Phillip Koo:

There's still a lot of patients who might be on just one treatment–only ADT. And we know now that that is not the optimal care. So can you talk to us a little bit about that and what's going on? Why aren't people, you know, getting the appropriate care?

Zachary Klaassen:

Yeah, it's a really tough question. We could probably spend another 30-minute webinar on that topic alone. But I'll synthesize it down to this, I think, for the majority of patients, 98%, 99%, ADT plus something else is the standard of care. There may be that 1% where they have really bad comorbidities. They're really elderly where that doublet therapy may not be the right option, but for the majority, overwhelming majority, treatment intensification is important.

To answer your question about why it's not happening, I think there's a lot of factors. I don't think anybody's fully put their finger on how to fix all of this. But it's gone from about 50% of patients getting treatment intensified about 5 years ago. Some of the more recent data is up to 70% to 80%, so I think we're getting better. That 20% is that gap that's really difficult.  Whether this is, you know, payer-related, coverage-related may be part of it. Whether it's just somebody that's not keeping up with the literature as much as, you know, the people on the line and folks that go to all these meetings.

There's a lot of potential hypotheses as to where that 20% still is falling through the cracks, but I think, encouragingly, it is getting better. Excuse me, it's not perfect yet, but certainly it is getting better.

Phillip J. Koo:

You know, I think that's a great take home message for patients is, you know, patients becoming educated and taking power and being informed about their care really can make a difference. And yes, there are going to be exceptions. But you know, patients who have metastatic disease–disease outside the prostate should be getting more than just one anti-hormonal drug. So that's great to know.