Dr. Rana McKay

And studies have actually demonstrated that the interprostatic and intratumoral androgen levels are even higher than what they are in circulation. And even when the levels are undetectable in circulation, you can still detect potent androgens within the tumor. So that's just my rationale to like continue to drive the T levels as low as you can get them. When you're on therapy, you're on.

And studies have actually demonstrated that the interprostatic and intratumoral androgen levels are even higher than what they are in circulation. And even when the levels are undetectable in circulation, you can still detect potent androgens within the tumor. So that's just my rationale to like continue to drive the T levels as low as you can get them. When you're on therapy, you're on.

And studies have actually demonstrated that the interprostatic and intratumoral androgen levels are even higher than what they are in circulation. And even when the levels are undetectable in circulation, you can still detect potent androgens within the tumor. So that's just my rationale to like continue to drive the T levels as low as you can get them. When you're on therapy, you're on.

When you're off therapy, you're off. But

When you're off therapy, you're off. But

When you're off therapy, you're off. But

Yeah, very good question. So I think certainly in the biochemical recurrence setting, that's where I'm thinking of more intermittent ADT. And there's really no data to suggest that continuous ADT is associated with better outcomes, probably increases the risk of toxicity. And so giving them opportunities where they can have, patients can have, you know, T recovery is critically key.

Yeah, very good question. So I think certainly in the biochemical recurrence setting, that's where I'm thinking of more intermittent ADT. And there's really no data to suggest that continuous ADT is associated with better outcomes, probably increases the risk of toxicity. And so giving them opportunities where they can have, patients can have, you know, T recovery is critically key.

Yeah, very good question. So I think certainly in the biochemical recurrence setting, that's where I'm thinking of more intermittent ADT. And there's really no data to suggest that continuous ADT is associated with better outcomes, probably increases the risk of toxicity. And so giving them opportunities where they can have, patients can have, you know, T recovery is critically key.

I think in the metastatic setting, I think in general continuous, but, you know, there are caveats to that. And I think a lot of the caveats stem from what PSMA PET imaging has done in the field, what Saber has done in the field with regards to localized treatment for metastatic disease, particularly in individuals with oligometastatic disease.

I think in the metastatic setting, I think in general continuous, but, you know, there are caveats to that. And I think a lot of the caveats stem from what PSMA PET imaging has done in the field, what Saber has done in the field with regards to localized treatment for metastatic disease, particularly in individuals with oligometastatic disease.

I think in the metastatic setting, I think in general continuous, but, you know, there are caveats to that. And I think a lot of the caveats stem from what PSMA PET imaging has done in the field, what Saber has done in the field with regards to localized treatment for metastatic disease, particularly in individuals with oligometastatic disease.

So I think we've really challenged the paradigm a little bit in the metastatic setting for those patients that have low volume oligometastatic disease, actually giving more finite treatment and actually thinking about introducing a holiday if the primary has been treated, the metastatic foci have been treated, and they've received intensified therapy.

So I think we've really challenged the paradigm a little bit in the metastatic setting for those patients that have low volume oligometastatic disease, actually giving more finite treatment and actually thinking about introducing a holiday if the primary has been treated, the metastatic foci have been treated, and they've received intensified therapy.

So I think we've really challenged the paradigm a little bit in the metastatic setting for those patients that have low volume oligometastatic disease, actually giving more finite treatment and actually thinking about introducing a holiday if the primary has been treated, the metastatic foci have been treated, and they've received intensified therapy.

I think that's sort of how I like to think about the continuous versus intermittent strategy.

I think that's sort of how I like to think about the continuous versus intermittent strategy.

I think that's sort of how I like to think about the continuous versus intermittent strategy.

You know, it's all the above and everybody's different. And what I will say is you're never going to find in a textbook a number for which, yeah, when you hit that number, go ahead and resume because everybody's different. So I think it depends on what's their risk, their PSA kinetics, what's their rate of rise. What's their rate of rise in the context of what their testosterone is doing?

You know, it's all the above and everybody's different. And what I will say is you're never going to find in a textbook a number for which, yeah, when you hit that number, go ahead and resume because everybody's different. So I think it depends on what's their risk, their PSA kinetics, what's their rate of rise. What's their rate of rise in the context of what their testosterone is doing?