Dr. Rana McKay

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.

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.

for those individuals that relapse post-surgery, there certainly is a role for ADT combined with radiation. And particularly, it's largely dependent on what's the PSA level at the time of radiation, and also what's the patient's risk factors coming in to the radiation therapy, whether they should or shouldn't undergo ADT. And then for those individuals that have a relapse

for those individuals that relapse post-surgery, there certainly is a role for ADT combined with radiation. And particularly, it's largely dependent on what's the PSA level at the time of radiation, and also what's the patient's risk factors coming in to the radiation therapy, whether they should or shouldn't undergo ADT. And then for those individuals that have a relapse

for those individuals that relapse post-surgery, there certainly is a role for ADT combined with radiation. And particularly, it's largely dependent on what's the PSA level at the time of radiation, and also what's the patient's risk factors coming in to the radiation therapy, whether they should or shouldn't undergo ADT. And then for those individuals that have a relapse

post definitive treatment, post salvage radiation, post definitive radiation. They're not really a candidate for any more pelvic directed therapy. We're treating with intermittent ADT in the BCR setting. And again, the potency, of treatment is largely dependent on risk of disease.

post definitive treatment, post salvage radiation, post definitive radiation. They're not really a candidate for any more pelvic directed therapy. We're treating with intermittent ADT in the BCR setting. And again, the potency, of treatment is largely dependent on risk of disease.

post definitive treatment, post salvage radiation, post definitive radiation. They're not really a candidate for any more pelvic directed therapy. We're treating with intermittent ADT in the BCR setting. And again, the potency, of treatment is largely dependent on risk of disease.

For patients with a rapid PSA doubling time, we're generally now leaning towards doublet therapy with ADT plus an ARSI, particularly enzalutamide, which has been tested in this setting for intermittent duration. So one year of therapy and then off treatment.

For patients with a rapid PSA doubling time, we're generally now leaning towards doublet therapy with ADT plus an ARSI, particularly enzalutamide, which has been tested in this setting for intermittent duration. So one year of therapy and then off treatment.

For patients with a rapid PSA doubling time, we're generally now leaning towards doublet therapy with ADT plus an ARSI, particularly enzalutamide, which has been tested in this setting for intermittent duration. So one year of therapy and then off treatment.

And then in the metastatic disease setting, you know, that's where we're really thinking about more continuous therapy with more lifelong hormonal therapy, though I think that many are beginning to challenge that paradigm a little bit. But more lifelong therapy and particularly for those individuals with high risk disease or de novo metastatic disease, adding an additional RSI.

And then in the metastatic disease setting, you know, that's where we're really thinking about more continuous therapy with more lifelong hormonal therapy, though I think that many are beginning to challenge that paradigm a little bit. But more lifelong therapy and particularly for those individuals with high risk disease or de novo metastatic disease, adding an additional RSI.

And then in the metastatic disease setting, you know, that's where we're really thinking about more continuous therapy with more lifelong hormonal therapy, though I think that many are beginning to challenge that paradigm a little bit. But more lifelong therapy and particularly for those individuals with high risk disease or de novo metastatic disease, adding an additional RSI.

And I think, you know, the one caveat to everything that I've just stated is like PSMA PET imaging has really kind of wreaked havoc in our defining of different stages of prostate cancer. And so we're identifying disease earlier, we're identifying low volume metastatic disease,

And I think, you know, the one caveat to everything that I've just stated is like PSMA PET imaging has really kind of wreaked havoc in our defining of different stages of prostate cancer. And so we're identifying disease earlier, we're identifying low volume metastatic disease,

And I think, you know, the one caveat to everything that I've just stated is like PSMA PET imaging has really kind of wreaked havoc in our defining of different stages of prostate cancer. And so we're identifying disease earlier, we're identifying low volume metastatic disease,

And sort of some thought around, you know, intermittent therapy for people with metastatic disease by PSMA PET imaging, but conventional imaging negative and not wetting those patients to lifelong ADT. So that's still sort of also being tested.

And sort of some thought around, you know, intermittent therapy for people with metastatic disease by PSMA PET imaging, but conventional imaging negative and not wetting those patients to lifelong ADT. So that's still sort of also being tested.

And sort of some thought around, you know, intermittent therapy for people with metastatic disease by PSMA PET imaging, but conventional imaging negative and not wetting those patients to lifelong ADT. So that's still sort of also being tested.