Dr. Rana McKay

And, you know, there's still a role for that even in the modern era, if you will, if we think about the cost of care and in people who are going to be on indefinite ADT without any reason to discontinue therapy, it still plays a role in the modern era for a select number of patients.

And certainly as we think about underserved, you know, regions of the world where there's a lack of access to drugs and treatments. I think as we think about the GnRH analogs, I think there's been an evolution. Classically, we think of GnRH agonists that have been kind of the backbone of treatment. And if we go back to normal physiology, typically the LH and FSH are released in a

And certainly as we think about underserved, you know, regions of the world where there's a lack of access to drugs and treatments. I think as we think about the GnRH analogs, I think there's been an evolution. Classically, we think of GnRH agonists that have been kind of the backbone of treatment. And if we go back to normal physiology, typically the LH and FSH are released in a

And certainly as we think about underserved, you know, regions of the world where there's a lack of access to drugs and treatments. I think as we think about the GnRH analogs, I think there's been an evolution. Classically, we think of GnRH agonists that have been kind of the backbone of treatment. And if we go back to normal physiology, typically the LH and FSH are released in a

let's say, pulsatile fashion, if you will, when there's a continuous stimulation of the pituitary hypothalamus access, it results in complete kind of shutdown of the access, you know, pulsatile therapy versus continuous therapy. And that's basically how we achieve suppressed T levels with the GnRH agonist.

let's say, pulsatile fashion, if you will, when there's a continuous stimulation of the pituitary hypothalamus access, it results in complete kind of shutdown of the access, you know, pulsatile therapy versus continuous therapy. And that's basically how we achieve suppressed T levels with the GnRH agonist.

let's say, pulsatile fashion, if you will, when there's a continuous stimulation of the pituitary hypothalamus access, it results in complete kind of shutdown of the access, you know, pulsatile therapy versus continuous therapy. And that's basically how we achieve suppressed T levels with the GnRH agonist.

And then the antagonists have come around, which instead of, you know, working first to turn on the access before they turn it off, immediately suppress. And then, you know, now we've got androgen receptor pathway inhibitors. I mean, there's many of them out there that further suppress or block androgen signaling that have really entered into the landscape.

And then the antagonists have come around, which instead of, you know, working first to turn on the access before they turn it off, immediately suppress. And then, you know, now we've got androgen receptor pathway inhibitors. I mean, there's many of them out there that further suppress or block androgen signaling that have really entered into the landscape.

And then the antagonists have come around, which instead of, you know, working first to turn on the access before they turn it off, immediately suppress. And then, you know, now we've got androgen receptor pathway inhibitors. I mean, there's many of them out there that further suppress or block androgen signaling that have really entered into the landscape.

So I think we've seen an evolution from surgery to the injectable analogs to now next generation potent oral agents.

So I think we've seen an evolution from surgery to the injectable analogs to now next generation potent oral agents.

So I think we've seen an evolution from surgery to the injectable analogs to now next generation potent oral agents.

Yeah, absolutely. So very good question. You know, I think in the localized setting for individuals that are undergoing surgery, at the present time, there's no role for perioperative therapy, though there are clinical trials that are looking at investigating that, but currently no role.

Yeah, absolutely. So very good question. You know, I think in the localized setting for individuals that are undergoing surgery, at the present time, there's no role for perioperative therapy, though there are clinical trials that are looking at investigating that, but currently no role.

Yeah, absolutely. So very good question. You know, I think in the localized setting for individuals that are undergoing surgery, at the present time, there's no role for perioperative therapy, though there are clinical trials that are looking at investigating that, but currently no role.

I think for people that have, that are undergoing radiation, there absolutely is a role for ADT and the duration and intensity varies dependent on the risk of the patient. And so in the context of intermediate risk disease, six months of a GnRH analog would be sufficient for patients with high risk disease, two years of therapy.

I think for people that have, that are undergoing radiation, there absolutely is a role for ADT and the duration and intensity varies dependent on the risk of the patient. And so in the context of intermediate risk disease, six months of a GnRH analog would be sufficient for patients with high risk disease, two years of therapy.

I think for people that have, that are undergoing radiation, there absolutely is a role for ADT and the duration and intensity varies dependent on the risk of the patient. And so in the context of intermediate risk disease, six months of a GnRH analog would be sufficient for patients with high risk disease, two years of therapy.

And for patients with very high risk disease defined as a PSA of greater than 40, at least an 8, 9, 10 disease or T3 disease, having two out of three of those factors, they're getting the addition of abiraterone to ADT. So that's treatment in the definitive setting with a curative intent. And we know that there are some patients that go on to relapse following definitive treatment.