Alan Bryce, MD: We have this embarrassment of riches, and it’s a wonderful problem to have, trying to figure out who gets which regimen, and recognizing how quickly the field is moving forward. To anybody on the panel, what will you tell your patients about why you’re selecting doublet versus triplet [therapy]? Or, and I think we’ll talk about that next, let’s start talking about clinical trials and the other combinations. We’re not slowing down in this first-line setting. Say the patient comes in after having read online, they’ve got a lot of advice coming to them from different directions, what does the decision-making hinge on? We talked about fitness and risk, and how we describe risk is probably where we have the biggest uncertainty. Volume is easy, or metastasis—liver metastases are easy. But how do we talk to the patient about risk?

Edwin Posadas, MD: There are things the patients already hear: the Gleason score, certain patterns of metastasis, we can explain they’re bad. Everyone is familiar with bone metastases and lymph node, liver, lung, those always send a red flare up saying you’re starting in a tougher position. Those always make you want to be a little more aggressive, and when a patient hears that they’re falling out of the norm, they’re a little more inclined to take that lead, especially when you can back it up with some literature. Looking at the ARASENS study as an example, but even in LATITUDE, when you start seeing these higher-risk features, you need to be more rather than less aggressive. But then you’ve got to balance that same discussion with who’s chemotherapy fit and who’s intensified AR [androgen receptor] suppression fit. That has already come up here, where we’re balancing overall survival with quality of life and other comorbid conditions. This is why medicine is still an art and not a cookbook type of profession.

Transcript edited for clarity.