Dr. Ruchika Talwar

So let's start just with tackling a bit about this heterogeneity that we see within favorable intermediate risk disease.

Tell me your thoughts there.

Yeah, absolutely.

I mean, I think it's a no-brainer.

Even a decade ago, when active surveillance wasn't quite as widespread, I shouldn't say it wasn't quite used as widely, we were still considering things like

active surveillance or just observation in patients who were sick or patients in whom treating the cancer wasn't within their goals of care.

So great point there, and we should call that out.

But I'm curious, for the healthy young patient who would be a reasonable treatment candidate, are there specific things in the pathology report that you are looking for?

Yeah, great point.

You know, we're going to talk about your surveillance protocol and monitoring in a moment, but I want to just spend a minute going back to something you said about estimating disease volume.

Now, let's say in this patient who's presenting with a new diagnosis of prostate cancer, you're considering active surveillance.

You know, here in the U.S., I think we're still mostly doing systematic plus targeted biopsies.

So let's say they present that way.

Do you look at the size of the lesion on the MRI if, for example, all of the targeted cores were grade group two, there were maybe none or maybe just a small amount of grade group one in the systematic biopsy?

Is the size of the lesion on MRI playing a role here?

Yeah.

And again, great segue to my next question for you.

You know, you talk about early biopsy.

I want to hear a little bit about your surveillance protocol for these patients.

Does monitoring look different in patients with intermediate risk disease versus those with low risk disease?