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Welcome. As part of this program, we want to take a moment to step away from the science and guidelines and hear directly from the patient perspective. We're joined today by Darrell Wilson, a patient advocate with a lived experience navigating advanced prostate cancer. His perspective helps ground today's discussion in the real-world challenges patients face as treatment pathways evolve and resistance emerges. Darryl, thank you so much for being here and for sharing your experience with us. You're welcome. Thank you. So to begin, could you briefly share your prostate cancer journey and how do you came to be diagnosed with uh metastatic castration resistant prostate cancer? Certainly. I was diagnosed in 2015. Uh, with the metastatic castrate resistant prostate cancer that came after about, after a, a year after I've done my brachytherapy, which was a treatment that we used for recurrence. So originally we thought it was just simple recurrence and then discovered that it was uh metastatic. Thank you. So, as clinicians, we often talk about progression in clinical terms, but that moment can feel very different for patients. So, at what point did you realize your cancer had progressed despite treatment, and how was that communicated to you? OK. Uh, the first indications that we had that the cancer, uh, progressed from just recurrent localized, uh, to metastatic came during the year after brachytherapy when the repeated, uh, prostate-specific antigen tests, the PSAs, uh, Uh, continued to rise. So, uh, having done the localized treatment, we At least I surmised that it was probably metastatic. Uh, about a year after the brachytherapy, with the rising, with the rising PSA, we, uh, did another scan. And in the days before PSMA scans, we did another scan. We found tumors outside. They called me and said they shared that information with me with a phone call that said uh we're transferring you or recommending you to uh uh oncology. Mhm. Thank you. So when patients hear about progression, new terminology often enters the conversation. What would you say were your biggest concerns or questions when you first heard the term treatment resistance? Um With treatment resistance or uh essentially the first resistance after the initial ADT we were using uh Lupron in those days and uh The progression is, is difficult. Uh, finding out that it had progressed, uh, to metastatic and was now castrate resistant as well, uh, was a big step, and it, it, you know, being honest, it did bring tears, uh, to both my wife and I. It was a difficult change, uh, recognizing at that point that Um There was little hope of curative. You know, uh, now it was just hoping management, uh, extended and became, uh, Oh, what do you call it, uh, Just a disease that you managed for years and years. Thank you. We do appreciate you sharing that so openly. Um, so beyond scans and lab values, progression also affects daily life in important ways. Uh, from a patient perspective, what does disease progression feel like both physically and emotionally? Uh, physically, uh, the progression at that point hadn't changed anything. Uh, my initial symptoms that way back at the beginning, uh, prompted, uh, uh, examining and doing the PSA tests and following the very first before diagnosis. Uh, the symptoms then were just low urine flow. A weak flow, uh, and that continued to be the case. The radiation, uh, caused, of course, fatigue. The treatments caused fatigue, you know, the Lupron, uh, the addition of, uh, in that time abiraterone, uh. You know, they all become cumulative and add up, um, uh, low and then no libido, low and the brachytherapy caused complete erectile dysfunction. Uh, those cause some changes. But realistically, uh, I try to be realistic. Um, I was already, I was growing old anyway. You know, I was diagnosed at 59 and by the time we got to these things, I was another 5, 10 years older. As it progressed, uh, I'm now 75. Um So they're natural issues anyway, most of them, uh, to some degree or another. Um, so those are easily for me, easy to accept. A lot of my men in my groups have tremendous difficulty with one or another of them, uh, particularly younger men diagnosed in their late 40s and 50s. Uh, it's a big deal. They expect to live a long time and to live with these issues is, uh, Disconcerting to say the least. Um, I didn't start experiencing actual side effects from the disease, uh, until Maybe a year, 1 year and a half years ago, when I started getting some pain in the shoulder blades and the spine. So, it's been for me an easy ride. Mhm. And many patients assume that newer therapies will continue working indefinitely. Uh, were you aware that resistance could happen even with advanced therapies, or was this a surprise to you? It's not a surprise. Uh, I try to stay well informed through the various websites and such and the doctors. Uh, so it wasn't a surprise. Uh, in fact, most of my treatments lasted longer than, uh, the median in their clinical trials. Uh, of course, I recognize in clinical trials you're picking a very select subset of people that are, as they advance. But I did do well. I did better than most, uh, typically the Typically, the treatments lasted the median or even twice as long as the median. The abiraterone lasted twice as long as the normal or average. Nothing's normal in this case. Uh, no, I was, I was aware, we were aware. I see. So when it became clear that one therapy was no longer working, um, how are the next steps discussed with you? Usually I was aware of what would be coming next and uh always, always planned for it ahead of time actually with uh research and discussions with doctors and others in the uh prostate cancer community, support community especially. Um, so I was aware that something would come up and we tried to prepare for what we would do next. Um, of course, the discussions or the, the events when we finally had to recognize that, hey, we've crossed this threshold, and we're now in the next room. Um, some of those are very difficult, especially, as I said, the one going metastatic and castrate resistant, uh. Very difficult. That moment often involves complex decisions. Um, so what information or type of explanation helped you the most when deciding whether to move on to a new treatment? Uh Usually information that I would get uh from. The internet, but I, I don't mean that. In the broad sense that, you know, is, is a negative. Uh, I don't just Google prostate cancer. Uh, I trust some, I trust certain sites and we go to them, including the manufacturers of the pharmaceuticals websites. They have good information on side effects, uh. It's often difficult to tell which ones are, uh, realistically. Gonna occur, but that's partly because everybody's different. Uh, I tend to be a little healthier going into this than a lot of men, even men my age. Uh, and that helps mitigate side effects. Diet helps mitigate side effects, um. So in making the decision, I'm looking for as much information as I can get, including With through the support groups and such, men who've gone through it. Um, Typically before I add something, I've talked to several men who've used that. Therapy before.