cancer because it was so heinous."

What's interesting is so the men who have had it done our way, I have yet to have a man say, you know, "If I ever have to have this done again, I want to go back to the old way. I want to go back to that previous method of in the office." I've never had that in hundreds of men who've had it done both ways. So if a man has a biopsy for an elevated PSA, and it comes back negative, if a couple years later it comes back higher and the recommendation is to have a repeat biopsy, now they're getting those repeat biopsies done.

Host: Yeah. Yeah, I'm thinking about this. Maybe they're not lining up outside and pounding on the door to get in for ExactVu. But I totally get, you know, I understand completely why, if you have to have it done, once you've had it done this way, you would never go back to the old school method. It sounds entirely unpleasant. Just connecting the dots here, Doctor, right? So if we're diagnosing more folks because you can see better, you can see the cancer and all of that, then I'm assuming that just in general outcomes are better in terms of early diagnosis, early treatments, saving lives, all of that, right?

Dr. Joseph Dankoff: All of that is so much improved because no longer is the high grade cancer left to not be diagnosed. The analogy that I use for patients is if you're driving on a country road and you see a flock of sheep off in the distance, they look like sheep. They're not bothering anybody. What we're looking for with this is the camera that can identify the wolf dressed up in sheep's clothing that's lurking in the middle there that is way more aggressive, and that's what this machine allows us to do.

Host: And obviously, patients are benefiting and it sounds like providers as well along the way. Is there anybody who isn't eligible for ExactVu or come one, come all?

Dr. Joseph Dankoff: Well, it's pretty much anybody who would be a candidate for a prostate biopsy. If now some people have had surgery where their rectum has been removed, we wouldn't be able to do this procedure on them, but we wouldn't be able to do the old style biopsy on them either. So short of that, somebody that's on active blood thinner that can't come off of that, or somebody who's had other associated health issues, that makes the idea of doing a prostate biopsy on them not wise, if somebody just had a cardiac stent placed last week, even if they have an elevated PSA, we're going to need to wait on that a little while.

Host: Yeah, you said PSA there and it occurred to me, you know, I have some labs waiting that I have to go take care of. And one of them, of course, being my age is the PSA screening. I just wanted to have you maybe go over for folks, let's say, prostate cancer screening guidelines.

Dr. Joseph Dankoff: Yeah. So, the serum prostate specific antigen blood test is a blood test that is our main screening tool for this. So, men over the age of 50 are recommended by the American Cancer Society and a variety of other national organizations to get the annual PSA blood test.

If a man has a strong family history, in a close relative, a father, a brother, those men, we recommend that those men start at age 45. If a man is African American, we recommend that those men start at age 45 because African American men, for reasons that's not quite yet understood, are at higher risk, not only of getting prostate cancer, but of getting the more aggressive kinds of prostate cancer.

And if an African American man has a direct family member, a father or a brother who has been diagnosed with prostate cancer, especially at a younger age, those men can have as much as three times the national average of prostate cancer. So, we recommend those men actually start at age 40 to get annual checkups.

Host: it sounds very similar to colonoscopy, that for most it's 50, but maybe now 45 for some, especially with a family history and then a direct family history a little bit earlier. All good stuff today. I'll just give you a chance here at the end, Doctor, when you, you know, are discussing things with patients, if ExactVu isn't the gold standard yet, maybe it will be soon. Is that why we're talking about this today? That it really is so revolutionary that you want to tell everybody about it?

Dr. Joseph Dankoff: So, we use prostate MRI, multiparametric MRI, as another way to scan through the prostate. And there are different biopsy techniques that can use the MRI, but there are men who can't have an MRI be it whether they have metal in their body or they're claustrophobic. So for those men, this is an option for them that provides equally effective ability to image them. And in our patient population, a good 15% of the men who we've done biopsies on were men who didn't have an MRI because they couldn't have an MRI.

Host: Yeah. Well, I really appreciate your time today. You know, I'm a person like everybody else, and I see the news and social media and I'd heard about ExactVu and I knew that we were going to speak, and I'm like, you know what? I'm just going to wait and talk to the expert and get all my facts from him to better inform myself and obviously share that with listeners as well. So, thank you so much.

Dr. Joseph Dankoff: You're quite welcome.

Host: And to schedule an appointment, call 330-374-1255 or visit summa health.org/urology for more information. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.