Unlocking Prostate Cancer Secrets with Dr. Stephen Scionti

Unlocking Prostate Cancer Secrets with Dr. Stephen Scionti

Prostate Cancer Diagnosis and Modern Focal Therapy Options with Dr. Stephen Scionti

Season eight of Villages Vitality: Senior Life Unscripted opens with host Mike Roth interviewing Dr. Stephen Scionti, a board-certified urologist and founder of the Scionti Prostate Center, about modern prostate cancer diagnosis and treatment. Scionti explains diagnosis begins with a PSA blood test, followed by prostate MRI to assess enlargement and identify suspicious lesions, using MRI as a roadmap for biopsy. He recommends MRI-fusion targeted biopsy—preferably transperineal rather than transrectal—to improve accuracy and reduce infection risk. Treatment depends on risk: low-risk cancers may be monitored with active surveillance, while intermediate cancers may be treated with focal therapy to preserve urinary and erectile function. He outlines focal options including cryotherapy, HIFU, and MRI-guided TULSA, discusses candidacy (often Gleason 7, prostate-confined disease, sometimes with BPH), coverage differences between traditional Medicare and Medicare Advantage, and improved drug options for metastatic disease.

• 0:00 - Introduction
• 1:18 - Diagnosing Prostate Cancer
• 2:29 - The PSA Test
• 6:45 - Targeted vs. Random Biopsy
• 7:19 - Treatment Options
• 9:34 - Alzheimer's Medical Tip
• 10:54 - Focal Therapies for Prostate Cancer
• 12:53 - The TULSA Procedure
• 15:21 - Insurance & Medicare Coverage
• 18:13 - Advanced Prostate Cancer
• 19:39 - Best Candidates for TULSA
• 23:52 - The Male Lumpectomy Analogy

Villages Vitality Listeners, I've got some good news for you. In season 8 most new episodes will released as both audio & video versions. Videos on Apple Podcasts, Busssprout.com and YouTube. If you're listening via our Buzzsprout feed, you can ask questions via the Fan Mail button or leave me comments as a text or in our new feature, you can send it as a voicemail. If you'd like a response, make sure you leave your name, email address and cell phone number.

Transcript

[00:00:00] Dolores: Welcome to Season eight of Village's Vitality Life, senior's Life unscripted. In this new season, we talk to leaders of clubs and interesting folks who live in and around The Villages. We also talk to people who have information vital to seniors. You will get perspectives of what is happening in and around The Villages, Florida.

In addition, we will add more information for all seniors.

[00:00:39] Mike Roth: This is Mike Roth on Villages Vitality, Senior Life Unscripted. Today I have a very special guest, Dr. Stephen Scionti, a board certified urologist who specializes in prostate cancer treatment and a founder of the Scionti Prostate Center.

He offers comprehensive diagnostic services. Including MRI fusion, targeted prostate biopsy and MRI guided targeted focal treatment of prostate cancer. Thanks for joining me. Dr. Scionti.

[00:01:18] Mike Roth: How is prostate cancer diagnosed?

[00:01:22] Dr Stephen Scionti: Mike prostate cancer diagnosis starts with getting the PSA blood test That's the first step 

[00:01:29] Mike: Mmhmm 

[00:01:29] Dr Stephen Scionti: They go to a screening but usually as part of an annual physical a man has a blood test called a PSA The PSA reflects the degree of really of activity within the prostate If that PSA number is abnormal that will prompt more investigation okay So that's the first step though Once the PSA is elevated I'm always gonna recommend an MRI study of the prostate So MRI is a imaging test in which the prostate can be seen in great detail and areas that have a cancer will show up very nicely on MRI so the decision about whether a man needs a prostate biopsy or not starts with an elevated PSA and an MRI study. Now the MRI shows whether the prostate's enlarged because an enlarged prostate may be a cause of an elevated PSA .

[00:02:20] Mike: Mmhmm 

[00:02:20] Dr Stephen Scionti: is an area if there's a cancer though that will show up nicely on the MRI and will tell the urologist that the next step would be a prostate biopsy.

[00:02:29] Mike: Now the PSA test

[00:02:31] Dr Stephen Scionti: has

[00:02:32] Mike: has been around for a long time 

[00:02:33] Dr Stephen Scionti: of

[00:02:34] Mike: false positives in the past even a, a tendency to not offer a PSA test to men over 75. 

[00:02:43] Dr Stephen Scionti: Do

[00:02:44] Mike: you think that's wrong?

[00:02:45] Dr Stephen Scionti: I think it depends on the age of the man and that's a conversation that doctors got to have with the patient I've got a lot of 75yearolds that are They're like 50 year olds right If they got 10 15 year life expectancy and they have prostate cancer we'd probably wanna know about it On the other hand we have gentlemen who are 75 with a lot of medical problems and it's probably not as important But that's a discussion with the doctor But I don't believe there should not be an age cutoff strictly It's really a shared decision made between the doctor and the patient.

[00:03:16] Mike: How high of a prostate

Test number does someone have to have before

they should be considered worrisome? 

[00:03:21] Dr Stephen Scionti: The number really depends on prostate size and the old adage that a PSA over four is too high That really depends on the size of the prostate But in general if there's a PSA that for the typical say 70 yearold man if the PSA is over four at least the PSA should be monitored carefully And if it keeps on rising then the next step is to take a look at the prostate with an MRI study So the days I think there's a tendency still for this reflex approach PSA is elevated let's just do a biopsy on a patient I think that's oldfashioned and I don't think that's correct Today's technology allows for much better precision diagnostics By getting that MRI we can determine whether a man really needs a biopsy or not and if a man does need a biopsy the MRI becomes the roadmap It's the roadmap as to how to direct the biopsy So biopsies are done into the prostate via what's called a needle biopsy My preference is to use what's called a transperineal approach which means we no longer put needles through the rectum into the prostate So I've gotten away from what's called a transrectal prostate biopsy because of real infection issues and bleeding it can cause in the rectum The modern technology is to take a biopsy through the perineal skin that patch of skin that's town kind of where you sit on a bicycle seat It's that patch of skin between the scrotal area and the rectal canal Now here's the key with this is that if the MRI shows an abnormality software is used to create a 3D model of the prostate That 3D model of the prostate is integrated to an ultrasound picture and now the biopsy becomes targeted Targeted random right Can

[00:05:04] Mike: Yeah

[00:05:04] Dr Stephen Scionti: going fishing without a fish finder right Or going hunting without aiming right That's what a random biopsy is right So a targeted biopsy is using the MRI roadmap to direct a biopsy needle directly to where the abnormality is. And that precision in diagnostics allows for a much more accurate ability to understand whether a man has cancer or not and if there's a cancer how aggressive is the cancer right If the needle doesn't capture the tumor then we miss the whole thing and we don't know what we're dealing with.

[00:05:37] Mike: What do you see differently on a, an MRI that tells you it's cancer?

[00:05:42] Dr Stephen Scionti: it's cancer the tumor region looks very different right The MRI has different ways to look at the tissue right there's a series of images that are not to get too technical but there's something called a T2 image and the MR the tumor's gonna appear as a dark spot okay there's another way the MRI looks at that It looks at the way water moves through the prostate tissues That's called diffusion And so if there's restricted water movement that shows up as a bright spot on the MRI and those are signs that there may be a cancer present in that area.

[00:06:14] Mike: Now you said that you create A 3D model of the Of prostate. 

[00:06:19] Dr Stephen Scionti: Yeah that's called fusion right And so what that is it's using computer software to overlay the MRI picture to the ultrasound picture right And then we see exactly using ultrasound technology with the MRI overlaid to it where that suspicious area is So that allows then for a biopsy needle to be tracked directly to where the abnormality is

[00:06:45] Mike: That makes a lot more sense than the the random placement of 12 samples

[00:06:50] Dr Stephen Scionti: I've been doing targeted biopsies since 2012 I was very much involved in the early phase of that but I will tell guys out there that be careful because there's still some urologists that still do the oldfashioned random nonguided biopsy So it always helps to ask when the doctor says you need a biopsy ask how are you gonna do it Are you gonna use the MRI to guide it Are you gonna use software to help guide that biopsy

[00:07:14] Mike: So the worst case is

You

discover some prostate cancer. It--

[00:07:18] Dr Stephen Scionti: it

[00:07:18] Mike: wh- 

what are the treatment options today that you recommend for patients?

[00:07:23] Dr Stephen Scionti: Prostate cancer comes in all sizes and shapes and flavors right So you can have these very small very slow growing prostate tumors that will probably never be dangerous right And that's called a low risk prostate cancer if someone's got a low risk prostate cancer and they're 70 or 75 years old then they're likely never gonna need treatment so we put those men on a monitoring or what's called a surveillance process right So a lot of men don't need treatment They just need to be monitored and they'll never come to any harm with that The next step up though sometimes we see these tumors that are in a region or an area of the prostate and it's got the characteristics of a more active cancer that's got the ability to grow and spread if we leave it alone And if that's regional if that's in an area have advanced techniques to just treat the bad spot So instead of destroying the entire prostate the bad region can be treated That's called focal therapy It's a targeted treatment to the tumor region of the prostate but preserving much normal prostate as we can preserve And why that's important because preserving prostate tissue preserves function preserves urinary function preserves erectile function right Sometimes it's a cancer that's so advanced that the entire and it's got a very aggressive characteristic to the cancer and those are the men that need a much more invasive type approach Some of those men may need surgery Other times they'll need radiation usually with what's called hormone therapy or medication to lower their testosterone but that's the extreme end There's a lot of men who live right in the middle ground enough cancer that they more than should be watched but not so much that we need to use an elephant gun to treat them right That middle ground where we can use a precision targeted therapy is where a lot of guys are gonna live with their cancer and the nice thing is that if we take that approach then we can treat the cancer and preserve their quality of life So there's a balance here right And that's really important Really important

[00:09:27] Mike: Good.

[00:09:28] Dr Stephen Scionti: Good

[00:09:28] Mike: Let's take a short break here and listen to an Alzheimer's tip from Dr. Craig Curtis

[00:09:34]  Dr. Craig Curtis: We now know that Alzheimer's disease starts about 20 years before the symptoms with the buildup of a toxic protein called amyloid. And so scientists have been on a quest to remove amyloid to see how it affects the disease. The medicine that was recently FDA approved to slow down symptoms in people with Alzheimer's disease memory problems.

Works by removing this substance called amyloid out of the brain. And now we're attempting to use those medicines to actually remove amyloid before someone develops symptoms of Alzheimer's disease, such as memory loss and forgetfulness. So that's in that 20 year period before the disease is obvious.

That's right. Scientists now call it Alzheimer's Pathologic change versus Alzheimer's disease. We're saving the term Alzheimer's disease for when someone is actually experiencing symptoms due to Alzheimer's disease. With over 20 years of experience studying brain health, Dr. Curtis's goal is to educate The Villages community on how to live a longer, healthier life.

[00:10:42] Warren: To learn more, visit his website, craigcurtismd.com, or call 3 5 2 5 0 0 5 2 5 2 to attend a free seminar.

[00:10:51] Mike: I'm back with

Dr. Stephen

Scionti.

What types of different focal therapies are there

for prostate cancer, and what makes each one unique? 

[00:11:03] Dr Stephen Scionti: At the Scionti Prostate Center I've been involved in doing this sort of work going back to the late 1990s I did my first focal therapy approach in 1999 and in those days we used a technology. The first approach was freezing freezing or what's called cryotherapy So the sort of granddaddy of all focal therapies is cryotherapy or freezing Now today it's gotten more modernized where you can use that MRI roadmap but basically we're placing freezing needles through the skin into the prostate to freeze a portion of the prostate And those freezing needles are connected to a computer which controls the freezing and it uses a gas called argon which creates a lot of cold. So that's freezing or cryotherapy It's a bit invasive because I've got to place several needles into the prostate to get the freezing but that's the first approach that was developed and we still use that for appropriate patients In - and 2004 we started to see the development of a technology called high intensity focused ultrasound or HIFU In fact the early research goes back to the mid'90s on that technology HIFU is focused ultrasound therapy so high intensity focused ultrasound the acronym is HIFU But that's focused sound energy that can be directed from a probe in the rectum focusing the sound energy to where the tumor is it's a focused sound treatment Now what does the sound do The sound creates heat So we're creating a very intense thermal or heat treatment of the tumor region again guided by the MRI guidance So taking that MRI model I talked about for the biopsy we can make

model and use that to guide the placement of ultrasound energy through the rectum the tumor region That's called focal HIFU treatment 

One of the more modern approaches in fact the most modern approach to date is something called TULSA transurethral ultrasound ablation Now this one's really cool because this is a technology done in the MRI machine which the MRI is running continuously taking continuous pictures of the prostate we can see the tumor region continuously real time the TULSA procedure delivers the ultrasound energy through the urinary channel so it's the center of the prostate out from the center of the prostate out the energy comes and it comes out like a radius or imagine a wheel and you've got the hub wheel is the direction that the ultrasound energy goes And we can sweep that through a radius through a a 10degree 20degree 30degree arc whatever we have to sweep that through to cover the tumor area But the nice thing about that is it's totally noninvasive There's no punctures There's a ultrasound probe in the urinary channel like a catheter right

[00:13:56] Mike: I know

[00:13:56] Dr Stephen Scionti: The MRI is guiding the treatment There's a lot of AI and robotics involved but it's a precision temperatureguided MRIguided treatment and I can treat sometimes a quarter of the prostate sometimes a half whatever I need to treat to get the tumor region But that would be the state of the art treatment today is the TULSA It's called TULSA-Pro in the area it's available at in our local region over in Wesley Chapel so we do a lot of work with the Bay Care system and Bay Care has a state of the art MRI suite in Wesley Chapel and that's where we do our TULSA-Pro treatments today

[00:14:31] Mike: Mm-hmm.

[00:14:32] Dr Stephen Scionti: Finally Yeah

[00:14:34] Mike: I'm curious, how many centers around the country are

doing this Tulsa Pro approach, which sounds phenomenal? 

[00:14:41] Dr Stephen Scionti: about 20 probably it just it takes a lot of specialized training and it takes a very advanced treatment center to do this There's a lot of complex technology that's going on there but there's there's about 20 centers that have active programs in the United States the nice thing is that a treatment that's done in the hospital environment like we have at Bay Care for our Medicare patients gonna be able to get some insurance coverage and that's important If it's not done in a hospital setting there'll be no insurance coverage at all But for our Medicare patients if we're using a hospital center like Bay Care we depending on the Medicare type policy someone has oftentimes we can get some coverage for that patient.

[00:15:21] Mike: Now, when you say Medicare, you're talking about traditional Medicare or Medicare Advantage?

[00:15:27] Dr Stephen Scionti: It's traditional Medicare is pretty automatic That that's a great question because most people don't understand the difference traditional Medicare no questions asked is gonna have coverage for TULSA Medicare Advantage plans are very much individual it's they get to make their own rules right 

.

 And it's arbitrary right that's on a very much a

[00:15:47] Mike: Like them too much. Right. So your center is in Tampa area

[00:15:51] Dr Stephen Scionti: Tampa but My office is in Sarasota 

[00:15:54] Mike: Okay

[00:15:54] Dr Stephen Scionti: center our Tulsa program is all performed at BayCare in Wesley Chapel . Our HIFU procedures for example happen here in Sarasota but our Tulsa programs is located at this stateoftheart center that's a brandnew hospital and beautiful MRI center . This is an anesthesia procedure where the patient goes to sleep in the anesthesia machine So one of the big 

[00:16:13] Mike: Right 

[00:16:14] Dr Stephen Scionti: of a center in a hospital is you've got skilled anesthesiologists who are used to working inside of an MRI suite It's called an interventional MRI suite in the Bay Care footprint they built this beautiful center in Wesley Chapel So it's a wonderful center for us

[00:16:30] Mike: I'm wondering how that compares because I've been in an MRI machine and they go crazy with you

[00:16:36] Dr Stephen Scionti: with

[00:16:36] Mike: taking off all the metal off your body. I can't imagine that,

[00:16:40] Dr Stephen Scionti: the 

[00:16:40] Mike: when you're doing these procedures

[00:16:41] Dr Stephen Scionti: No that's the challenge

[00:16:42] Mike: metal

[00:16:43] Dr Stephen Scionti: equipment that has to be compatible in that MRI environment right And so it's not any center can do that your anesthesia machine's gotta be MRI compatible all the anesthesia monitoring equipment's gotta be MRI compatible And so yes you have to have staff that's used to working in the MRI suite cause there can be no metal You're right No metal at all

[00:17:04] Mike: metal of any kind

[00:17:05] Dr Stephen Scionti: Yeah No that's right If someone came in with a piece of metal in their pocket that'd be very bad

[00:17:10] Mike: Yeah.

[00:17:10] Dr Stephen Scionti: Because it'd go right into the magnet

[00:17:12] Mike: Well, people have fillings in their mouths or, 

[00:17:14] Dr Stephen Scionti: Fillings in the mouth are fine That's not magnetic and but things like so some of the patients that we gotta be careful about is if someone's got a pacemaker they might not be a good candidate for this procedure because most pacemakers don't work well in an MRI environment But anyway that's the most state of the art technique that we have today So the three main treatments then to summarize that we can freeze the area we can put ultrasound energy from the bottom up that's HIFU or in the MRI suite from the inside out under MRI control that's TULSA And TULSA would be the most recently introduced process It was FDA approved in 2019 We've done several hundred of these procedures to date and I will tell you that they're some of my happiest patients because they've had a noninvasive precision treatment but you gotta be a right candidate So it all starts with the diagnostics the correct way All You gotta biopsy the prostate the right way You have to know where the cancer is You have to understand where it lives in three dimensional space how to get energy to that But if someone's a great candidate for that it's a tremendous approach for them.

[00:18:13] Mike: What about patients who had prostate cancer that spread beyond the

prostate? 

[00:18:17] Dr Stephen Scionti: yeah and so that happens unfortunately all too often right and men like that today applying treatment just to the gonna help them But that story's really different than what it was 20 or 30 years ago when I was a young doctor early on in my career the only option we had for men like that was a castration operation they had their testicles removed because if you starve the cancer of testosterone the cancer would slow down And that was the And there were drugs that did that for years Today that that is so different there's so many advanced drugs that can be used that that alter how that cancer inter interacts with the male hormone testosterone different immune therapies today that are available there's different types of chemotherapy So whereas years ago man who had cancer that had spread throughout his prostate that was a death sentence usually we would say that half the men would be dead in two years That's not true today We have a lot of men living five 10 years and longer with that condition So that's a very promising area where a lot of new drugs have come along to extend the the lives of men with these advanced prostate cancers 

[00:19:29] Mike: So drugs are, the treatment of choice for the prostate cancers that have spread.

Now can we go back again? I wanna touch that question I asked a little bit earlier maybe. 

Who are the best candidates for the MRI-guided treatment of prostate cancer?

[00:19:45] Dr Stephen Scionti: the best candidate for that is a man that's got a cancer number one that's contained confined to the prostate they've got a cancer that lives in that middle range We use something called a Gleason score So these Gleason score 7 patients are the sweet spot That's that intermediate grade cancer contained confined to the prostate With TULSA if I have to treat a quarter of the prostate I can do that If I have to treat half or three quarters of the prostate I can do that So as long as the prostate is of the proper size and the energy can reach we can treat those men here's the other added benefit Men who have an enlarged prostate who have what we call benign prostate enlargement or BPH does a beautiful job treating the BPH tissue as well So the man that's got a combination of an enlarged prostate and prostate cancer the cancer's contained confined to the prostate and he's got an intermediate risk intermediate grade cancer TULSA's gonna be a great option because we can treat both conditions the enlargement and the cancer with a single treatment .

[00:20:50] Mike: And again, how long have you been doing this?

[00:20:52] Dr Stephen Scionti: I did my first TULSA procedure the first urologist in the United States by the way of 2020 January 2020 started the program right before COVID and we And that first year 2020 I think we had 66 patients that had TULSA procedure know a lot of a lot of patients couldn't see their doctors because of COVID we were open We're in Florida so we were open we saw patients come from all over the country here to have their cancer treated But since that time we've been quite busy with this I'm I do the TULSA procedures generally about four days every month So I devote four days a month to the our TULSA program and our patients come from all over the country We recently treated a patient that came from Alaska so we see patients from all over the country here.

[00:21:38] Mike: So I imagine the machine is very specialized and there aren't very many hospitals around the country that have it.

How many patients do you see? Do you see many patients from The Villages area?

[00:21:48] Dr Stephen Scionti: We see plenty of patients from The Villages area and we see them for all the for patients coming down for biopsies for these precision biopsies and and with all the different focal therapies But sure it's not that far it's a what from The Villages to Sarasota is what About a two hour drive So it's Yeah it's not bad a lot of our patients come again they've got to fly in But our Florida patients we make it's easy to see us from the Florida area So it's a This is something that this is a program I've been working on for well over 20 years well over 20 years. When we first started this whole concept of focal therapy people thought we were crazy people because the idea that you could treat a portion of the prostate technology didn't exist to do that 25 years ago It didn't exist and the idea was the cancer is always involved with the entire prostate the problem is in those days we didn't have MRI we didn't have good diagnostics and we didn't have good technology to be able to deliver treatment to a region So the only thing we could do 25 years ago was take the prostate out or apply radiation to the entire prostate But today it's different The diagnostics are different The ability to localize the cancer is now there The ability to deliver energy to a region is there and that's resulted in a tremendous improvement in quality of life for our prostate cancer patients So what was very controversial 25 years ago now is becoming very popular and many of the major medical centers around the United States have initiated programs in focal therapy So where they used to think we were crazy people now they think we're pretty smart And so I speak continuously around the United States on these topics at meetings And i if you're ahead of the pack in anything people think you're a little off right They think you're a little nuts .

[00:23:36] Mike: Well 

[00:23:37] Dr Stephen Scionti: they begin to think maybe there is something to that And then eventually they think you're pretty smart That's how it goes

[00:23:43] Mike: Yeah,- I've seen that before.

I had a friend who had the freezing procedure on his,

[00:23:48] Dr Stephen Scionti: on

[00:23:48] Mike: half of his prostate,

[00:23:50] Dr Stephen Scionti: prostate

[00:23:50] Mike: wanted him to come back for the second half

[00:23:52] Dr Stephen Scionti: One of the analogies that's been used over the years is an analogy was made to breast cancer In fact one of the early terms used for focal therapy was the male lumpectomy The male lumpectomy The idea is that in the old days if a woman had breast cancer the only option she had was a complete removal of the entire breast of course all the things that go along with that all the all the negative consequences that went with that were there Complications That's right But as technology improved there was a realization that if the breast lump could be removed with a safety margin around it as long as the cancers weren't overly aggressive women did just as well and they maintained their normal quality of life so the same analogy has been made to prostate cancer Now if a few years later in the other breast a woman got another lump and they can have another lumpectomy So the same analogy is there If we treat a bad area of the prostate cancer and maintain function and we monitor someone periodically with MRI studies and say five years from now something shows up on the other side of the prostate we can go back and treat that area if it's necessary But all along we're maintaining a balance between treating the cancer and maintaining that quality of life and that's the tightrope that we're always trying to walk know and that's the that's where we got in a lot of trouble years ago with of the government task force panels saying that prostate cancer is being overtreated Let's not even bother to diagnose it anymore So there was a recommendation if you'll recall going back about 10 years ago from one of the governmental task force agencies that said Too many PSAs are being done You're finding too much prostate cancer You're over treating too many patients unnecessarily the government's their approach was let's tell doctors not to do PSAs anymore So what they did is they to use an old saying they threw out the baby with the bathwater is what they did answer is let's be smart about we do a PSA on and let's be smart about our diagnostics Let's not treat the people who don't need treatment That is do surveillance on the low risk patients The patients that need treatment we can treat focally Let's treat the bad area Let's preserve quality of life and let's reserve those aggressive treatments only for the men that truly need it All right

[00:26:10] Mike: Good

[00:26:10] Dr Stephen Scionti: The more enlightened approach I think and that's where I think the world has come to

[00:26:14] Mike: I think that's, that is more enlightened Dr. Scionti.

[00:26:17] Dr Stephen Scionti: Of you

[00:26:17] Mike: Find out more or set up an appointment, how do they do that? 

[00:26:20] Dr Stephen Scionti: Our website's been up and running for well over 10 years now It's Scionti Prostate Center Scionti SCIONTI sciontiprostatecentercom That's the best way to find us have a lot of videos on YouTube explaining a lot of this stuff But people find us from word of mouth That's really that's probably the most common way but we're really easy to find on the web And we have a way where a patient can fill out an inquiry form and our staff gets back with them really within the hour and gets right back with folks and they get me records I review records and we have a we review patients cases to see if they're candidates If they are then we take the next step and get them in to see me . We do an initial review on anyone that's interested with prostate cancer.

[00:26:58] Mike: Thanks Dr. Scionti and I'm sure you'll be hearing from , some 

of our

listeners .

[00:27:04] Dr Stephen Scionti: Thank you. I enjoyed the opportunity.

[00:27:06] Speaker 4: Remember, our next episode will be released next Friday at 9:00 AM. Should you wanna become a major supporter of the show or have questions, please contact us at mike@rothvoice.com. This is a shout out for supporters, Tweet Coleman, Ed Williams, Duane Roemmich, Paul Sorgen, and Dr. Craig Curtis at K 2 in The Villages.

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