Dr. Rana McKay

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?

Are they just rapidly rising because their testosterone is recovering and that's what's driving their doubling time? Or are they... Do they have a stable testosterone and they're rising? What's the absolute number of the PSA? How do they do with hormone therapy before? Do they want to go back on hormone therapy? What does their PSMA PET scan shows when their PSA gets up to a certain level?

Are they just rapidly rising because their testosterone is recovering and that's what's driving their doubling time? Or are they... Do they have a stable testosterone and they're rising? What's the absolute number of the PSA? How do they do with hormone therapy before? Do they want to go back on hormone therapy? What does their PSMA PET scan shows when their PSA gets up to a certain level?

Are they just rapidly rising because their testosterone is recovering and that's what's driving their doubling time? Or are they... Do they have a stable testosterone and they're rising? What's the absolute number of the PSA? How do they do with hormone therapy before? Do they want to go back on hormone therapy? What does their PSMA PET scan shows when their PSA gets up to a certain level?

So I think it's all of these factors. that will weigh in when is the right time. And, you know, the right time is what's right for the patient, quite honestly. So there's no, you know, in the BCR setting, not to say you're treating a number, but you kind of are. There's no clinical symptoms. They don't have metastases.

So I think it's all of these factors. that will weigh in when is the right time. And, you know, the right time is what's right for the patient, quite honestly. So there's no, you know, in the BCR setting, not to say you're treating a number, but you kind of are. There's no clinical symptoms. They don't have metastases.

So I think it's all of these factors. that will weigh in when is the right time. And, you know, the right time is what's right for the patient, quite honestly. So there's no, you know, in the BCR setting, not to say you're treating a number, but you kind of are. There's no clinical symptoms. They don't have metastases.

You're trying to ward off the development of metastases and improve their longevity. But Whether you start at three months or at six months or wait a little bit longer, there's no data to say that doing something one way versus another way improves outcomes.

You're trying to ward off the development of metastases and improve their longevity. But Whether you start at three months or at six months or wait a little bit longer, there's no data to say that doing something one way versus another way improves outcomes.

You're trying to ward off the development of metastases and improve their longevity. But Whether you start at three months or at six months or wait a little bit longer, there's no data to say that doing something one way versus another way improves outcomes.

Yeah, no, very good. I mean, I think the way to approach it is to be systematic about it. and provide education. I think, you know, actually in communicating with patients about their different experiences in when they started ADT, I think one of the biggest take homes was like, everybody does it different. Every doc doesn't different. There isn't sort of like a system.

Yeah, no, very good. I mean, I think the way to approach it is to be systematic about it. and provide education. I think, you know, actually in communicating with patients about their different experiences in when they started ADT, I think one of the biggest take homes was like, everybody does it different. Every doc doesn't different. There isn't sort of like a system.

Yeah, no, very good. I mean, I think the way to approach it is to be systematic about it. and provide education. I think, you know, actually in communicating with patients about their different experiences in when they started ADT, I think one of the biggest take homes was like, everybody does it different. Every doc doesn't different. There isn't sort of like a system.

So I think like kind of being a little bit more systematic about, you know, these are the options that you have and these are the side effects and just, you know, You know, at our institution, you know, Aditya kind of we piloted together kind of like an ADT order set, you know, like when you're going to start ADT, these are the things to think of. These are the labs to think of.

So I think like kind of being a little bit more systematic about, you know, these are the options that you have and these are the side effects and just, you know, You know, at our institution, you know, Aditya kind of we piloted together kind of like an ADT order set, you know, like when you're going to start ADT, these are the things to think of. These are the labs to think of.

So I think like kind of being a little bit more systematic about, you know, these are the options that you have and these are the side effects and just, you know, You know, at our institution, you know, Aditya kind of we piloted together kind of like an ADT order set, you know, like when you're going to start ADT, these are the things to think of. These are the labs to think of.

This is the imaging. Here's the teaching. And I think that that really kind of takes out a lot of bias from the process. So I think standardization is important and also kind of seeing what the goals are for the patient and aligning with them is really key. I think what's really cool that's coming down the pike is, you know, we continue to bat away at the androgen receptor in prostate cancer.

This is the imaging. Here's the teaching. And I think that that really kind of takes out a lot of bias from the process. So I think standardization is important and also kind of seeing what the goals are for the patient and aligning with them is really key. I think what's really cool that's coming down the pike is, you know, we continue to bat away at the androgen receptor in prostate cancer.

This is the imaging. Here's the teaching. And I think that that really kind of takes out a lot of bias from the process. So I think standardization is important and also kind of seeing what the goals are for the patient and aligning with them is really key. I think what's really cool that's coming down the pike is, you know, we continue to bat away at the androgen receptor in prostate cancer.

And I think the next generation of hormonal agents, we've got CYP11 inhibitors that now not, you know, the abiraterone is a CYP17 inhibitor, blocks a little bit lower down in the adrenal hormonal axis. You know, MK5684 is a CYP11 inhibitor that blocks even higher up. preventing cholesterol from entering into the hormone production pathway.