And true story, how this goes, I said to my

wife, I said, okay, I think I'm going to reach out to my friends and then see, you know, if there are jobs available.

And she says, okay, I understand.

You know, she's very supportive.

And before I've done anything, you know, we wake up in the morning, I check my email and an email from Mayo, Arizona, colleagues there saying, Alan, we have an opening for a GU oncologist.

Would you be interested? And that's how I became a GU oncologist.

I took that job.

What was it for you, Alan? What drew you to City of Hope?

So I guess on those lines, Dr. Bryce, can you share a little bit with us how you thought about, or city of hope has thought about bringing in talent to the hospital, how you thought about recruiting, how you thought about training, how you've gotten to where you are now staffing up this, these Arizona, Arizona presence.

Yeah, absolutely.

I mean, in the past kind of three years, we've been building this.

You know, we started right from scratch.

You know, 1% market share in terms of the number of new cancer diagnoses in Phoenix in a given year.

You know, this last year, about 8% of all new cancer diagnoses in Phoenix, the patients came and saw us at City of Hope, right? So that's over the course of three years.

So it's a lot of growth.

Would you tell us a little bit about that and that community that it's serving up there?

Let's hear about the ESMO PRESTO trial.

Yeah.

So, so PRESTO, th- this, uh, study designed and led by our colleagues at UCSF, uh, Rahul Aggarwal and team.

So again, in the biochemically recurrent space, but a, a, a very different design.

So, so right off the bat, I would tell you, don't compare EMBARC and PRESTO.

Very, very different designs.

Um, and I'll, I'll get into some of that.

[clears throat] Again, Dr. Fazazi, uh, presented this at the ESMO meeting, really a ground baking-- breaking trial.

All right, let's hear about the ESMO PRESTO trial.

Yeah, so PRESTO, this is a study designed and led by our colleagues at UCSF, Rahul Agarwal and team.

So again, in the biochemically recurrent space, but a very different design.

So right off the bat, I would tell you, don't compare Embark and PRESTO.

Very, very different designs.

um and i'll get into some of that so again high risk biochemically relapsed defined by doubling time defined by no metastases on conventional imaging okay a patient has to have normal testosterone here the primary endpoint is psa progression free survival not metastasis free survival okay so again a very different endpoint you can't compare these studies um The three arms also are different.

So again, the control here, arm one is LHRH analog.

And again, Dr. Fazazi presented this at the ESMO meeting, really a groundbreaking trial.

All right, let's hear about the ESMO PRESTO trial.

Yeah, so PRESTO, this is a study designed and led by our colleagues at UCSF, Rahul Agarwal and team.

So again, in the biochemically recurrent space, but a very different design.

So right off the bat, I would tell you, don't compare Embark and PRESTO.

Very, very different designs.

um and i'll get into some of that so again high risk biochemically relapsed defined by doubling time defined by no metastases on conventional imaging okay a patient has to have normal testosterone here the primary endpoint is psa progression free survival not metastasis free survival okay so again a very different endpoint you can't compare these studies um The three arms also are different.

So again, the control here, arm one is LHRH analog.

And again, Dr. Fazazi presented this at the ESMO meeting, really a groundbreaking trial.

But, you know, certainly this is probably going to add some fuel to that fire, right? So what do you think it means for that decision initially between radiation and surgery?

Absolutely.

I mean, this is where the debate's going to come in.

So the MED-ONC's role often ends up being as the neutral arbiter, right? The patient meets with RAD-ONC, the patient meets with urology, the patient says, I don't know what I want to do.

Can I meet with the MED-ONC? And then they'll come to my clinic.

Um, so, you know, we talked through the different side effect profiles of the options, right? With radiation, you know, less risk of impact on erectile function, less risk of impact on urinary function.

Um, with surgery, you know, the idea has always been, well, you generally aren't going to do ADT, although these results would now say you probably would.

What else really enticed you to ASCA this year, Alan?

Tell our audience about that.

My father would always remind me, he said I was maybe 14 when I told him I was going to be a medical oncologist.

And honestly reflecting, I don't know why exactly we don't have any doctors in the family.

It's not that there was a lot of cancer history per se, but I think it was a time when I thought I wanted to be a doctor, but I looked at the science.

I realized cancers were so much of where we're struggling, right? We're looking for cures.

It was a big, difficult problem.

It was going to take a lot of effort, a lot of smart people working on it.

Is there stuff we can do there?