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Zachary Klaassen: Hi, my name is Zach Klaassen. I'm a urologic oncologist. We are live at GU ASCO 2025 in San Francisco. I'm delighted to be joined by Dr. Oliver Sartor, who is a medical oncologist at the Mayo Clinic in Rochester. Oliver, thanks so much for joining us.

Oliver Sartor: Thanks, Zach. Glad to be here.

Zachary Klaassen: So we're going to be discussing the PRECISION database. And it's a huge platform. I'm excited to talk about it. And this specific study was looking at treatment patterns and outcomes. Maybe just give our listeners a brief overview of what the PRECISION data platform is.

Oliver Sartor: It's a really cool registry. Yeah. It's taken in about 500 practice sites. It's a combination of both medical oncology and urology, and actually a little more weighted to the urology in the early phases. We're talking about over 65,000 patients with advanced prostate cancer.

The follow-up now is relatively short. So kind of starting in 2022, and data cutoffs 2024. And so we don't have a huge amount of data yet, but it's evolving. And it's going to be a tremendous resource as we go forward. Sponsored by Novartis.

Zachary Klaassen: Yep.

Oliver Sartor: Good people on the steering committee, including myself, that are helping to ask the questions and be able to say, OK, what are the practice patterns, et cetera, et cetera. So it's a really cool registry.

Zachary Klaassen: And it's awesome because we're not only going to continue to add numbers, but each year, more follow-up and more follow-ups. We're going to have really meaningful conversations about sequencing. For this conversation, we're talking about just treatment patterns that we see in that first initial batch of patients. So maybe just take us through that study design and maybe some of the key results.

Oliver Sartor: Yeah, so I mentioned the interval we're talking about, starting in 2022 to 2024. And the first thing is just like, well, what happens to the patients? And there's still some incomplete data. Let me say that. But in terms of the true and complete data, patients who are like—we don't have very much data at all—it's probably 10% or 11%.

Zachary Klaassen: That's pretty good.

Oliver Sartor: And the interesting thing to me is people have talked about how the ARPis are not being utilized in the hormone-sensitive space. Well, they actually are. And if you actually look at the delta between the ADT use and the ARPi, the ARPis, just to name them, would be darolutamide, enzalutamide, apalutamide, abiraterone. So the utilization of these in the castrate-sensitive or hormone-sensitive metastatic space is actually not too much different than the ADT.

Now it was a little bit of a surprise. We had a lot of discussions about charted, a lot of discussions about triple therapy, and all that. Docetaxel use is pretty low. Now, weighted a little bit to the urologist. Majority of these patients were in urologic practices. But nevertheless, we've not seen a lot of docetaxel uptake.

Now I don't know if you want me to pivot to the castrate-resistance space—

Zachary Klaassen: Sure.

Oliver Sartor: OK, so castrate-resistant—going to be running about 18,000 patients as opposed to, say, 35,000 in the castrate-sensitive. And what we're seeing again is a lot of ARPi use. Of course, persistence to the ADT. A little bit low on the docetaxel—lower than you might anticipate.

And then we're starting to see the other therapies come in. And other therapies, we haven't done all the breakouts right now. It might be PARP inhibitors, might be the PD-1 inhibitors, might be the Pluvicto. But remember, we're dealing with a snapshot in time. It's going to change over time.

One thing that was interesting: these patients have a pretty good prognosis. By the way, the metastatic CRPC was almost 50/50 between urology and medical. Median survival about 29 months for the metastatic CRPC. So pretty good. I think we're picking them up. And this is going to be an evolutionary story. And we'll be able to start picking up those other therapies, I think, over the next year or two.

For the castrate-sensitive, just for a contrast, meaning not reached. But of course, that's not a surprise. Median follow-up is about 17 months. So there's a lot more to learn. And we're getting a first snapshot, but it won't be the last snapshot.

Zachary Klaassen: It's great. I think 35,000 and 18,000, that's a ton of patients—real-world setting.

Oliver Sartor: And growing. And growing.

Zachary Klaassen: And growing, not just 500 practices, but academic urology and community, academic medical oncology and community. In terms of—and it's early—take-home from what you've learned from the metastatic hormone-sensitive setting at this point?

Oliver Sartor: I think the initial impression was that ARPis are being used probably in the majority of patients, which is good news because some of the older databases said no. But now I'm saying yes. Docetaxel use is not very high, but ARPi is being adopted. And I think that's true in both the castrate-sensitive and metastatic space.

Bottom line is these are good drugs. Again, enzalutamide, apalutamide, darolutamide, abiraterone. These are really active drugs, and they're getting used across urology and medical oncology.

Zachary Klaassen: That's great. Similar question for mCRPC—obviously great survival data, which you mentioned. Anything else that really was a big take-home from this early snapshot of the PRECISION database?

Oliver Sartor: You know, at this point, I would not want to make much in the way of more conclusions. We're going to have to have a little more evolution, a little more data. And we're going to start getting some use of the Pluvicto. We're going to start getting some utilization of the cabazitaxels. Maybe a little more definition on the PARP inhibitors over time. But as we see this big cohort—18,000 men and growing—I think you'll get a great snapshot of what's going on in the United States today.

Zachary Klaassen: Fantastic. Oliver, great conversation. We're looking forward to more from the PRECISION database. Thanks for your time.

Oliver Sartor: No, thank you, Zach.