Jason Hafron: Thanks so much for having me. Really appreciate being here.
Neeraj Agarwal: So I found you wraps up really interesting, Jason. Mitigating side effects of androgen deprivation therapy through this PC360 initiative. Could you please tell us more about this working group you have put together known as Prostate Cancer 360 Working Group?
Jason Hafron: Yeah, yeah. Thanks so much for this opportunity. PC360 is a program that was initially developed with Dr. David Crawford. We set it up a few years ago where we brought 14 different specialties together to address the side effects of ADT. We know there's significant risk of cardiotoxicity, bone health, neurocognitive, all the things that we battle every day, but we wanted to develop a working document or algorithm so that we could manage these side effects. We put that together. We published it a few years ago in urology practice and now what PC360 and what we presented at AUA 2026 is implementation of our algorithm or of our pathway.
Neeraj Agarwal: So this is a great initiative, first of all, congratulations. Because really so many practices out there that are dealing with all these side effects in their patients and it's great for the audience at the American Urology Association 2026 meeting to know about implementation of these strategies. So could you please tell us more about how did you implement?
Jason Hafron: Yeah. So we broke it onto specific domains, cardio, bone health, neurocognitive and lifestyle, which is mostly exercise, nutrition. And we focused on those key domains within the patient population. But the key that really led to the implementation and what's leading to our success is using chronic care management. Chronic care management is a Medicare initiative that uses virtual health to coordinate care between multiple specialties. We know that androgen deprivation therapy is very good at lowering testosterone, but there's significant long-term health consequences because of these therapies. And in our health system where we're working with multiple specialties, this care sometimes gets fragmented, gets unrecognized, and there's significant gaps. And that was the impetus for this is to close those gaps, to take ownership of these side effects. And as urologists, as the ones prescribing a lot of these medications, we felt the need to have a program to make sure that these side effects were recognized and then improved.
Neeraj Agarwal: And going to the methods part of this, how did you actually implement this?
Jason Hafron: Yeah. So through chronic care management with the Medicare initiative, we use patients in our practices. We use one of our practices in Florida and in Michigan as well as in California, we enrolled 300 patients in this program. The study was to see, could we do this? We had this great algorithm, but implementation is always a challenge. And what we found in the 300 patients, we were able to implement this program. We were able to enroll 300 patients with very good adherence, again, through chronic care management.
Neeraj Agarwal: And while we have the opportunity to have you here, could you tell us more about management of these long-term side effects, especially cardiovascular and bone health. I think those two stand out because they tend to impact everything else from your perspective.
Jason Hafron: I think we have to really take cardiotoxicity and bone health seriously. When you look at the numbers in the patient population we're treating, over 90% of the patients have at least one cardiac risk, over 50% have three cardiac risks. So the patient population that is suffering from prostate cancer, the patient that we're putting on these therapies are at significant risk. And we know based on the literature, most of the cardiotoxicity happens within the first six months of initiation therapy.
So that being said, we have to really work with our medical people, work with our cardiologists to make sure that these patients are optimized to reduce risk. And this is just ADT alone. When you start looking at ADT plus an ARPI, that cardiac risk actually goes up pretty significantly. And there's been some recent meta-analysis of real-world data that shows patients outside the trials who aren't ideal patients who are not on a clinical trial. The cardiac risk in these patients is eye-opening. And I think that's a call to action for all of us in this field to really take ownership of these side effects to make sure that these patients get the care that they deserve.
Neeraj Agarwal: How about bone health, Jason?
Jason Hafron: Bone health is interesting, obviously important. If a patient suffers a fracture while on therapy, there's a significant risk of death soon after the skeletal-related event. So bone health is critical. We know these agents impact bone health and layer on falls and fractures that becomes a recipe for a disaster. In our study, a third of our patients didn't have a DXA scan, a third of our patients weren't on vitamin D and calcium supplementation. So this program, again, through chronic care management, will identify these gaps and reorientate that patient, remind the primary physician, this patient's missing a DXA. This patient is not taking their vitamin D and calcium, again, to better treat these patients in this fragmented health system that we all work in.
Neeraj Agarwal: That's a wonderful initiative. Congratulations. Anything else you would like to add?
Jason Hafron: I think that the next phase for us, this was our initial... We can implement the pathway. We're recognizing the gaps, but our next phase and hopefully next year we can talk is, can we intervene and improve this? Can we improve our LDLs in our patients? Can we improve the A1Cs? Can we get them to the cardiologists, their primary care physicians? Can we really make a difference and optimize these patients so that we can minimize or mitigate the side effects of ADT?
Neeraj Agarwal: As our patients with metastatic prostate cancer, which is a good problem to have living much longer, we are increasingly seeing more and more incidents of cardiovascular events, bone fractures, bone health issues. And I must applaud you for all your initiative, you and your group have taken with obviously the leadership of Dr. Crawford is there, for implementing these strategies to mitigate these long-term side effects. And we look forward to hearing more from you and the group in the upcoming meeting. So thank you, Jason.
Jason Hafron: Thank you so much. Appreciate it.