think that we should, for these kind of patients, have more biopsies or image-guided biopsies and evaluate other biological or genetic factors that could influence patient treatment?

Yes, and I suppose, Mariana, because this is a treatment based on imaging, imaging is our best tool for selecting these patients.

And as you might know, here in Australia, for all of our trials we've done in metastatic disease, hormone sensitive and CRPC, we've always used both FDG and PSMA PET CT to optimally select our patients.

Whereas in the VISION trial, it was a much more liberal inclusion.

You know, you just had to have a little bit of PSMA avidity, basically.

Now, critics of the Australian setup will say, look, we probably are disadvantaging some patients.

Maybe we're too particular about making sure these scans are optimal for radioligand therapy.

And staying on the MCRPC side of things at the moment, we know that the Pluto trial, which evaluated the clinical question of should we start with docetaxel or lutetium PSMA on patients that were progressing after RP, Maybe I'll just let Detan comment on the study.

That's

right.

We're seeing a change.

They used to have these cycles because our weather had more cycles that you'd get a good summer and then we'd have damp summers, which weren't as good for these butterflies to move north because they would come up from Spain and they'd reach a wall of rain and a rain of fog and they're kind of saying, well, I'm not going to go into that because I'm a warm, loving butterfly.

Now, year after year, our country is warming up more and more.

So it's becoming more suitable for them.

So they're able to get in year.

Not just numbers, but species.

What's your reaction to all of this?

Yes, look, I think it caught everybody by surprise when this announcement came out during the week.

But there are some details to it that we still have to understand.

So what they've announced really is not a complete demolition of the funding for the programme.

It appears they've announced that the funding that traditionally flowed to the Prostate Cancer Foundation of Australia, who were the ones who set up these nursing positions in the first place from zero, and instead they're diverting it away to a different organisation, to the McGrath Foundation, which of course does very worthy work for breast cancer and so on.

So I understand that's what's happened.

The amount of funding that they've been using to support these prostate cancer nurses in recent years will no longer go to the Prostate Cancer Foundation, but to the McGrath Foundation.

What should Australian men be doing to test and also stay on top of their prostate health?

What's your reaction to all of this?

Yes, look, I think it caught everybody by surprise when this announcement came out during the week.

But there are some details to it that we still have to understand.

So what they've announced really is not a complete demolition of the funding for the programme.

It appears they've announced that the funding that traditionally flowed to the Prostate Cancer Foundation of Australia, who were the ones who set up these nursing positions in the first place from zero, and instead they're diverting it away to a different organisation, to the McGrath Foundation, which of course does very worthy work for breast cancer and so on.

So I understand that's what's happened.

The amount of funding that they've been using to support these prostate cancer nurses in recent years will no longer go to the Prostate Cancer Foundation, but to the McGrath Foundation.

What should Australian men be doing to test and also stay on top of their prostate health?

What exactly is driving the disparity compared to major cities, Declan?

Unfortunately, Ross, it's a familiar story, not just for prostate cancer, but for a lot of other health issues as well.

We know there is this disparity between regional and metro things.

Some of it's about awareness.

Sometimes it is literally just people not getting access to the same awareness that they might be in the city.

And footy finals is a great time of the year to be, you know, for a lot of men who support those sports to be out and about.

And if there are messages at these events about getting tested for prostate cancer or other stuff, you know, heart disease and so on, that's good.

Now with all these major shifts underway what are the most critical immediate steps Australian men and their families should take right now to protect their health?

What exactly is driving the disparity compared to major cities, Declan?

Unfortunately, Ross, it's a familiar story, not just for prostate cancer, but for a lot of other health issues as well.

We know there is this disparity between regional and metro things.

Some of it's about awareness.

Sometimes it is literally just people not getting access to the same awareness as they might be in the city.

For example, you know, footy finals is a great time of the year to be for a lot of men who support those sports to be out and about and if there are messages at these events about getting tested for prostate cancer or other stuff you know heart disease and so on that's good but sometimes living out in the country you don't get access to the same messaging that's the first issue and the second issue is Sometimes you just don't get that same support, access to tests, access to treatment, access to nurses like the PCFA support.

So we still want to narrow that gap, especially in prostate cancer.

Now, with all these major shifts underway, what are the most critical immediate steps Australian men and their families should take right now to protect their health?

Can you talk us through what this pros and cons, risks, benefits, what does that chat look like?

Yeah, so prostate cancer...

And, and by the way, you know, um, you, you well know yourself, Priya, we have screening, uh, for a number of other conditions, like for breast cancer, you know, when women reach a certain age, a notice will pop in the door, "Please come and have a mammogram." For the bowel test, you know, above a certain age, automatically a letter will come in the door saying, "Do this test." We don't have the same for prostate cancer, and indeed, we're not proposing that we should automatically trigger a PSA test, for example, once a man hits the age of 50 or whatever.

And the reason for that is the PSA test on its own is not as useful a test as some other tests, like a mammogram or one of these bowel tests.

So the discussion is a little bit more nuanced about the pros and the cons because it's not the perfect test.

But let me be clear, it's by far and away, uh, the best tool we have to make sure that for this very common cancer, by far the commonest cancer in men in Australia, can be detected at an early time point rather than when it's already spread and it, it's too late.

The conversation is really one that GPs are best empowered to have because over the past 10 years we've seen big changes, for example, the use of MRI scans.

[laughs]