Podcasts about ADT

My guest today is Nigel Jones who is making his third appearance on the Tribe Sober podcast – our conversations always get plenty of downloads and Nigel is a mine of valuable information! In this episode:- Nigel's secret to success was becoming a non-drinker from Day One — rather than a drinker trying to quit. He used the metaphor of a mountain — put yourself on top from the start rather than struggling to climb it. It's our beliefs and values shape our identity, then it's our identity that drives our intentions and actions. We need to flip our beliefs: once we truly believe that alcohol is a poison, then everything changes. Nigel is a qualified Hypnotherapist and he came up with a great analogy to explain how hypnotherapy works Our conscious mind is often resistant and has “bouncers” to prevent new information from entering our subconscious Hypnotherapy can remove those bouncers allowing better access to the subconscious Drinking creates a program in our subconscious and hypnotherapy helps us to replace it with healthier programs. Nigel is also qualified in NLP - Neuro Linguistic Programming which can help us to rewire our beliefs We both agreed that Drinking is deeply tribal — Nigel calls the Alcohol Drinking Tribe the ADT People protect their ADT which is why we often encounter resistance when we announce that we have quit drinking When we leave the ADT, we need to find another tribe quickly so that we don't feel isolated or judged In fact Connection is the opposite of addiction and That's why we set up Tribe Sober which offers connection, vulnerability, and authenticity  – so if you're ready to swop your drinking tribe for Tribe Sober then click here to check out our membership program Nigel shares his own inspiring story called Walking Back to Happiness He's also a certified hypnotherapist, NLP practitioner and life coach. He offers 1:1 and group coaching, for habit change, phobias, and anxiety. His website and social media is 9kmby9am.com  Nigel's previous podcast interviews with Tribe Sober are here and here   Episode Sponsor This episode is sponsored by the Tribe Sober Membership Program.  If you want to change your relationship with alcohol then sign up today - here is the link.  Help us to spread the word! We made this podcast so that we can reach more people who need our help.  Please subscribe and share. We release a podcast episode every Saturday morning. You can follow Tribe Sober on Facebook, Twitter and Instagram.  You can join our private Facebook group HERE PS: How to Leave a Rating/Review in Apple Podcasts (on an iOS Device) Open the Podcasts app. EASY. Choose “Search” from the bottom row of icons and enter the name of the show (e.g. Recover Like a Mother) into the search field. Select the show under Shows (not under Episodes). Scroll down past the first few episodes until you see Ratings & Reviews. Click Write a Review underneath the displayed reviews from other listeners. You'll then have the option to rate the show on a 5-star scale and write a review (you can rate without writing too but it's always good to read your experience).  

Abby Brennan joined us on The Modern People Leader. We discussed the power of ONA as the “shadow org chart,” how it reveals hidden influencers, and why it may be key to building smarter, more connected teams in the age of AI.---- Sponsor Links:

You should know this: The common approach to prostate cancer is NOT the best path for your long-term health. In this episode, Dr. Stephen Petteruti uncovers essential truths behind President Joe Biden's prostate cancer diagnosis. Dr. Stephen critically examines conventional treatments, such as androgen deprivation therapy (ADT), highlighting their severe side effects. He also challenges the long-held medical belief linking testosterone to cancer progression, presenting innovative and less harmful alternative treatments.Discover safer, science-backed alternatives your doctor might not mention. It's time to take control of your health with knowledge, clarity, and confidence.Don't miss this episode: Biden's Prostate Cancer: The TRUTH Doctors Don't Want You To Know!Enjoy the podcast? Subscribe and leave a 5-star review!Dr. Stephen Petteruti is a leading Functional Medicine Physician dedicated to enhancing vitality by addressing health at a cellular level. Combining the best of conventional medicine with advancements in cellular biology, he offers a patient-centered approach through his practice, Intellectual Medicine 120. A seasoned speaker and educator, he has lectured at prestigious conferences like A4M and ACAM, sharing his expertise on anti-aging. His innovative methods include concierge medicine and non-invasive anti-aging treatments, empowering patients to live longer, healthier lives.Website: www.intellectualmedicine.com  YouTube: https://www.youtube.com/@dr.stephenpetteruti LinkedIn: https://www.linkedin.com/in/drstephenpetteruti/ Instagram: instagram.com/dr.stephenpetteruti Disclaimer:  The content presented in this video reflects the opinions and clinical experience of Dr. Stephen Petteruti and is intended for informational and educational purposes only. It is not medical advice and should not be used as a substitute for professional diagnosis, treatment, or guidance from your personal healthcare provider. Always consult your physician or qualified healthcare professional before making any changes to your health regimen or treatment plan.#CastrationCrisis #ProstateCancer #ProstateChoices

AUA2025: Embracing Multi-Disciplinary Care for Advanced Prostate Cancer: A Case-Based Update 2025 CME Available: https://auau.auanet.org/node/42997 At the conclusion of this activity, participants will be able to: 1. Initial Management of Metastatic Prostate Cancer: Evaluate and treat a patient with new diagnosed M1 prostate cancer with androgen deprivation therapy (ADT) plus be skilled to offer novel oral antiandrogens. Furthermore, to recognize high-volume new M1 prostate cancer so as to be able to partner with GU medical oncologist for docetaxel chemotherapy in a multidisciplinary team. 2. Non-Metastatic Castrate Resistant Prostate Cancer (M0 CRPC): The learner will be skilled to diagnose M0 CRPC and be able to educate patients about using either enzalutamide or apalutamide or darolutamide added to traditional ADT as a way to improve their patent's overall and radiographic progression-free survival. Furthermore, the skilled learner will be able to understand the differences between these three oral agents and to educate patients about side-effects and toxicities. Finally, understand the pros and cons of PSMA PET scan imaging in further staging in this disease Non-metastatic Castrate-Resistant Prostate Cancer (M0 CRPC): Diagnose M0 CRPC and be able to educate patients about using novel oral antiandrogens added to traditional ADT as a way to improve their patent's overall and radiographic progression-free survival. Furthermore, the skilled learner will be able to understand the differences between these novel oral agents and to educate patients about side effects and toxicities. Finally, understand the pros and cons of PSMA PET scan imaging in further staging in this disease state. 3. Metastatic Castrate-Resistant Prostate Cancer (M1 CRPC): Describe and have a working knowledge of the latest phase III RCT results for new therapies in M1 CRPC and be able to educate their patients on treatment options and participate in a multidisciplinary team caring for men with this disease state of far-advanced prostate cancer. 4. Describe that advanced prostate cancer is a complex group of disease states with an ever-changing therapeutic landscape and for providers and teams to embrace the multi-disciplinary nature of care for our patients. 5. Identify the molecular and molecular genetic underpinnings of advanced prostate cancer and recognize the future will be based on a more personalized therapy landscape including PARP inhibition, immune checkpoint agents, and novel AR targeted agents emerging in 2025 and beyond.

Jessica Zwaan joined us again on The Modern People Leader to unpack how to structure a people ops as a product team. She shared four ways to build an HR squad, how to use a spider diagram for squad design, and why it's smart to pilot just one squad first.---- Sponsor Links:

这是一个独属于女性的夜晚。4月27日，耐克全球女子夜跑系列赛After Dark Tour来到上海，3500名女性跑者在南京东路集结，将上海的夜「跑为己有」。10公里结束，她们在跑百巷再次聚首，聊聊这段旅程中的汗水、成长与感动。本期节目，运动博主孙佳祺、赵依侬客串我们的代班主播，和跑龄两个月的「老跑者」颜如晶、在训练过程里能同时拥有天使和魔鬼两幅面孔的小彩教练，以及20位参赛跑者一起「续摊儿」，不仅回味了一番After DarkTour强烈的后劲，还有轻松的跑步趣事和坚韧的女性内核：当我们穿上跑鞋，不只是踏上赛道，更是在一步步中靠近那个更坚定、更自由的自己。- 聊天的人 -代班主播：孙佳祺、赵依侬嘉宾：颜如晶，耐克女子夜跑参赛者小彩，耐克NRC 城市教练ADT参赛者和跑者- 时间轴 -01:47 After Dark Tour之后，跑百巷迎来一场「全女局」05:19 颜如晶：为了准备这场10K，我先去跑了个半马10:14 从「厌跑」到半马，是怎么一步步跑起来的18:43 参加ADT的跑者们，发枪前后的反差也太大了28:26 全女赛事的特别之处？垃圾很少，还香香的32:45 在舞台一样的赛道上跑步，是种什么体验？36:32 这是属于我的勋章，不需要任何人帮忙戴上37:43 在这个夜晚，女性之间的温暖连结悄然发生39:27 夜跑的「危险」主要体现在...夜宵的诱惑？49:00 夜幕降临，正是探索城市新样貌的好时机53:36 虽然都说不忘初心，但过程有时更有意义01:01:15 不用比较，跑步是一项完全由你自己掌控的运动01:04:37 出来跑步，最重要的是先「出来」01:06:43 泡泡跑、动物园跑、胶片跑，怎么有趣怎么跑！01:09:42 跑步没那么难，但科学训练才是跑得久的秘诀01:12:17 当我们穿上跑鞋、走上赛道，成为真正的自己- 本节目由耐克出品，JustPod制作发行 -- 制作团队 -策划：孙佳祺、赵依侬、Jimmy、Tiara、王童语统筹：Cora、王冰倩制作：王童语声音设计：陆佳杰、马若晨节目运营：邓逸轩

Bryan Power, Head of People at Nextdoor, joined us on The Modern People Leader. We talked about how the company is navigating its “third era” under the return of co-founder Nirav Tolia. We explored “The Founders Mentality”, embracing an owner's mindset, and Nextdoor's AI bootcamp.---- Sponsor Links:

Jessica Zwaan, COO at Talentful and author of Built for People,  joined us on The Modern People Leader.We talked about “human ops” versus “people ops”, the sprint planning process for her people team, and how nobody gets people ops as a product 100% right (and that's ok).---- Sponsor Links:

Send us a textAward-winning excellence doesn't happen by accident. After receiving the news that Habitation Investigation had earned the prestigious "Best in the Midwest" award for the third consecutive year, we decided to peel back the curtain and share what makes our home inspection company different from the competition.This episode explores the factors that contribute to our continued success, from our customer-first approach to our ethical business practices. With over 1,700 Google reviews and a stellar 4.9-star rating, we've built a reputation on clear communication, thorough inspections, and reports that set the standard for the industry. Our team shares how we've grown from our humble beginnings in 2002 to become one of Ohio's premier inspection companies, expanding our services based directly on client requests rather than arbitrary business decisions.We tackle a particularly important topic for homeowners: privacy protection. Unlike many inspection companies that generate revenue by selling client information to third parties, we maintain strict privacy standards. Our single partnership with ADT is completely optional for clients and directs benefits to charities rather than our bottom line. We also discuss the value of maintenance inspections every 3-5 years and regular radon testing—services that can save homeowners thousands by catching small issues before they become expensive problems.What truly sets an inspection company apart isn't fancy technology or marketing gimmicks—it's having inspectors who genuinely care about their clients and communicate clearly without fear-mongering. Whether you're a homeowner, real estate professional, or aspiring entrepreneur, this episode offers valuable insights into building a service business based on integrity, customer care, and consistent quality. Ready to learn what makes a home inspection company worthy of multiple industry awards? Listen now and discover how excellence becomes a habit.Support the showTo learn more about Habitation Investigation, the Three-time Winner of the Best Home Inspection Company in the Midwest Plus the Winner of Consumer Choice Award for Columbus Ohio visit Home Inspection Columbus Ohio - Habitation Investigation (homeinspectionsinohio.com) NBC4 news segments: The importance of home inspections, and what to look for | NBC4 WCMH-TV Advice from experts: Don't skip the home inspection | NBC4 WCMH-TV OSU student's mysterious symptoms end up tied to apartment's air quality | NBC4 WCMH-TV How to save money by winterizing your home | NBC4 WCMH-TV Continuing Education for Ohio Agents Scheduled classes Continuing Education for Ohio Agents Course lis...

Reggie Marable is the Head of Global Sales at Sierra, a conversational AI platform for businesses. Sierra enables companies like ADT, Sonos, SiriusXM, and WeightWatchers to build AI agents that transform customer experiences. The company has rapidly become a hypergrowth leader in Silicon Valley, recently securing a funding round that values it at $4.5 billion. Before joining Sierra, Reggie was the Head of Sales in North America at Slack and the Area Vice President of Enterprise Sales at Salesforce.  In Today's Episode We Discuss:  02:50 “What I Learned from Failing Early as a CRO” 06:06 The Most Effective Sales Strategy and the BS Sales Methodology 06:55 How to Build Sales Processes from Scratch 12:28 When and How to do Verticalised Sales Teams 14:15 How to Become World Class as Sales Prospecting and Outbound 17:21 How to Use Proof of Concepts to Win Enterprise Deals 22:04 Enterprise vs. Self-Serve: Both or One and How 30:09 Building a Sales Team from Scratch 37:39 Structuring the Hiring Process 41:14 How Founders F*** Up Hiring in Sales 46:25 Handling Salary and Title Expectations 51:36 How to Run Effective Deal Cycles 57:06:07 How to do Onboarding for New Sales Hires 59:07:48 How to do Post Mortems in Sales Processes 01:04:24 Negotiating Enterprise Deals 01:08:04 Quick Fire Round: Sales Tactics and Strategies  

Taylor Bradley, VP of Talent Strategy and Success at Turing, joined us on The Modern People Leader.We talked about why every HR team needs to create an AI “prompt pantry”, how Turing “AI'd” their way out of onboarding 800 employees in five days, and how to build AI workflows for HR.---- Sponsor Links:

On this week's show: Yale has a new lock with easy integration with ADT systems, Google kills 1st and 2nd gen Nest devices, Aqara releases a few new products, Wiz shows off a new HDMI TV light, light bulb cameras are a thing, Roku has new cameras, Eve joins Home Assistant, letters from the mailbag, a pick of the week, project updates, and so much more!

Dr. Rohan Garje shares the updated recommendations for the ASCO guideline on systemic therapy for patients with metastatic castration-resistant prostate cancer. He discusses the systemic therapy options for patients based on prior therapy received in the castration-sensitive and non-metastatic castration-resistant settings. He emphasizes personalizing treatment choices for each individual, considering patient-specific symptoms and signs, treatment-related toxicities, potential drug interactions, cost, and access. He also reviews recommendations on response assessment. The conversation wraps up with a discussion of potential future updates to this guideline, as the guideline transitions into a “living guideline” on mCRPC. Read the full guideline update, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update”. Transcript This guideline, clinical tools, and resources are available at www.asco.org/genitourinary-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology.      Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Rohan Garje from Miami Cancer Institute Baptist Health South Florida, lead author on, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Garje. Dr. Rohan Garje: Absolutely. Thank you so much for having me, Brittany. Brittany Harvey: And then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Garje, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to start on the content of this guideline, first, could you provide us an overview of the purpose of this guideline update? Dr. Rohan Garje: Sure. So ASCO has guidelines for prostate cancer and the specific guideline which we have updated for metastatic castrate-resistant prostate cancer was originally published in 2014. It's almost a decade. It's been a long time due for an update. Over the last decade, we have seen a lot of advances in the treatment of prostate cancer, specifically with regards to genomic testing, newer imaging modalities, and also the treatment landscape. Now we have newer options based on genomic targets such as PARP inhibitors, we have radiopharmaceuticals, a newer variant of chemotherapy, and also some specific indications for immunotherapy which were not addressed previously. Because all these advances have been new, it was really important for us to make an update. In 2022, we did make a rapid update with lutetium-177, but these additional changes which we have seen made it an appropriate time frame for us to proceed with a newer guideline. Brittany Harvey: Absolutely. It's great to hear about all these advances in the field to provide new options. So I'd like to next review the key recommendations from this guideline. So let's start with the overarching principles of practice that the panel outlined. What are these key principles? Dr. Rohan Garje: As a group, all the panel members came up with some ground rules: What are necessary for all our patients who are being treated for metastatic CRPC? First, the founding aspect was a definition for what is metastatic CRPC. So we defined metastatic CRPC as castrate level of testosterone with evidence of either new or progressive metastatic disease on radiological assessments or patients who have two consecutive rising PSAs in the setting of existing metastatic disease. We also emphasized on the need for germline and somatic testing for patients with metastatic prostate cancer at an earliest available opportunity because it is critical to select appropriate treatment and also right treatment for patients at the right time. And we actually have a concurrent guideline which addresses what genes to be tested and the timing. The other principles are patients should continue to receive androgen deprivation therapy or undergo surgical castration to maintain castrate level of testosterone. Now the key aspect with these guidelines is personalizing treatment choices. As you can see the evolution of treatment options for prostate cancer, the drugs that were initially developed and approved for prostate cancer were primarily in castrate-resistant settings, but now most of these drugs are being utilized in castrate-sensitive. So, when these patients develop castration resistance, the challenges are there are no appropriate particular drug-specific guidelines they meet. So, it's very important for the clinicians to be aware of what treatments have been received so far prior to castration resistance so that they can tailor the treatment to patient specific situations. In addition, prior to choosing a therapy, it is important for the physicians to consider patient specific symptoms or signs, treatment-related toxicities, potential drug interactions, cost, and also access to the drugs. There may be multiple treatment options available for the patients, but for a patient specific scenario, there may be a drug that may be more promising than the others. So, it is important to tailor the drug choices based on patients' unique circumstances. The panel also recommends to early integrate palliative and supportive care teams for symptom management and also discuss goals of care with the patient as each patient may have unique needs and it's important for physicians to address those concerns upfront in the care. The panel also suggests patients to receive RANK ligand inhibitors such as denosumab or bisphosphonates such as zoledronic acid to maintain the bone strength to prevent skeletal-related events. Finally, I would like to also emphasize this point about the lack of randomized clinical trial data for optimal sequencing of therapies for patients with metastatic CRPC. As I previously alluded, we have taken into account all ongoing clinical trials, prior published data, and came up with a format of preferred drugs based on prior treatments and, I think, by following these several clinical principles which I just mentioned, we can optimally choose and utilize best treatments for patients with metastatic CRPC. Brittany Harvey: Absolutely. These principles that you just outlined are important for optimal patient care, and then I want to touch on one of those things. You talked importantly about the treatments received so far. So in the next set of recommendations, the role of systemic therapy was stratified by the prior therapy received in the castration-sensitive and non-metastatic castration-resistant setting. So starting with what does the panel recommend for patients who are previously treated with androgen deprivation therapy alone in these previous settings and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: There are multiple treatment options based on prior treatment received. So for patients who received only ADT for their castration-sensitive disease, the panel strongly urges to get HRR testing to check for homologous recombinant repair related changes, specifically for BRCA1 and BRCA2 mutations, because we have three studies which have really shown significant clinical benefit for patients who have BRCA1 and BRCA2 mutations with drugs such as the combination of talazoparib and enzalutamide or olaparib with abiraterone or niraparib with abiraterone. Unless we test for those mutations, we'll not be able to give these agents upfront for the patients. In the HRR testing, if patients have HRR alterations but they are in genes which are non-BRCA, the guideline panel recommends to utilize talazoparib and enzalutamide based combination therapies. Now, if they don't have HRR alterations then there are multiple treatment choices available. It could either include androgen receptor pathway inhibitors such as abiraterone with prednisone. We could also consider docetaxel chemotherapy. The alternate choices for androgen receptor pathways include enzalutamide or the newer agents such as apalutamide and docetaxel. So, as you can see there are multiple options available, but the panel definitely emphasizes to test for HRR testing because this gives patients access to more precision therapies at this point. There may be various scenarios where a unique drug may be available for a specific patient situation. For example, patients who have very limited disease burden and may have one or two metastatic lesions, after a multidisciplinary discussion, targeted local therapies such as radiation or potentially surgery could also be offered. In select patients who have very indolent disease where they are castrate-resistant based on slow rising PSA, low-volume disease or asymptomatic disease can consider sipuleucel-T. And in patients who have bone-only metastatic disease, we could also consider radium-223, which is primarily now utilized for patients who have symptomatic bone disease. Brittany Harvey: Great. I appreciate you reviewing all those options and talking about how important it is to tailor treatment to the individual patient. So then the next category of patients, what is recommended for those who have been previously treated with ADT and an androgen receptor pathway inhibitor and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: So for patients who received ADT along with an androgen receptor pathway inhibitor, which we consider would be a most common cohort because most patients now in castration-sensitive setting are receiving androgen receptor pathway inhibitor. It was different in the past where five or six years back ADT alone was the most common treatment, but fortunately, with enough awareness and education, treatment choices have improved. Patients are now receiving ADT and ARPI as the most common choice of drug. Once again, at this point the panel emphasizes to consider HRR testing in there is enough data for us to suggest that patients who have alterations in the HRR pathway definitely will benefit with the PARP inhibitor. You know the multiple options, but specifically we speak about olaparib. And then if they are HRR-negative, we prefer patients receive agents such as docetaxel or if they are intolerant to docetaxel, consider cabazitaxel chemotherapy, options such as radium-223, and if they have a specific scenario such as MSI-high or mismatch repair deficiency, pembrolizumab could also be considered. The panel also discussed about the role of a second ARPI agent. For example, if patients progressed on one androgen receptor pathway inhibitor, the second androgen receptor pathway inhibitor may not be effective and the panel suggests to utilize alternate options before considering androgen receptor pathway inhibitor. There may be specific scenarios where a second ARPI may be meaningful, specifically, if alternate choices are not feasible for the concern of side effects or toxicities or lack of access, then a potential ARPI could be considered after progression on ARPI, but the panel definitely encourages to utilize alternate options first. Brittany Harvey: Great. Thank you for outlining those options as well for those patients. So then the next category, what is recommended for patients who have been previously treated with ADT and docetaxel? Dr. Rohan Garje: For patients who received ADT and docetaxel and were never treated with androgen receptor pathway inhibitors, the panel again emphasizes on HRR testing. If they have BRCA1 and 2 mutations, the combination therapies of talazoparib with enzalutamide, olaparib with abiraterone, or niraparib with abiraterone are all good choices. If they don't have BRCA mutations but they have other HRR mutations, the panel suggests to potentially utilize talazoparib with enzalutamide. And if they do not have any HRR alterations, the options could include androgen receptor pathway inhibitors such as abiraterone or enzalutamide. I want to emphasize that these are preferred options, but not the only options. As you can see, there are multiple options available for a particular clinical situation - so the ability of the physicians to access particular combinations, the familiarity of those drugs or the patient's unique situation where they have other medications which can potentially interact with a choice of agents. So I think based on access, based on cost and patients' concurrent illness with potential drug interactions can make one particular combination of therapy better over the other options. Brittany Harvey: Absolutely. That's key to keep in mind that access, contraindications, and cost all play a role here. So then the next set of recommendations. What are the key recommendations for patients who have previously been treated with ADT, an androgen receptor pathway inhibitor, and docetaxel who now have mCRPC? Dr. Rohan Garje: Yes. In this group, the options remain, again, broad. We utilize PSMA imaging here specifically and if they are positive on PSMA imaging, lutetium-177 is a good option. If they do not have PSMA-positive disease on PSMA imaging but if they have HRR alterations, olaparib could be utilized. And if they are negative on PSA imaging, they don't have HRR alterations, then alternate options could include cabazitaxel, radium-223. And if they have MSI-high or deficiency in mismatch repair, pembrolizumab could be utilized in this setting. Brittany Harvey: Thank you for outlining those options as well. So then next the panel addressed treatment options for de novo or treatment emergent small cell neuroendocrine carcinoma of the prostate. What are those key recommendations? Dr. Rohan Garje: Yes. This is a very high unmet need group because there are limited clinical trials, especially prospective clinical trials addressing treatment options for this group. Most of our current guidelines are always an extrapolation from lung small cell cancer based guidelines, but the panel recommends to utilize cisplatin or carboplatin along with etoposide as a preferred choice for this group. Also, an alternate option of carboplatin along with cabazitaxel could be considered for this cohort. The panel also encourages participation in clinical trials. There are numerous trials ongoing now in smaller phase studies and I think it's important for patients to consider these trials as well, because this will give them access to newer agents with potential biological targets. In addition to these agents in specific scenarios or potentially case by case basis, because we don't have prospective data, so we have made it as a select case by case basis to consider adding immunotherapy along with platinum-based chemotherapy followed by maintenance immunotherapy, which is currently a standard of care in small cell lung cancer. But the data is so limited in prostate cancer, so the panel suggested that it has to be a case by case basis only. The alternate options also include lurbinectedin, topotecan, tarlatamab upon progression on platinum-based chemotherapy. Brittany Harvey: Yes. It's important to have these recommendations in these unique situations where there is really a lack of data. So then the final set of recommendations I'd like to cover, what does the panel recommend for how clinicians should assess for response while patients are on systemic therapy and what scans are recommended for this response assessment? Dr. Rohan Garje: Yes. Again, this is another strong emphasis of the panel for global assessment of the patients. Traditionally, patients and physicians per se are heavily reliant on PSA as an accurate marker for response. This is in fact true in earlier phases of prostate cancer either in castrate-sensitive setting or localized prostate cancer setting. But as patients evolve into castrate-resistant, we don't want to heavily rely on PSA alone as a marker of response. The panel suggests to incorporate clinical response, radiological response, and also include PSA as a component, but not just rely primarily on PSA. So the panel also suggests that patients should get a bone scan and a CT scan every three to six months while on treatment to assess for appropriate response or for progression. And now one key important aspect, we are all aware about the evolving role of PSMA-based imaging with several of these new agents that are currently available. We do acknowledge these scans definitely have an important role in the care for patients with metastatic prostate cancer. Currently, the utility is primarily to select patients for lutetium-based therapy and also in situations where the traditional scans such as technitium 99 bone scan or CT scan are equivocal, then a PSMA-based imaging can be helpful. Now we are also aware that there are newer studies coming up, prospective data coming up for the role of PSMA-based imaging for response assessment. We are hoping to update the guidelines if we get access to newer data, but currently we have not recommended the utility of PSMA-based imaging for response assessments. Brittany Harvey: Understood. And I appreciate you describing where there is data here and where there's a lack of data to currently recommend. And we'll look forward to future updates of this guideline. Coming back to – at the start you mentioned how much has changed since the last guideline update. So Dr. Garje, in your view, what is the importance of this update and how will it impact both clinicians and patients with metastatic castration-resistant prostate cancer? Dr. Rohan Garje: The updated guidelines are designed to have a significant impact on clinical practice and also patient outcomes by providing clinicians with a comprehensive evidence-based framework for managing patients with metastatic CRPC. And also, by using these guidelines can make informed decisions, can select therapies tailored to patients' unique genomic status, clinical situation, where they are in the course of the cancer based on what they received previously. Also utilizing these guidelines, we can potentially improve patient outcomes, improve survival, and importantly have efficient use of healthcare resources. Brittany Harvey: Absolutely. We're always looking for ways to improve patient outcomes and survival. I want to wrap us up by talking a little bit about the outstanding questions in this field. So earlier you had mentioned about prospective data to come about PSMA PET scans, but what other outstanding questions are there for patients with metastatic castration-resistant prostate cancer? And what evidence is the panel looking forward to for future updates? Dr. Rohan Garje: We do have now rapidly evolving data specifically about the utility of the radiopharmaceutical lutetium-177 prior to chemotherapy. We are hoping that with newer data we can make some changes to the guideline based on that. We are also looking at newer drugs that are coming up in the pipeline, for example, androgen receptor degraders. We are looking at data that might potentially help based on bispecific T-cell engagers and newer radiopharmaceuticals. So I think in the next few years, we will definitely update all the guidelines again. But this time we are trying to do it more proactively. We are following a newer model. We are calling it as ‘living guidelines' where we are actually utilizing week by week updates where we look at the literature and see if there is any potential practice impacting change or publication that comes up. And we are trying to incorporate those changes as soon as they are available. That way patients and practicing physicians can get the latest information available through the guidelines as well. Brittany Harvey: That's great to hear. Yes, we'll await this data that you mentioned to continuously update this guideline and continue to improve patient outcomes for the future. So Dr. Garje, I want to thank you so much for your time to update this guideline. It was certainly a large amount of recommendations, and thank you for your time today, too. Dr. Rohan Garje: Thank you so much for having me here. And it's always nice talking to you. Brittany Harvey: And finally, thank you to our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/genitourinary-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Live from AUA2025: Advances in ADT Program CME Available: https://auau.auanet.org/content/LiveFromAUA2025#group-tabs-node-course-default1 At the conclusion of this CME activity, participants will be able to: 1. Employ the latest AUA and NCCN guidelines (Version 1.2025) related to Androgen Deprivation Therapy (ADT) into practice 2. Evaluate clinical outcomes, efficacy, and safety profiles of different types of ADT including oral and parenteral LHRH agonists and GnRH receptor antagonists in different treatment settings. 3. Compare testosterone recovery, treatment efficacy, safety profiles, and patient preferences between different modalities of ADT. 4. Recognize common side effects associated with different types of ADT and its combination therapies as well as strategies to mitigate these adverse effects to improve patient outcomes. 5. Implement a multi-disciplinary approach in managing advanced prostate cancer with ADT. 6. Evaluate the future directions and ongoing research that may impact the use of ADT in clinical practice.

Tämä jakso sai sytykkeensä muutamasta viestinvaihdosta, jossa pohdin vieraiden kanssa miten voisimme tuoda näkökulmia ja ratkaisuehdotuksia suomalaisiakin vaivaaviin suorituskulttuuriin sekä burnout-ahdistusepidemiaan sekä pohtia mistä syntyy yksilön inhimillinen huippusuorituskyky. Jaksossa käydään läpi mm. mitä suorittamisen tunne ylipäätään on, mistä se syntyy ja mitä sille voi tehdä? Onko kaikki totaalisen rikki, miksi kaikki tuntuu uupuvan ja mitä ongelmien selättämiselle voi tehdä? Onko tämä pelkkä somekeskustelun illuusio vai mitä ihmisten arjessa oikeasti tapahtuu? Mitä kokonaiskuormitukselle voi tehdä yksilö itse ja myös työnantaja? Mitä on inhimillinen tehokkuus ja mistä se syntyy? Miten elintavat ja fyysinen kunto vaikuttaa siihen, että miten työtä, arkea ja perhe-elämää jaksaa hyvällä vireellä? Millaisia erilaisia haasteita ja mahdollisuuksia on työelämässä eri ikäluokilla? Miten elää hyvää elämää ja suoriutua arjen vastuista hyvin jos tarkkaavaisuuden kanssa on haasteita (ADT, ADHD, jne.)? Näitä ja muita aihepiirin kysymyksiä pohdin yhdessä psyykkisen ja fyysisen suorituskyvyn valmentaja Heikki Huovisen ja psykologi ja traumapsykoterapeutti Hanna Markukselan kanssa.LinkitOptimal Performance- Hyvinvointiluennot ja verkkovalmennukset: https://www.optimalperformance.fi- Kuntosali ja valmennuskeskus, Helsinki: https://www.opcenter.fiHeikki Huovinen ja Hanna Markuksela- HPA IG: https://www.instagram.com/higherperformanceacademy/- Suorituskyvyn ytimessä -podcast: https://open.spotify.com/show/7pN53RJdSsAnnfCY08G9MI?si=db8f73d99bc24534- Vireysvalmentaja-koulutus: https://hannamarkuksela.mykajabi.com/koulutusilmoittautuminen-vireysvalmentaja- Verkkosivu: https://www.higherperformanceacademy.com/- Hanna IG: https://www.instagram.com/hannamarkuksela/- Heikki IG: https://www.instagram.com/heikkihuovinencoach/

Check out this week's QuadCast as we highlight the predictive abilities of AI for ADT duration in prostate cancer, how consolidative chemoRT benefits patients with unresectable gallbladder cancer, the benefits of immunotherapy in clear cell GYN cancer, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Molly Sands, Head of the Teamwork Lab at Atlassian, joined us on The Modern People Leader.We talked about Atlassian's latest research on the three things the best teams do differently, the power of unleashing collective knowledge, and why distributed teams have a headstart on AI adoption.---- 

Really Interesting Women The Podcast Ep. 147 Meryl TankardMeryl Tankard is one of Australia's most distinguished and innovative figures in contemporary dance and choreography. Her talent was recognised very early - and even at that early stage she knew the 'old school' teaching techniques were, at times, abhorrent. But despite this, her talent flourished. To the point where she auditioned and earned a place in the Australian Ballet. But in her mind she wanted more. She joined the prestigious Pina Bausch Tanztheater Wuppertal in Germany, where she became a principal artist and developed her distinctive artistic voice.Upon returning to Australia in the early 1990s, she served as Artistic Director of the Australian Dance Theatre (ADT) in Adelaide, transforming it into a globally recognised company. And that led inexplicably to a controversial move by the ADT that we talk about. But it's her bold, theatrical productions that merged dance with other art forms that have impressed audiences the world over. Her choreographic style is characterised by emotional intensity, physical dynamism, and a unique blend of classical technique with contemporary expression.She has created works for opera, film, and large-scale events, including contributions to the Sydney 2000 Olympic Games ceremonies.And as if for good measure she's a qualified and exceptional film maker. To this day Meryl Tankard remains an influential force in Australian performing arts, celebrated for her passionate commitment to artistic innovation and her ability to create deeply moving dance experiences.It was a great conversation with an enduring, warm, immensely talented artist. You can see the clips I was referring to in our conversation at:https://meryltankard.com/workHead to the link in my bio to hear our conversation. Visit instagram @reallyinterestingwomen for further interviews and posts of interesting women in history. Follow the link to leave a review....and tell your friendshttps://podcasts.apple.com/au/podcast/really-interesting-women/id1526764849

Marine Corps Veteran Edgar Rodriguez joins Joe on this episode of Veteran On the Move. Edgar shares his journey transitioning into the communication industry, highlighting his experience in sales with ADT and the valuable lessons learned through Wolf Management's Capstone program. They discuss the power of connecting with like-minded individuals, building strong relationships, and the role of executive coaching in establishing a solid team based on the five pillars of business. Ultimately, Edgar emphasizes the significance of discovering one's passion and forging a fulfilling path. Episode Resources:  Master the Network Edgar's LinkedIn   About Our Sponsors Navy Federal Credit Union   Navy Federal Credit Union has made it their mission to help people in the military community. Navy Federal Credit Union is open to all branches of the military, Veterans and their families. They have lots of flexible savings and investing options to help their members reach their financial goals. Don't miss out. The sooner you start building your finances with savings and investing options, the better off they could be in the long run.  At Navy Federal, our members are the mission.        Join the conversation on Facebook! Check out Veteran on the Move on Facebook to connect with our guests and other listeners. A place where you can network with other like-minded veterans who are transitioning to entrepreneurship and get updates on people, programs and resources to help you in YOUR transition to entrepreneurship.   Want to be our next guest? Send us an email at interview@veteranonthemove.com.  Did you love this episode? Leave us a 5-star rating and review!  Download Joe Crane's Top 7 Paths to Freedom or get it on your mobile device. Text VETERAN to 38470. Veteran On the Move podcast has published 500 episodes. Our listeners have the opportunity to hear in-depth interviews conducted by host Joe Crane. The podcast features people, programs, and resources to assist veterans in their transition to entrepreneurship.  As a result, Veteran On the Move has over 7,000,000 verified downloads through Stitcher Radio, SoundCloud, iTunes and RSS Feed Syndication making it one of the most popular Military Entrepreneur Shows on the Internet Today.

Pat Wadors, CHRO at Intuitive, joined us on The Modern People Leader. We talked about how to find and amplify the golden nuggets of your culture, the three layers of a great employee experience, why you need to “touch the elephant”, and what kids' stories can teach us about leadership.---- 

In this episode of the Dr. Geo Prostate Podcast, we welcome Dr. Jonathan Lischalk, Director of Genitourinary Cancers at MedStar Georgetown University Hospital and former Medical Director at NYU's NYCyberKnife Center. Dr. Lischalk breaks down the evolution of radiation oncology and how cutting-edge imaging and targeted SBRT (Stereotactic Body Radiation Therapy) are reshaping prostate cancer treatment.We explore how imaging advances like MRI and PSMA PET scans are enabling unprecedented precision, the future of genetic-based personalization in prostate cancer therapy, and why fewer, more focused radiation sessions might soon become the new standard. From understanding the biology of radiation dosing to upcoming trials eliminating ADT in select patients, this is a must-listen for anyone looking to stay informed on the forefront of cancer care.

JCO PO author Dr. Timothy Showalter at Artera and University of Virginia shares insights into his JCO PO article, “Digital Pathology–Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase III Trial in Men With Nonmetastatic Castration-Resistant Prostate Cancer” . Host Dr. Rafeh Naqash and Dr. Showalter discuss how multimodal AI as a prognostic marker in nonmetastatic castration-resistant prostate cancer may serve as a predictive biomarker with high-risk patients deriving the greatest benefit from treatment with apalutamide. TRANSCRIPT  Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations where we'll bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, podcast Editor for JCO Precision Oncology and assistant professor at the OU Health Stephenson Cancer Center at the University of Oklahoma. Today, we are excited to be joined by Dr. Timothy Showalter, Chief Medical Officer at Artera and professor of Radiation Oncology at the University of Virginia and author of the JCO Precision Oncology article entitled, “Digital Pathology Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase 3 Trial in Men with Non-Metastatic Castration Resistant Prostate Cancer.” At the time of this recording, our guest's disclosures will be linked in the transcript. Dr. Showalter, it's a pleasure to have you here today. Dr. Timothy Showalter: It's a pleasure to be here. Thanks for having me. Dr. Rafeh Naqash: I think this is going to be a very interesting discussion, not just from a biomarker perspective, but also in terms of how technologies have evolved and how we are trying to stratify patients, trying to escalate or deescalate treatments based on biomarkers. And this article is a good example of that. One of the things I do want to highlight as part of this article is that Dr. Felix Feng is the first author for this article. Unfortunately, Dr. Felix Feng passed away in December of 2024. He was a luminary in this field of prostate cancer research. He was also the Chair of the NRG GU Committee as well as Board of Directors for RTOG Foundation and has mentored a lot of individuals from what I have heard. I didn't know Dr. Feng but heard a lot about him from my GU colleagues. It's a huge loss for the community, but it was an interesting surprise for me when I saw his name on this article as I was reviewing it. Could you briefly talk about Dr. Feng for a minute and how you knew him and how he's been an asset to the field? Dr. Timothy Showalter: Yeah. I'm always happy to talk about Felix whenever there's an opportunity. You know, I was fortunate to know Felix Feng for about 20 years as we met during our residency programs through a career development workshop that we both attended and stayed close ever since. And you know, he's someone who made an impact on hundreds of lives of cancer researchers and other radiation oncologists and physicians in addition to the cancer patients he helped, either through direct clinical care or through his innovation. For this project in particular, I first became involved soon after Felix had co-founded Artera, which is, you know the company that developed this. And because Felix was such a prolific researcher, he was actually involved in this and this research project from all different angles, both from the multimodal digital pathology tool to the trial itself and being part of moving the field forward in that way. It's really great to be able to sort of celebrate a great example of Felix's legacy, which is team science, and really moving the field forward in terms of translational projects based on clinical trials. So, it's a great opportunity to highlight some of his work and I'm really happy to talk about it with you. Dr. Rafeh Naqash: Thanks, Tim. Definitely a huge loss for the scientific community. And I did see a while back that there was an international symposium organized, showcasing his work for him to talk about his journey last year where more than 200, 250 people from around the globe actually attended that. That speaks volumes to the kind of impact he's had as an individual and impact he's had on the scientific side of things as well. Dr. Timothy Showalter: Yes. And we just had the second annual Feng Symposium the day before ASCO GU this year with, again, a great turnout and some great science highlighted, as well as a real focus on mentorship and team science and collaboration. Dr. Rafeh Naqash: Thank you so much for telling us all about that. Now going to what you guys published in JCO Precision Oncology, which is this article on using a biomarker approach to stratify non-metastatic prostate cancer using this artificial intelligence based H&E score. Could you tell us the background for what started off this project? And I see there is a clinical trial data set that you guys have used, but there's probably some background to how this score or how this technology came into being. So, could you superficially give us an idea of how that started? Dr. Timothy Showalter: Sure. So, the multimodal AI score was first published in a peer reviewed journal back in 2022 and the test was originally developed through a collaboration with the Radiation Therapy Oncology Group or Energy Oncology Prostate Cancer Research Team. The original publication describes development and validation of a risk stratification tool designed to predict distant metastasis and prostate cancer specific mortality for men with localized prostate cancer. And the first validation was in men who were treated with definitive radiation therapy. There have been subsequent publications in that context and there's a set of algorithms that have been validated in localized prostate cancer and there's a test that's listed on NCCN guidelines based on that technology. The genesis for this paper was really looking at extending that risk stratification tool that was developed in localized prostate cancer to see if it could one, validate in a non-metastatic castrate refractory prostate cancer population for patients enrolled on the SPARTAN trial. And two, whether there was a potential role for the test output in terms of predicting benefit from apalutamide for patients with non-metastatic prostate cancer. For patients who are enrolled on the SPARTAN study, almost 40% of them had H&E stain biopsy slide material available and were eligible to be included in this study. Dr. Rafeh Naqash: Going a step back to how prostate cancer, perhaps on the diagnostic side using the pathology images is different as you guys have Gleason scoring, which to the best of my knowledge is not necessarily something that most other tumor types use. Maybe Ki-67 is somewhat of a comparison in some of the neuroendocrine cancers where high Ki-67 correlates with aggressive biology for prognosis. And similarly high Gleason scores, as we know for some of the trainees, correlates with poor prognosis. So, was the idea behind this based on trying to stratify or sub-stratify Gleason scoring further, where you may not necessarily know what to do with the intermediate high Gleason score individual tumor tissues? Dr. Timothy Showalter: Well, yeah. I mean, Gleason score is a really powerful risk stratification tool. As you know, our clinical risk groupings are really anchored to Gleason scores as an important driver for that. And while that's a powerful tool, I think, you know, some of the original recognition for applying computer vision AI into this context is that there are likely many other features located in the morphology that can be used to build a prognostic model. Going back to the genesis of the discovery project for the multimodal AI model, I think Felix Feng would have described it as doing with digital pathology and computer vision AI what can otherwise be done with gene expression testing. You know, he would have approached it from a genomic perspective. That's what the idea was. So, it's along the line of what you're saying, which is to think about assigning a stronger Gleason score. But I think really more broadly, the motivation was to come up with an advanced complementary risk stratification tool that can be used in conjunction with clinical risk factors to help make better therapy recommendations potentially. So that was the motivation behind it. Dr. Rafeh Naqash: Sure. And one of the, I think, other important teaching points we try to think about, trainees of course, who are listening to this podcast, is trying to differentiate between prognostic and predictive scores. So, highlighting the results that you guys show in relation to the MMAI score, the digital pathology score, and outcomes as far as survival as well as outcomes in general, could you try to help the listeners understand the difference between the prognostic aspect of this test and the predictive aspect of this test? Dr. Timothy Showalter: So let me recap for the listeners what we found in the study and how it kind of fits into the prognostic and the predictive insights. So, one, you know, as I mentioned before, this is ultimately a model that was developed and validated for localized prostate cancer for risk stratification. So, first, the team looked at whether that same tool developed in localized prostate cancer serves as a prognostic tool in non-metastatic castrate-refractory prostate cancer. So, we applied the tool as it was previously developed and identified that about 2/3 of patients on the SPARTAN trial that had specimens available for analysis qualified as high risk and 1/3 of patients as either intermediate or low risk, which we called in the paper ‘non-high risk'. And we're able to show that the multimodal AI score, which ranges from 0 to 1, and risk group, was associated with metastasis free survival time to second progression or PFS 2 and overall survival. And so that shows that it performs as a prognostic tool in this setting. And this paper was the first validation of this tool in non-metastatic castrate-refractory prostate cancer. So, what that means to trainees is basically it helps you understand how aggressive that cancer is or better stratify the risk of progression over time. So that's the prognostic performance. Dr. Rafeh Naqash: Thank you for trying to explain that. It's always useful to get an example and understand the difference between prognostic and predictive. Now again, going back to the technology, which obviously is way more complicated than the four letter word MMAI, I per se haven't necessarily done research in this space, but I've collaborated with some individuals who've done digital pathology assessments, and one of the projects we worked on was TIL estimation and immune checkpoint related adverse events using some correlation and something that one of my collaborators had sent to me when we were working on this project as part of this H&E slide digitalization, you need color deconvolution, you need segmentation cell profiling. Superficially, is that something that was done as part of development of this MMAI score as well? Dr. Timothy Showalter You need a ground truth, right? So, you need to train your model to predict whatever the outcome is. You know, if you're designing an AI algorithm for Ki-67 or something I think you mentioned before, you would need to have a set of Ki-67 scores and train your models to create those scores. In this case, the clinical annotation for how we develop the multimodal AI algorithm is the clinical endpoints. So going back to how this tool was developed, the computer vision AI model is interpreting a set of features on the scan and what it's trying to do is identify high risk features and make a map that would ultimately predict clinical outcomes. So, it's a little bit different than the many digital pathology algorithms where the AI is being trained to predict a particular morphological finding. In this case, the ground truth that the model is trained to predict is the clinical outcome. Dr. Rafeh Naqash: Sure. And from what you explained earlier, obviously, tumors that had a high MMAI score were the ones that were benefiting the most from the ADT plus the applausive. Is this specific for this androgen receptor inhibitor or is it interchangeable with other inhibitors that are currently approved? Dr. Timothy Showalter: That's a great question and we don't know yet. So, as you're alluding to, we did find that the MMAI risk score was predictive for benefit from apalutamide and so it met the statistical definition of having a significant interaction p value so we can call it a predictive performance. And so far, we've only looked in this population for apalutamide. I think you're raising a really interesting point, which is the next question is, is this generalizable to other androgen receptor inhibitors? There will be future research looking at that, but I think it's too early to say. Just for summary, I think I mentioned before, there are about 40% of patients enrolled on the SPARTAN study had specimens available for inclusion in this analysis. So, the SPARTAN study did show in the entire clinical trial set that patients with non-metastatic castrate-refractory prostate cancer benefited from apalutamide. The current study did show that there seems to be a larger magnitude of benefit for those patients who are multimodal AI high risk scores. And I think that's very interesting research and suggests that there's some interaction there. But I certainly would want to emphasize that we have not shown that patients with intermediate or low risk don't benefit from apalutamide. I think we can say that the original study showed that that trial showed a benefit and that we've got this interesting story with multimodal AI as well. Dr. Rafeh Naqash: Sure. And I think from a similar comparison, ctDNA where ctDNA shows prognostic aspects, I treat people with lung cancer especially, and if you're ctDNA positive at a 3 to 4-month period, likely chances of you having a shorter disease-free interval is higher. Same thing I think for colorectal cancers. And now there are studies that are using ctDNA as an integral biomarker to stratify patients positive/negative and then decide on escalation/de-escalation of treatment. So, using a similar approach, is there something that is being done in the context of the H&E based stratification to de-intensify or intensify treatments based on this approach? Dr. Timothy Showalter: You're hitting right on the point in the most promising direction. You know, as we pointed out in the manuscript, one of the most exciting areas as a next step for this is to use a tool like this for stratification for prospective trials. The multimodal AI test is not being used currently in clinical trials of non-metastatic castrate-refractory prostate cancer, which is a disease setting for this paper. There are other trials that are in development or currently accruing where multimodal AI stratification approach is being taken, where you see among the high-risk scores, at least in the postoperative setting for a clinical trial that's open right now, high risk score patients are being randomized to basically a treatment intensification question. And then the multimodal AI low risk patients are being randomized to a de-intensification experimental arm where less androgen deprivation therapy is being given. So, I think it's a really promising area to see, and I think what has been shown is that this tool has been validated really across the disease continuum. And so, I think there are opportunities to do that in multiple clinical scenarios. Dr. Rafeh Naqash: Then moving on to the technological advancements, very fascinating how we've kind of evolved over the last 10 years perhaps, from DNA based biomarkers to RNA expression and now H&E. And when you look at cost savings, if you were to think of H&E as a simpler, easier methodology, perhaps, with the limitations that centers need to digitalize their slides, probably will have more cost savings. But in your experience, as you've tried to navigate this H&E aspect of trying to either develop the model or validate the model, what are some of the logistics that you've experienced can be a challenge? As we evolve in this biomarker space, how can centers try to tackle those challenges early on in terms of digitalizing data, whether it's simple data or slides for that matter? Dr. Timothy Showalter: I think there's two main areas to cover. One, I think that the push towards digitalization is going to be, I think, really driven by increasing availability and access to augmentative technologies like this multimodal AI technology where it's really adding some sort of a clinical insight beyond what is going to be generated through routine human diagnostic pathology. I think that when you can get these sorts of algorithms for patient care and have them so readily accessible with a fast turnaround time, I think that's really going to drive the field forward. Right now, in the United States, the latest data I've seen is that less than 10% of pathology labs have gone digital. So, we're still at an early stage in that. I hope that this test and similar ones are part of that push to go more digital. The other, I think, more interesting challenge that's a technical challenge but isn't about necessarily how you collect the data, but it certainly creates data volume challenges, is how do you deal with image robustness and sort of translating these tools into routine real-world settings. And as you can imagine, there's a lot of variation for staining protocols, intensity scanner variations, all these things that can affect the reliability of your test. And at least for this research group that I'm a part of that has developed this multimodal AI tool can tell you that the development is sophisticated, but very data and energy intensive in terms of how to deal with making a tool that can be consistent across a whole range of image parameters. And so that presents its own challenges for dealing with a large amount of compute time and AI cycles to make robust algorithms like that. And practically speaking, I think moving into other diseases and making this widely available, the size of data required and the amount of cloud compute time will be a real challenge. Dr. Rafeh Naqash: Thank you for summarizing. I can say that definitely, you know, this is maybe a small step in prostate cancer biomarker research, but perhaps a big step in the overall landscape of biomarker research in general. So definitely very interesting. Now, moving on to the next part of the discussion is more about you as a researcher, as an individual, your career path, if you can summarize that for us. And more interestingly, this intersection between being part of industry as well as academia for perhaps some of the listeners, trainees who might be thinking about what path they want to choose. Dr. Timothy Showalter: Sure. So, as you may know, I'm a professor at the University of Virginia and I climbed the academic ladder and had a full research grant program and thought I'd be in academia forever. And my story is that along the way, I kind of by accident ended up founding a medical device company that was called Advaray and that was related to NCI SBIR funding. And I found myself as a company founder and ultimately in that process, I started to learn about the opportunity to make an impact by being an innovator within the industry space. And that was really the starting point for me. About four years ago, soon after Felix Feng co-founded Artera, he called me and told me that he needed me to join the company. For those who were lucky to know Felix well, at that very moment, it was inevitable that I was going to join Artera and be a part of this. He was just so persuasive. So, I will say, you know, from my experience of being sort of in between the academic and industry area, it's been a really great opportunity for me to enter a space where there's another way of making an impact within cancer care. I've gotten to work with top notch collaborators, work on great science, and be part of a team that's growing a company that can make technology like this available. Dr. Rafeh Naqash: Thank you so much, Tim, for sharing some of those thoughts and insights. We really appreciate you discussing this very interesting work with us and also appreciate you submitting this to JCO Precision Oncology and hopefully we'll see more of this as this space evolves and maybe perhaps bigger more better validation studies in the context of this test. Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

How powerful is exercise in the fight against advanced prostate cancer? Dr. Geo speaks with world-renowned exercise oncology expert Dr. Rob Newton from Australia, whose groundbreaking research has shaped how clinicians approach fitness and cancer care. From bone metastasis to androgen deprivation therapy (ADT), Dr. Newton explains how the right exercise, at the right dose, can not only improve quality of life but potentially extend it.Together, they explore the science, practical guidelines, and inspiring stories behind using movement as medicine—even for men with metastatic, castration-resistant disease.Key TakeawaysExercise is medicine for men with prostate cancer—including advanced and metastatic cases.Resistance training helps preserve or build muscle during androgen deprivation therapy (ADT), reducing side effects like fatigue, bone loss, and metabolic issues.Even with bone metastases, exercise can be done safely with modified strength programs—no increase in fractures observed in studies.Muscle strength and fitness are strongly linked to lower cancer-related and all-cause mortality.Myokines released from working muscles have direct anti-cancer effects and support immune function.Focus on large muscle groups (legs, back, chest) using moderate to heavy weights—6 to 15 reps per set.Tailor workouts to the individual: more strength training for muscle loss, more cardio for heart/metabolic risk.Periodized, varied routines improve outcomes and help patients tolerate treatments like chemo better._________________________ Introducing The Dr. Geo Prostate Podcast Exclusive MembershipWe'll continue bringing you powerful weekly episodes to support your prostate health journey. But if you're ready to dive deeper, the Exclusive Membership gives you more: curated transcripts, detailed show notes, expert resources, and member-only perks—all designed to help you live better with age. Join HERE [https://drgeo.com/membership]_________________________ Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that keep the body in a fasting state.Special Offer: As a listener, you can get the ProLon kit for just $148 using this [https://bit.ly/3TVehAx ].We'd also like to thank our partner AG1 by Athletic Greens. AG1 includes 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This blend supports your gut, immune system, energy, focus, and more—all in one daily scoop. https://bit.ly/3mA2tVV_________________________

The Ramblin Gambler, answers listeners questions in a Questions My Sons Ask segment (12:30), before revealing an additional secret ADT consideration casino use to determine how players are comped in a Core Koncepts segment (26:30). Then, TRG continues to share results from playing Beyond the Book, as taught by authors Bruce Dye and Dave Krite (40:38). Finally, in the Virtual VIP Lounge, TRG shares a free opportunity that he things every listeners should take advantage of (50:)0).

Jessica Zwaan returned to The Modern People Leader for a deep dive on how her PeopleOps as a Product philosophy came to life. We talked about the early days of the framework, writing her book, and the launch of MPL Build — a new collaboration between MPL and Jessica to bring the methodology to more teams.---- 

Today, we discuss the role of triplet therapy (ie, chemotherapy and androgen receptor signalling inhibitor and ADT) in high-volume metastatic hormone-sensitive prostate cancer and whether darolutamide is equivalent to the other androgen receptor signalling inhibitors in the castrate-sensitive space. Two good trials, and as always, some interesting discussion points.Studies discussed in the episode:ARASENSARANOTEFor more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comArt courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice.Oncology for the Inquisitive Mind is recorded with the support of education grants from our foundation partners Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have access to the episode at the same time you do and have no editorial control over the content. Hosted on Acast. See acast.com/privacy for more information.

Shane Koller joined us on The Modern People Leader. We talked about adopting a product mindset in HR, how Ancestry's people team built their “product roadmap”, and why even great HR programs fall short when they're not connected.---- 

Eric Beyrich says, “this is the time of year we actually thrive” as he looks at a low-bid, high-yield strategy. He compares the ratio of value to growth in the market and says there's a “long way to go” to get back to equilibrium after tech's massive run. He expects the S&P 500 to have a bad year, but most stocks to have an up year. His picks include ADT, DOW, PFE, AMCR, and BERY.======== Schwab Network ========Empowering every investor and trader, every market day.Subscribe to the Market Minute newsletter - https://schwabnetwork.com/subscribeDownload the iOS app - https://apps.apple.com/us/app/schwab-network/id1460719185Download the Amazon Fire Tv App - https://www.amazon.com/TD-Ameritrade-Network/dp/B07KRD76C7Watch on Sling - https://watch.sling.com/1/asset/191928615bd8d47686f94682aefaa007/watchWatch on Vizio - https://www.vizio.com/en/watchfreeplus-exploreWatch on DistroTV - https://www.distro.tv/live/schwab-network/Follow us on X – https://twitter.com/schwabnetworkFollow us on Facebook – https://www.facebook.com/schwabnetworkFollow us on LinkedIn - https://www.linkedin.com/company/schwab-network/About Schwab Network - https://schwabnetwork.com/about

Michele Bousquet joined us on The Modern People Leader. We talked about her career journey, leading with heart, and why HR shouldn't be so complicated.---- 

In this JCO Precision Oncology Article Insights episode, Natalie DelRocco summarizes "Digital Pathology–Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase III Trial in Men With Nonmetastatic Castration-Resistant Prostate Cancer" by Felix Y. Feng, et al published January 31, 2025. Come back for the next episode where JCO Precision Oncology Conversations host, Dr. Rafeh Naqash interviews the author of the JCO PO article discussed, Dr. Tim Showalter. TRANSCRIPT Natalie DelRocco: Hello and welcome to JCO Precision Oncology Article Insights. I'm your host Natalie Del Rocco. Today, we'll be discussing the article, “Digital Pathology-Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase III Trial in Men With Nonmetastatic Castration-Resistant Prostate Cancer.” We will also be discussing the accompanying editorial, “Leveraging Artificial Intelligence to Improve Risk Stratification in Nonmetastatic Castration-Resistant Prostate Cancer.” So, we're going to start by summarizing the original report and then we'll jump into a few of the high-level interpretations that were supplied by the editorial.   The original report by Feng et. al. describes the application of multimodal artificial intelligence to data collected on a nonmetastatic castration-resistant prostate cancer. We will call this disease moving forward NMCRPC, a Clinical Trial. So, we're looking at data from an NMCRPC clinical trial. The SPARTAN trial was a randomized phase three trial and this study compared metastasis-free survival as the primary endpoint for those treated with traditional androgen deprivation therapy or ADT to those treated with androgen deprivation therapy plus apalutamide. Other secondary endpoints included progression-free survival and overall survival, but the primary endpoint there was metastasis-free survival or MFS. This study found that the addition of apalutamide resulted in a significantly longer median metastasis-free survival compared to androgen deprivation therapy alone. And we should note that this is a double-blind placebo-controlled trial. In the overall study, 1,207 patients participated and over the course of this study histopathology slides were collected and they were digitized for future use. And that future use is what we are going to be discussing today.  The authors do note that there are currently no good biomarkers for use in NMCRPC. The authors seem to be inspired by the ArteraAI prostate test, which was a recent application of multimodal artificial intelligence models. But in localized prostate cancer as opposed to NMCRPC, the authors constructed a multimodal artificial intelligence model or an MMAI model. They applied this to the SPARTAN trial with the intention of developing a risk score that could be used for risk stratification in NMCRPC. And we should note here that multimodal artificial intelligence or MMAI is a broad class of artificial intelligence models, and they can analyze different types of data at one time, hence the term multimodal. So in this example, the author's primary data source of interest were those digitized histopathology images because histopathology tells you a lot about NMCRPC. The authors though also wanted their model to consider traditional clinical factors that are known to be prognostic such as Gleason score, tumor stage, PSA level, and age. So those two different types of data, those histopathology images and that traditional clinical data are the two different types of data that make this model multimodal. So we should note here importantly, after dropping missing data, 420 patients contribute to this model, the MMAI model.  The authors generate a risk score from this MMAI model and they categorize that risk score into low, intermediate, and high risk groups using clinical knowledge. The authors found in their results that an increase in this MMAI risk score was associated with an increased hazard of metastasis-free survival event with a hazard ratio from a Cox proportional hazards model of 1.72. To summarize how the authors arrived here, they derived a risk score from this MMAI model which incorporates both imaging and regular data. They plugged this risk score into a Cox proportional hazards mode,l modeling metastasis-free survival and they found that an increase in that MMAI based risk score is associated with increased hazard of metastasis-free event with a hazard ratio of 1.72, which is quite large. Additionally, the risk score seemed to be associated with PFS2 and OS, which were two of the secondary endpoints from the SPARTAN clinical trial, though the effect sizes were more modest. Those are the highlights from the original report, the methods and the results.  The accompanying editorial notes that both histopathology and Gleason score specifically are very critical to understanding prostate cancer, and Gleason score alone is not sufficient to summarize the complexity of the disease, although it is a well validated prognostic factor for prostate cancer. So this makes MMAI an excellent tool in the setting described by the authors. We have an existing prognostic factor that doesn't describe the entire picture of the disease by itself and so we can use those digitized histopathology slides to help bolster our understanding and provide the model more information. MMAI allows you to do this because it can take in different types of data. So that was the main conclusion of the editorial.  They also summarize a number of recent validations of MMAI models in prostate cancer research, noting that it will be an important tool for risk stratification and has already been shown to outperform classical techniques. The editorial though does highlight a number of weaknesses of this paper, limitations and I think the most important one to highlight, and we touched on this earlier, is that 420 patients from the SPARTAN clinical trial contributed to the development of this MMAI score. That is a small proportion of the roughly 1200 patients that did participate in the SPARTAN clinical trial. So we have a small subgroup analysis that can be limiting and this model will need to be validated in a broader population in the future.   Thank you for listening to JCO Precision Oncology Article Insights. Don't forget to give us a rating or a review and be sure to subscribe so that you never miss an episode. You can find all ASCO shows at asco.org/podcasts.    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.      

Michael Walsh, CEO of Cariloop, joined us on The Modern People Leader. We discussed the caregiving challenges facing employees today, how companies can better support working caregivers, and the data-backed insights from Cariloop's Top Needs Report.---- 

Cooper Schwartz: Monetizing Content: How Top Publishers and Brands Maximize Reach and Revenue Impact“The brands that win aren't just the ones with the biggest budgets—they're the ones that strategically align performance and brand marketing to maximize reach and revenue.” That's a quote from Cooper Schwartz and a sneak peek at today's episode.Hey there, I'm Kerry Curran, Revenue Growth Consultant, Industry Analyst, and host of Revenue Boost: A Marketing Podcast.Every episode, I sit down with top experts to bring you actionable strategies that drive real revenue results. If you're serious about growth, hit subscribe to stay ahead of your competition.In this episode, titled Monetizing Content: How Top Publishers and Brands Maximize Reach and Revenue Impact, Cooper Schwartz, Head of New Business and Growth at Money Group, shares his expertise.In a crowded digital landscape, content alone isn't enough. Brands need a strategy that turns visibility into real revenue. Cooper and I discuss strategies for leveraging publisher partnerships to create high-impact, holistic, cross-channel digital programs that drive both reach and ROI.We dive into the winning formula for balancing performance marketing and brand strategy—and how to dominate non-branded paid search while outmaneuvering your competition.Stay tuned until the end, where Cooper shares actionable strategies to optimize content for revenue growth. Let's go!Kerry Curran, RBMA (00:01.107)Welcome, Cooper! Please introduce yourself and share a bit about your background and expertise.Cooper Schwartz (00:07.534)Hi, Kerry. Thanks for having me. My name is Cooper Schwartz, and I am the Head of New Business and Growth at Money Group, a portfolio company that has been around for about 11 years. We own notable brands like Money.com and ConsumersAdvocate.org, as well as proprietary technology like NavChain. I'm also one of the founding partners and have been with the company for 11 years.I was actually the first employee. I originally came from a therapy background—my mother is a therapist, and I thought I would follow in her footsteps. However, two of my close friends—one with 10 years at Google and the other at SEO Moz—convinced me to jump into affiliate marketing and help build this company. So here I am today, still finding opportunities in the market and excited to talk with you.Kerry Curran, RBMA (01:02.843)Awesome, thanks, Cooper! I had no idea about your therapy background. We could totally pivot and have a different conversation! I always say marketing is a lot like psychology—it plays a strong role in what we do, so I'm sure that background strengthens your expertise.Anyway, I'm excited to have you here because I know you have a ton of valuable platforms.Cooper Schwartz (01:09.484)Yeah, yeah.Kerry Curran, RBMA (01:29.617)You have a range of brands and technology under Money.com, so I'd love to hear more about how you're helping brands navigate their business challenges. When brands or agencies reach out to build a partnership with you, what are they typically looking for?Cooper Schwartz (01:51.672)You're right—Money.com is a strong domain. Before it became Money.com, it was Money Magazine, a 50-year-old brand that people have nostalgia for. It was all about planning for the future and sharing insights on managing finances.Today, brands still want to be aligned with the Money brand. But we don't just offer content alignment—we provide a variety of campaigns and marketing opportunities. Many brands approach us saying, “We love the brand, we love the content—how can we work together?” That's a great starting point for the many solutions we offer.From non-branded paid search to placements across our ad network of about 150 publishers, we help brands engage with their audience in unique ways. Some of these publishers might be seen as competitors, but in reality, they're “frenemies.” We help brands leverage content, align with our brand, activate paid search strategies, and secure placements on other high-authority sites, all while simplifying the management process.Kerry Curran, RBMA (03:37.691)That's great. It sounds like brands really value the partnership and brand equity you offer. Can you walk us through how you start these relationships and build custom strategies to increase their awareness and authority?Cooper Schwartz (04:03.192)Sure! There's always an initial “interview” process—almost like dating. Not to take it back to therapy, but it's about getting to know the brand:What are their needs?Who is their target audience?What are their expectations?What are their key performance goals?We get a lot of inbound interest because money impacts nearly every industry. But we have to ensure alignment goes both ways—not just that they align with our audience, but also that we can effectively reach their audience.At our scale, we also consider resources. Can we accommodate the brand in a way that sets them up for success? We prioritize enterprise-level partnerships that move the needle for both companies. That often means ensuring the investment in a given category can be six or seven figures annually—we need to create impact on both sides.Once we've established alignment—brand fit, budget, resources—we dive into which marketing channels make sense:Are they already running paid search? If not, why?How can we help them expand their shelf space on Google?Is brand awareness the priority? If so, we can integrate them into our franchise content like Best Places to Live, Best Hospitals, Best Colleges, which reach wide audiences.Are they struggling to get placements in high-authority content? If so, we can help them secure placements on Forbes, NerdWallet, CBS News, CNN, and others.Kerry Curran, RBMA (06:53.058)That's great! I love that you have such a wide portfolio of solutions that are fully customized to each brand's goals.So, let's say an enterprise brand comes to you for a rebrand, product expansion, or new launch. You work with them to align with the right publishers and strategies. Can you share a specific example of a successful partnership?Cooper Schwartz (07:39.918)Sure! One that I'm especially proud of is our partnership with ADT.We've worked with ADT for about eight or nine years, originally in non-branded paid search—helping them reach high-intent consumers who were still undecided. Over time, our relationship evolved into exploring additional channels.Last year, we launched a sponsorship activation for Money's Best Places to Live, working closely with ADT's PR, media acquisition, and marketing teams. The goal was to integrate ADT's branding into content about protecting the best places to live.This was a multichannel activation that included:Social media campaignsVideo contentTargeted PR effortsWeekly performance check-insThe result? A high-impact security hub on Money.com featuring ADT across 100+ articles. It was a strategic, elegant execution.Not only did we secure ADT placements on our own sites, but we also helped them get featured on CBS News, The New York Post, and other major publishers. This is the kind of holistic strategy that allows brands to gain visibility across multiple trusted sources.Kerry Curran, RBMA (10:34.345)That's an excellent example! It really demonstrates how brands can layer multiple channels—from paid search to PR to content—to create a unified, impactful strategy.Let's shift gears to AI and Google's generative search results. How do your strategies help brands compete with AI-driven summaries at the top of search results?Cooper Schwartz (20:43.342)Great question! One core belief we've held is that editorial integrity matters. We prioritize keeping a human voice in our content while leveraging AI in strategic ways.Here's our approach:Investing in real writers & editors – AI can assist, but human oversight ensures depth and quality.Creating content clusters – Instead of one-off articles, we develop deep, interconnected content that builds expertise and authority.Partnering with already-successful publishers – Instead of relying solely on our content, we collaborate with trusted media brands that are already ranking well.The reality is, the pie is big enough. Rather than fighting for every ranking, we focus on working with the best—helping publishers monetize better while delivering results for our partners.Kerry Curran, RBMA (25:25.383)That's a smart approach. So, for brands listening today—what's the first step if they want to explore this strategy?Cooper Schwartz (25:40.910)Start by researching who dominates your industry's review space. Look at organic rankings, paid search, and media partnerships. If you see competitors investing in multiple touchpoints, that's a sign they're onto something.Then, reach out! You can contact me at cooper@money.com or find me on LinkedIn.Kerry Curran, RBMA (26:07.537)Awesome! We'll include those links in the show notes. Cooper, thank you so much for your time and insights today!Cooper Schwartz (26:20.098)Thank you, Kerry!Kerry Curran, RBMA Thank you for tuning in to today's episode. If you're struggling with flat or slowing revenue growth, you are not alone. That's why Revenue Boost: A Marketing Podcast, brings you expert insights, actionable strategies, and real-world success stories to help you scale faster.So if you're serious about your revenue growth, hit follow,  subscribe, and drop a five-star rating. It helps us keep the game-changing content coming, as we're dropping new episodes regularly—and you don't want to miss out.

Linda Aiello (CPO, DraftKings), Carmel Galvin (CPO, Klaviyo), and Stacey Richey (Global VP, People, Smartcat), joined us for MPL Live in Boston, Massachusetts.We talked about the current state of HR, how roles are shifting with AI, and how they're moving beyond traditional engagement metrics.---- 

Shlomit Gruman-Navot joined us on The Modern People Leader. We talked about her evolution as a people leader and how Miro is making AI learning a priority for employees. ---- 

A fantastic episode for urologists, radiation oncologists, and anyone interested in localised prostate cancer. Biochemical recurrence (BCR) is unfortunately all too common after surgery or radiation for prostate cancer, and today we talk with someone who has been working in BCR for more than 20 years. Dr Steve Freedland, Urologist at Cedars-Sinai in Los Angeles, popped into the GU Cast studio to talk about the landmark series from Johns-Hopkins Medical Institute (links below) which still today remains our best guide to the natural history of BCR after radical prostatectomy. And the key message that PSA doubling time is our most important tool to risk stratify patients reminds true today. And Steve of course is the lead investigator of the EMBARK trial, published in NEJM in 2023, which has led to a new standard of care for men experiencing high-risk BCR after surgery or radiotherapy. EMBARK has clearly shown us that the use of enzaluamide, either on its own, or with androgen deprivation therapy, reduces the risk of metastases when compared with ADT alone. We dive deep into EMBARK with Steve.This is a Themed Podcast supported by our Gold Partners, Astellas. Astellas also supported Steve to be in Australia this week for the USANZ ASM in Perth, and visits to Melbourne and Sydney. Your hosts are Professor Declan Murphy and Dr Renu Eapen. Even better on our Youtube channelLinks:Freedland et al JAMA 2005 EMBARK paper in NEJM

Brandon Carson, Chief Learning Officer at Docebo, joined us on The Modern People Leader.We talked about the one thing holding companies back from adopting AI faster, why AI makes learning “scaled to one”, and why the future of work isn't about replacing humans - it's about amplifying them.---- 

Dr. Neeraj Agarwal and Dr. Peter Hoskin discuss key abstracts in GU cancers from the 2025 ASCO Genitourinary Cancers Symposium, including novel therapies in prostate, bladder, and kidney cancer and the impact of combination therapies on patient outcomes. TRANSCSRIPT Dr. Neeraj Agarwal: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, the director of the Genitourinary Oncology Program and professor of medicine at the Huntsman Cancer Institute at the University of Utah, and editor-in-chief of ASCO Daily News. Today, we'll be discussing practice-informing abstracts and other key advances in GU oncology featured at the 2025 ASCO Genitourinary Cancers Symposium. Joining me for this discussion is Dr. Peter Hoskin, the chair of this year's ASCO GU Symposium. Dr. Hoskin is a professor in clinical oncology in the University of Manchester and honorary consultant in clinical oncology at the Christie Hospital, Manchester, and University College Hospital London, in the United Kingdom. Our full disclosures are available in the transcript of this episode. Peter, thank you for joining us today. Dr. Peter Hoskin: Thank you so much, Neeraj. I am very pleased to be here. Dr. Neeraj Agarwal: The GU meeting highlighted remarkable advancements across the spectrum of GU malignancies. What stood out to you as the most exciting developments at the ASCO GU Symposium?  Dr. Peter Hoskin: The theme of this year's meeting was "Driving Innovation, Improving Patient Care," and this reflected ASCO GU's incredible milestone in GU cancer research over the years. We were thrilled to welcome almost 6,000 attendees on this occasion from over 70 countries, and most of them were attending in person and not online, although this was a hybrid meeting. Furthermore, we had more than 1,000 abstract submissions. You can imagine then that it fostered fantastic networking opportunities and facilitated valuable knowledge and idea exchanges among experts, trainees, and mentees. So, to start I'd like to come back to you for a second because the first day started with a focus on prostate cancer and some of the key clinical trials. And congratulations to you, Neeraj, on sharing the data from the TALAPRO-2 trial, which we were eagerly awaiting. I'd love to get your thoughts on the data that you presented. Could you tell us more about that trial, Abstract LBA18?  Dr. Neeraj Agarwal: Yes, Peter, I agree with you. It was such an exciting conference overall and thank you for your leadership of this conference. So, let's talk about the TALAPRO-2 trial. First of all, I would like to remind our audience that the combination of talazoparib plus enzalutamide was approved by the U.S. FDA in June 2023 in patients with metastatic castration-resistant prostate cancer harboring HRR gene alterations, after this combination improved the primary endpoint of radiographic progression-free survival compared to enzalutamide alone in the randomized, double-blind, placebo-controlled, multi-cohort phase 3 TALAPRO-2 trial. In the abstract I presented at ASCO GU 2025, we reported the final overall survival data, which was a key alpha-protected secondary endpoint in cohort 1, which enrolled an all-comer population of patients with mCRPC. So, at a median follow-up of around 53 months, in the intention-to-treat population, the combination of talazoparib plus enzalutamide significantly reduced the risk of death by 20% compared to enzalutamide alone, with a median OS of 45.8 months in the experimental arm versus 37 months in the control arm, which was an active control arm of enzalutamide. This improvement was consistent in patients with HRR alterations with a hazard ratio of 0.54 and in those with non-deficient or unknown HRR status, with a hazard ratio of 0.87. In a post hoc analysis, the hazard ratio for OS was 0.78 favoring the combination in those patients who did not have any HRR gene alteration in their tumors by both tissue and ctDNA testing. Consistent with the primary analysis, the updated rPFS data also favored the experimental arm with a median rPFS of 33.1 compared to 19.5 months in the control arm, and a hazard ratio of 0.667. No new safety signals were identified with extended follow-up. Thus, TALAPRO-2 is the first PARP inhibitor plus ARPI study to show a statistically significant and a clinically meaningful improvement in OS compared to standard-of-care enzalutamide as first-line treatment in patients with mCRPC unselected for HRR gene alterations. Dr. Peter Hoskin: Thank you, Neeraj. That's a great summary of the data presented and very important data indeed. There was another abstract also featured in the same session, Abstract 20, titled “Which patients with metastatic hormone-sensitive prostate cancer benefit more from androgen receptor pathway inhibitors? STOPCAP meta-analyses of individual participant data.” Neeraj, could you tell us more about this abstract? Dr. Neeraj Agarwal: Absolutely, I would be delighted to. So, in this meta-analysis, Dr. David Fischer and colleagues pooled individual participant data from different randomized phase 3 trials in the mHSPC setting to assess the potential ARPI effect modifiers and determine who benefits more from an ARPI plus ADT doublet. The primary outcome was OS for main effects and PFS for subgroup analyses. Prostate cancer specific survival was a sensitivity outcome. The investigators pooled data from 11 ARPI trials and more than 11,000 patients. Overall, there was a clear benefit of adding an ARPI on both OS and PFS, with hazard ratios of 0.66 and 0.51, respectively, representing a 13% and 21% absolute improvement at 5 years, respectively, with no clear difference by the class of agent. When stratifying the patients by age group, the effects of adding an ARPI on OS and PFS were slightly smaller in patients older than 75, than in those younger than 65, or aged between 65 and 75 years. Notably, in the trials assessing the use of abiraterone, we saw very little OS effects in the group of patients older than 75, however there was some benefit maintained in prostate-cancer specific survival, suggesting that other causes of death may be having an impact. The effects of the other ARPIs, or ‘lutamides' as I would call them, were similar across all three age subgroups on both OS and PFS. Therefore, the majority of patients with mHSPC benefit from the addition of ARPIs, and the benefits/risks of abiraterone and other ‘amides' must be considered in older patients.  Dr. Peter Hoskin: Thanks, Neeraj. Another great summary relevant to our day-to-day practice. Of course, there's ongoing collection of individual patient data from other key trials, which will allow robust comparison of ARPI doublet with triplet therapy (including docetaxel), guiding more personalized treatment.   Dr. Neeraj Agarwal: I agree with you, Peter, we need more data to help guide personalized treatment for patients with mHSPC and potentially guide de-escalation versus escalation strategies. Now, moving on to a different setting in prostate cancer, would you like to mention Abstract 17 titled, “Overall survival and quality of life with Lu-PSMA-617 plus enzalutamide versus enzalutamide alone in poor-risk, metastatic, castration-resistant prostate cancer in ENZA-p (ANZUP 1901),” presented by Dr. Louise Emmett? Dr. Peter Hoskin: Of course I will. So, ENZA-p was a multicenter, open-label, randomized, phase 2 trial conducted in Australia. It randomized 163 patients into adaptive doses (2 or 4 cycles) of Lu-PSMA-617 plus enzalutamide versus enzalutamide alone as first-line treatment in PSMA-PET-CT-positive, poor-risk, mCRPC. The interim analysis of ENZA-p with median follow-up 20 months showed improved PSA-progression-free survival with the addition of Lu-PSMA-617 to enzalutamide. Here, the investigators reported the secondary outcomes, overall survival, and health-related quality of life (HRQOL). After a median follow up of 34 months, overall survival was longer in the combination arm compared to the enzalutamide arm, with a median OS of 34 months compared to 26 months; with an HR of 0.55. Moreover, the combination improved both deterioration-free survival and health-related quality of life indicators for pain, fatigue, physical function, and overall health and quality of life compared to the control arm. Consistent with the primary analysis, the rPFS also favored the experimental arm with a median rPFS of 17 months compared to 14 months with a HR of 0.61. So, the addition of LuPSMA improved overall survival, and HRQOL in patients with high-risk mCRPC. Dr. Neeraj Agarwal: Thank you, Peter. Great summary, and promising results with Lu-177 and ARPI combination in first line treatment for mCRPC among patients who had two or more high risk features associated with early enzalutamide failure. Before we move on to bladder cancer, would you like to tell us about Abstract 15 titled, “World-wide oligometastatic prostate cancer (omPC) meta-analysis leveraging individual patient data (IPD) from randomized trials (WOLVERINE): An analysis from the X-MET collaboration,” presented by Dr. Chad Tang?  Dr. Peter Hoskin: Sure. So, with metastatic-directed therapy (MDT), we have a number of phase 2 studies making up the database, and the X-MET collaboration aimed to consolidate all randomized data on oligometastatic solid tumors. This abstract presented pooled individual patient data from all the published trials involving patients with oligometastatic prostate cancer who received MDT alongside standard of care (SOC) against SOC alone. The analysis included data from five trials, encompassing 472 patients with oligometastatic prostate cancer, and followed for a median of 41 months. Patients were randomly assigned in a 1:1 ratio to receive either MDT plus SOC or SOC alone. The addition of MDT significantly improved PFS. The median PFS was 32 months with MDT compared to 14.9 months with SOC alone, with an HR of 0.45. Subgroup analyses further confirmed the consistent benefits of MDT across different patient groups. Regardless of factors like castration status, receipt of prior primary treatment, stage, or number of metastases, MDT consistently improved PFS. In patients with mHSPC, MDT significantly delayed the time to castration resistance by nine months, extending it to a median of 72 months compared to 63 months in the SOC group with an HR of 0.58. In terms of OS, the addition of MDT improved the 48-month survival rate by 12%, with OS rates of 87% in the MDT+SOC group compared to 75% in the SOC alone group. Dr. Neeraj Agarwal: Thank you, Peter. These data demonstrate that adding MDT to systemic therapy significantly improves PFS, rPFS, and castration resistance-free survival, reinforcing its potential role in the treatment of oligometastatic prostate cancer. So, let's switch gears to bladder cancer and start with Abstract 658 reporting the OS analysis of the CheckMate-274 trial. Would you like to tell us about this abstract?  Dr. Peter Hoskin: Yes, sure, Neeraj. This was presented by Dr. Matt Milowsky, and it was additional efficacy outcomes, including overall survival, from the CheckMate-274 trial which evaluated adjuvant nivolumab versus placebo in patients with high-risk muscle-invasive bladder cancer after radical surgery. The phase 3 trial previously demonstrated a significant improvement in disease-free survival with nivolumab. With a median follow-up of 36.1 months, disease-free survival was longer with nivolumab compared to placebo across all patients with muscle-invasive bladder cancer, reducing the risk of disease recurrence or death by 37%. Among patients who had received prior neoadjuvant cisplatin-based chemotherapy, nivolumab reduced this risk by 42%, whilst in those who had not received chemotherapy, the risk was reduced by 31%. Overall survival also favored nivolumab over placebo, reducing the risk of death by 30% in all patients with muscle-invasive bladder cancer and by 52% in those with tumors expressing PD-L1 at 1% or higher. Among patients who had received prior neoadjuvant chemotherapy, nivolumab reduced the risk of death by 26%, whilst in those who had not received chemotherapy, the risk was reduced by 33%. Alongside this, the safety profile remained consistent with previous findings. Dr. Neeraj Agarwal: Thank you, Peter, for such a nice overview of this abstract. These results reinforce adjuvant nivolumab as a standard of care for high-risk muscle-invasive bladder cancer, offering the potential for a curative outcome for our patients. Dr. Peter Hoskin: I agree with you Neeraj. Perhaps you would like to mention Abstract 659 titled, “Additional efficacy and safety outcomes and an exploratory analysis of the impact of pathological complete response (pCR) on long-term outcomes from NIAGARA.” Dr. Neeraj Agarwal: Of course. Dr. Galsky presented additional outcomes from the phase 3 NIAGARA study, which evaluated perioperative durvalumab combined with neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer. The study previously demonstrated a significant improvement in event-free survival and overall survival with durvalumab compared to chemotherapy alone, with a manageable safety profile and no negative impact on the ability to undergo radical cystectomy. Among the 1,063 randomized patients, those who received durvalumab had a 33% reduction in the risk of developing distant metastases or death and a 31% reduction in the risk of dying from bladder cancer compared to those who received chemotherapy alone. More patients who received durvalumab achieved a pathological complete response at the time of surgery with 37% compared to 28% in the chemotherapy-alone group. Patients who achieved a pathological complete response had better event-free survival and overall survival compared to those who did not. In both groups, durvalumab provided additional survival benefits, reducing the risk of disease progression or death by 42% and the risk of death by 28% in patients with a pathological complete response, while in those patients without a pathological complete response, the risk of disease progression or death was reduced by 23% and the risk of death by 16% when durvalumab was added to the chemotherapy. Immune-mediated adverse events occurred in 21% of patients in the durvalumab group compared to 3% in the chemotherapy-alone group, with grade 3 or higher events occurring in 3% compared to 0.2%. The most common immune-related adverse events included hypothyroidism in 10% of patients treated with durvalumab compared to 1% in the chemotherapy-alone group, and hyperthyroidism in 3% versus 0.8%. At the time of the data cutoff, these adverse events had resolved in 41% of affected patients in the durvalumab group and 44% in the chemotherapy-alone group. Dr. Peter Hoskin: Thank you, Neeraj, for the great summary. These findings further support the role of perioperative durvalumab as a potential standard of care for patients with muscle-invasive bladder cancer. Dr. Neeraj Agarwal: I concur with your thoughts, Peter. Before wrapping up the bladder cancer section, would you like to mention Abstract 664 reporting updated results from the EV-302 trial, which evaluated enfortumab vedotin in combination with pembrolizumab compared to chemotherapy as first-line treatment for patients with previously untreated locally advanced or metastatic urothelial carcinoma? Dr. Peter Hoskin: Yes, of course. Dr. Tom Powles presented updated findings from the EV-302 study, and in this abstract presented 12 months of additional follow-up for EV-302 (>2 y of median follow-up) and an exploratory analysis of patients with confirmed complete response (cCR). The study had a median follow-up of 29.1 months and previously demonstrated significant improvements in progression-free survival and overall survival with enfortumab vedotin and pembrolizumab. This is now the standard of care in global treatment guidelines. Among the 886 randomized patients, enfortumab vedotin and pembrolizumab reduced the risk of disease progression or death by 52% and the risk of death by 49% compared to chemotherapy. The survival benefit was consistent regardless of cisplatin eligibility or the presence of liver metastases. The confirmed objective response rate was higher with enfortumab vedotin and pembrolizumab at 67.5% compared to 44.2% with chemotherapy. The median duration of response was 23.3 months with enfortumab vedotin and pembrolizumab compared to 7.0 months with chemotherapy. A complete response was achieved in 30.4% of patients in the enfortumab vedotin and pembrolizumab group compared to 14.5% in the chemotherapy group, with the median duration of complete response not yet reached in the enfortumab vedotin and pembrolizumab group compared to 15.2 months in the chemotherapy group. Severe treatment-related adverse events occurred in 57.3% of patients treated with enfortumab vedotin and pembrolizumab compared to 69.5% in the chemotherapy group, while in patients who achieved a complete response, severe adverse events occurred in 61.7% of those treated with enfortumab vedotin and pembrolizumab compared to 71.9% with chemotherapy. Treatment-related deaths were reported in 1.1% of patients treated with enfortumab vedotin and pembrolizumab compared to 0.9% with chemotherapy, with no treatment-related deaths occurring in those who achieved a complete response. These findings clearly confirm the durable efficacy of enfortumab vedotin and pembrolizumab, reinforcing its role as the standard of care for the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma, and no new safety concerns have been identified. Dr. Neeraj Agarwal: Thank you for this great summary. Moving on to kidney cancer, let's talk about Abstract 439 titled, “Nivolumab plus cabozantinib (N+C) vs sunitinib (S) for previously untreated advanced renal cell carcinoma (aRCC): Final follow-up results from the CheckMate-9ER trial.” Dr. Peter Hoskin: Sure. Dr. Motzer presented the final results from the phase 3 CheckMate-9ER trial, which compared the combination of cabozantinib and nivolumab against sunitinib in previously untreated advanced renal cell carcinoma. The data after more than five years follow-up show that the combination therapy provided sustained superior efficacy compared to sunitinib. In terms of overall survival, we see an 11-month improvement in median OS, 46.5 months for the cabo-nivo versus 35.5 months for sunitinib and a 42% reduction in the risk of disease progression or death, with median progression-free survival nearly doubling – that's 16.4 months in the combination group and 8.3 months with sunitinib. Importantly, the safety profile was consistent with the known safety profiles of the individual medicines, with no new safety concerns identified. Dr. Neeraj Agarwal: Great summary, Peter. These data further support the efficacy of cabo-nivo combination therapy in advanced renal cell carcinoma, which is showing a 11-month difference in overall survival. Dr. Peter Hoskin: Neeraj, before wrapping up this podcast, would you like to tell us about Abstract 618? This is titled “Prospective COTRIMS (Cologne trial of retroperitoneal lymphadenectomy in metastatic seminoma) trial: Final results.” Dr. Neeraj Agarwal: Sure, Peter. I would be delighted to. Dr Heidenrich from the University of Cologne in Germany presented the COTRIMS data evaluating retroperitoneal LN dissection in patients with clinical stage 2A/B seminomas. Seminomas are classified as 2A or B when the disease spreads to the retroperitoneal lymph nodes of up to 2 cm (CS IIA) or of more than 2 cm to up to 5 cm (CS 2B) in maximum diameter, respectively. They account for 10-15% of seminomas and they are usually treated with radiation and chemotherapy. However, radiation and chemo can be associated with long-term toxicities such as cardiovascular toxicities, diabetes, solid cancers, leukemia, particularly for younger patients. From this standpoint, Dr Heidenrich and colleagues evaluated unilateral, modified template, nerve-sparing retroperitoneal lymph node dissection as a less toxic alternative compared to chemo and radiation. They included 34 patients with negative AFP, beta-HCG, and clinical stage 2A/B seminomas. At a median follow-up of 43.2 months, the trial demonstrated great outcomes: a 99.3% treatment-free survival rate and 100% overall survival, with only four relapses. Antegrade ejaculation was preserved in 88% of patients, and severe complications such as grade 3 and 4 were observed in 12% of patients. Pathological analysis revealed metastatic seminoma in 85% of cases, with miR371 being true positive in 23 out of 24 cases and true negative in 100% of cases. It appears to be a valid biomarker for predicting the presence of lymph node metastases. These findings highlight retroperitoneal lymph node dissection is feasible; it has low morbidity, and excellent oncologic outcomes, avoiding overtreatment in 80% of patients and sparing unnecessary chemotherapy or radiotherapy in 10-15% of cases. Dr. Peter Hoskin: Great summary and important data on retroperitoneal lymphadenectomy in metastatic seminoma. These findings will help shape clinical practice. Any final remarks before we conclude today's podcast? Dr. Neeraj Agarwal: Before wrapping up this podcast, I would like to say that we have reviewed several abstracts addressing prostate, bladder, kidney cancers, and seminoma, which are impacting our medical practices now and in the near future. Peter, thank you for sharing your insights with us today. These updates are undoubtedly exciting for the entire GU oncology community, and we greatly appreciate your valuable contribution to the discussion and your leadership of the conference. Many thanks. Dr. Peter Hoskin: Thank you, Neeraj. Thank you for the opportunity to share this information more widely. I'm aware that whilst we have nearly 6,000 delegates, there are many other tens of thousands of colleagues around the world who need to have access to this information. And it was a great privilege to chair this ASCO GU25. So, thank you once again, Neeraj, for this opportunity to share more of this information that we discussed over those few days. Dr. Neeraj Agarwal: Thank you, Peter. And thank you to our listeners for joining us today. You will find links to the abstracts discussed today on the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  Find out more about today's speakers:   Dr. Neeraj Agarwal    @neerajaiims    Dr. Peter Hoskin Follow ASCO on social media:      @ASCO on Twitter      ASCO on Bluesky  ASCO on Facebook      ASCO on LinkedIn      Disclosures: Dr. Neeraj Agarwal: Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas Dr. Peter Hoskin: Research Funding (Institution): Varian Medical Systems, Astellas Pharma, Bayer, Roche, Pfizer, Elekta, Bristol Myers  

This week we wrap up Black History month, and Jim's guest is one of the most consequential black marketing leaders of all time. Jerri DeVard, the Founder and CEO of BECA, the Black Executive CMO Alliance. Jerri started her career in marketing the same year Jim joined Procter & Gamble; she also started in consumer goods, working 10 years at the Pillsbury company, now part of General Mills. Jerri went on to CMO roles at Verizon, Nokia, ADT and Office Depot. Jerri was a guest on the show in July 2020. Jim and Jerri chatted through a wide ranging talk about her career, our friendship over the years, and what she has learned about leadership. Well this week, Jim will focus on her life since then, including the founding of BECA, which has been astounding in its impact. It's an honest, heart-to-heart chat–which is the only way Jerri DeVard rolls. Listen to the previous episode featuring Jeri from 2020: https://tinyurl.com/3tcmrx9rLearn more about BECA: https://blackexec.com/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Crystal Boysen, Chief People Officer at Sprout Social, joined us for a deep dive into People Debt. We discussed what it is, how to identify it, and specific areas where Sprout Social is focusing its efforts to address it.---- 

Brian Elliott, a leading expert on flexible work, joined us on the show.We talked about whether or not remote work is actually dead (looked at the actual data), the questions to ask when your CEO pushes for a RTO, and why a return to office won't fix bad management.----  Sign up for our upcoming webinar with ChartHop. Get Atlassian's free guide to AI-powered knowledge management Buy tickets for MPL Live Boston.---- (07:36) How Brian became a leading voice on the future of work(13:39) The origins of Slack's Future Forum and key findings(14:56) The media vs. reality: Is remote work really dead?(17:14) CEOs pushing RTO: Data-driven decision or gut feeling?(19:02) The role of real estate, stealth layoffs, and productivity concerns(23:27) The trust factor: Why some leaders struggle with hybrid models(26:35) Politics and workplace decisions: The hidden forces at play(28:34) The shift from central business districts to neighborhood economies(30:37) The future of work isn't fully remote or in-office—it's flexible(34:12) How HR leaders can push back on RTO mandates(38:19) The contradiction: CEOs demanding AI innovation while enforcing RTO(41:50) Performance management in a hybrid world: Why tracking outcomes matters(47:33) How leading companies successfully implement flexible work policies(49:30) The impact of return-to-office policies on women in the workforce(54:23) What cities will look like in a remote-first future(57:57) Five years from now: What will the workplace look like?(01:01:43) The economic realities of remote work and city tax structures---- 

In this episode, Dr. Geo welcomes Dr. Jonathan Haas, Director of Radiation Oncology at NYU Grossman School of Medicine in Long Island, to discuss the latest advancements in stereotactic body radiation therapy (SBRT) for prostate cancer. Dr. Haas, a pioneer in CyberKnife radiation, shares the latest research, treatment options, and what's on the horizon for prostate cancer care.Episode Highlights:✔ SBRT & CyberKnife Technology – How high-dose, highly targeted radiation is replacing traditional 9-week radiation therapy.✔ New Developments – Research is underway to reduce SBRT treatment from five sessions to just two, making therapy even more convenient.✔ Prostate Motion & Radiation Accuracy – The prostate moves during treatment—learn how advanced imaging and AI-powered tracking compensate for movement to improve precision.✔ Androgen Deprivation Therapy (ADT) & SBRT – Not all patients may need ADT. New studies explore whether men with Gleason 4+3 can avoid hormone therapy.✔ Who is a Candidate? – Understanding the differences between Gleason 6, 7, 8, and 9 patients and who may benefit most from SBRT.✔ Side Effects & Risk Factors – Discussing common side effects like bladder bleeding (2%), rectal irritation (5%), erectile dysfunction (25% over 5 years), and strictures (2%).✔ Artificial Intelligence & Radiation Therapy – The RayStation AI system is now optimizing radiation planning, increasing precision, and making treatments more effective.✔ Choosing the Right Treatment Center – Why it's crucial to seek multidisciplinary care, get second opinions, and explore clinical trials for the best possible outcome.Takeaway: The landscape of prostate cancer treatment is evolving rapidly. If you or a loved one is considering radiation therapy, ask about SBRT, AI-driven imaging, and new clinical trials to ensure you receive the most advanced and effective care.Join Dr. Geo each week for expert insights, science-backed advice, and empowering conversations designed to help you live better with age. ----------------Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that maintain the body in a fasting state.Special Offer: Thank you for listening, you can purchase the ProLon kit for just $148 by using this link.We'd also like to thank our partner AG1 by Athletic Greens. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the essentials in one scoop. Enjoy AG1 by Athletic Greens.----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube...

If you're in SF, join us tomorrow for a fun meetup at CodeGen Night!If you're in NYC, join us for AI Engineer Summit! The Agent Engineering track is now sold out, but 25 tickets remain for AI Leadership and 5 tickets for the workshops. You can see the full schedule of speakers and workshops at https://ai.engineer!It's exceedingly hard to introduce someone like Bret Taylor. We could recite his Wikipedia page, or his extensive work history through Silicon Valley's greatest companies, but everyone else already does that.As a podcast by AI engineers for AI engineers, we had the opportunity to do something a little different. We wanted to dig into what Bret sees from his vantage point at the top of our industry for the last 2 decades, and how that explains the rise of the AI Architect at Sierra, the leading conversational AI/CX platform.“Across our customer base, we are seeing a new role emerge - the role of the AI architect. These leaders are responsible for helping define, manage and evolve their company's AI agent over time. They come from a variety of both technical and business backgrounds, and we think that every company will have one or many AI architects managing their AI agent and related experience.”In our conversation, Bret Taylor confirms the Paul Buchheit legend that he rewrote Google Maps in a weekend, armed with only the help of a then-nascent Google Closure Compiler and no other modern tooling. But what we find remarkable is that he was the PM of Maps, not an engineer, though of course he still identifies as one. We find this theme recurring throughout Bret's career and worldview. We think it is plain as day that AI leadership will have to be hands-on and technical, especially when the ground is shifting as quickly as it is today:“There's a lot of power in combining product and engineering into as few people as possible… few great things have been created by committee.”“If engineering is an order taking organization for product you can sometimes make meaningful things, but rarely will you create extremely well crafted breakthrough products. Those tend to be small teams who deeply understand the customer need that they're solving, who have a maniacal focus on outcomes.”“And I think the reason why is if you look at like software as a service five years ago, maybe you can have a separation of product and engineering because most software as a service created five years ago. I wouldn't say there's like a lot of technological breakthroughs required for most business applications. And if you're making expense reporting software or whatever, it's useful… You kind of know how databases work, how to build auto scaling with your AWS cluster, whatever, you know, it's just, you're just applying best practices to yet another problem. "When you have areas like the early days of mobile development or the early days of interactive web applications, which I think Google Maps and Gmail represent, or now AI agents, you're in this constant conversation with what the requirements of your customers and stakeholders are and all the different people interacting with it and the capabilities of the technology. And it's almost impossible to specify the requirements of a product when you're not sure of the limitations of the technology itself.”This is the first time the difference between technical leadership for “normal” software and for “AI” software was articulated this clearly for us, and we'll be thinking a lot about this going forward. We left a lot of nuggets in the conversation, so we hope you'll just dive in with us (and thank Bret for joining the pod!)Timestamps* 00:00:02 Introductions and Bret Taylor's background* 00:01:23 Bret's experience at Stanford and the dot-com era* 00:04:04 The story of rewriting Google Maps backend* 00:11:06 Early days of interactive web applications at Google* 00:15:26 Discussion on product management and engineering roles* 00:21:00 AI and the future of software development* 00:26:42 Bret's approach to identifying customer needs and building AI companies* 00:32:09 The evolution of business models in the AI era* 00:41:00 The future of programming languages and software development* 00:49:38 Challenges in precisely communicating human intent to machines* 00:56:44 Discussion on Artificial General Intelligence (AGI) and its impact* 01:08:51 The future of agent-to-agent communication* 01:14:03 Bret's involvement in the OpenAI leadership crisis* 01:22:11 OpenAI's relationship with Microsoft* 01:23:23 OpenAI's mission and priorities* 01:27:40 Bret's guiding principles for career choices* 01:29:12 Brief discussion on pasta-making* 01:30:47 How Bret keeps up with AI developments* 01:32:15 Exciting research directions in AI* 01:35:19 Closing remarks and hiring at Sierra Transcript[00:02:05] Introduction and Guest Welcome[00:02:05] Alessio: Hey everyone, welcome to the Latent Space Podcast. This is Alessio, partner and CTO at Decibel Partners, and I'm joined by my co host swyx, founder of smol.ai.[00:02:17] swyx: Hey, and today we're super excited to have Bret Taylor join us. Welcome. Thanks for having me. It's a little unreal to have you in the studio.[00:02:25] swyx: I've read about you so much over the years, like even before. Open AI effectively. I mean, I use Google Maps to get here. So like, thank you for everything that you've done. Like, like your story history, like, you know, I think people can find out what your greatest hits have been.[00:02:40] Bret Taylor's Early Career and Education[00:02:40] swyx: How do you usually like to introduce yourself when, you know, you talk about, you summarize your career, like, how do you look at yourself?[00:02:47] Bret: Yeah, it's a great question. You know, we, before we went on the mics here, we're talking about the audience for this podcast being more engineering. And I do think depending on the audience, I'll introduce myself differently because I've had a lot of [00:03:00] corporate and board roles. I probably self identify as an engineer more than anything else though.[00:03:04] Bret: So even when I was. Salesforce, I was coding on the weekends. So I think of myself as an engineer and then all the roles that I do in my career sort of start with that just because I do feel like engineering is sort of a mindset and how I approach most of my life. So I'm an engineer first and that's how I describe myself.[00:03:24] Bret: You majored in computer[00:03:25] swyx: science, like 1998. And, and I was high[00:03:28] Bret: school, actually my, my college degree was Oh, two undergrad. Oh, three masters. Right. That old.[00:03:33] swyx: Yeah. I mean, no, I was going, I was going like 1998 to 2003, but like engineering wasn't as, wasn't a thing back then. Like we didn't have the title of senior engineer, you know, kind of like, it was just.[00:03:44] swyx: You were a programmer, you were a developer, maybe. What was it like in Stanford? Like, what was that feeling like? You know, was it, were you feeling like on the cusp of a great computer revolution? Or was it just like a niche, you know, interest at the time?[00:03:57] Stanford and the Dot-Com Bubble[00:03:57] Bret: Well, I was at Stanford, as you said, from 1998 to [00:04:00] 2002.[00:04:02] Bret: 1998 was near the peak of the dot com bubble. So. This is back in the day where most people that they're coding in the computer lab, just because there was these sun microsystems, Unix boxes there that most of us had to do our assignments on. And every single day there was a. com like buying pizza for everybody.[00:04:20] Bret: I didn't have to like, I got. Free food, like my first two years of university and then the dot com bubble burst in the middle of my college career. And so by the end there was like tumbleweed going to the job fair, you know, it was like, cause it was hard to describe unless you were there at the time, the like level of hype and being a computer science major at Stanford was like, A thousand opportunities.[00:04:45] Bret: And then, and then when I left, it was like Microsoft, IBM.[00:04:49] Joining Google and Early Projects[00:04:49] Bret: And then the two startups that I applied to were VMware and Google. And I ended up going to Google in large part because a woman named Marissa Meyer, who had been a teaching [00:05:00] assistant when I was, what was called a section leader, which was like a junior teaching assistant kind of for one of the big interest.[00:05:05] Bret: Yes. Classes. She had gone there. And she was recruiting me and I knew her and it was sort of felt safe, you know, like, I don't know. I thought about it much, but it turned out to be a real blessing. I realized like, you know, you always want to think you'd pick Google if given the option, but no one knew at the time.[00:05:20] Bret: And I wonder if I'd graduated in like 1999 where I've been like, mom, I just got a job at pets. com. It's good. But you know, at the end I just didn't have any options. So I was like, do I want to go like make kernel software at VMware? Do I want to go build search at Google? And I chose Google. 50, 50 ball.[00:05:36] Bret: I'm not really a 50, 50 ball. So I feel very fortunate in retrospect that the economy collapsed because in some ways it forced me into like one of the greatest companies of all time, but I kind of lucked into it, I think.[00:05:47] The Google Maps Rewrite Story[00:05:47] Alessio: So the famous story about Google is that you rewrote the Google maps back in, in one week after the map quest quest maps acquisition, what was the story there?[00:05:57] Alessio: Is it. Actually true. Is it [00:06:00] being glorified? Like how, how did that come to be? And is there any detail that maybe Paul hasn't shared before?[00:06:06] Bret: It's largely true, but I'll give the color commentary. So it was actually the front end, not the back end, but it turns out for Google maps, the front end was sort of the hard part just because Google maps was.[00:06:17] Bret: Largely the first ish kind of really interactive web application, say first ish. I think Gmail certainly was though Gmail, probably a lot of people then who weren't engineers probably didn't appreciate its level of interactivity. It was just fast, but. Google maps, because you could drag the map and it was sort of graphical.[00:06:38] Bret: My, it really in the mainstream, I think, was it a map[00:06:41] swyx: quest back then that was, you had the arrows up and down, it[00:06:44] Bret: was up and down arrows. Each map was a single image and you just click left and then wait for a few seconds to the new map to let it was really small too, because generating a big image was kind of expensive on computers that day.[00:06:57] Bret: So Google maps was truly innovative in that [00:07:00] regard. The story on it. There was a small company called where two technologies started by two Danish brothers, Lars and Jens Rasmussen, who are two of my closest friends now. They had made a windows app called expedition, which had beautiful maps. Even in 2000.[00:07:18] Bret: For whenever we acquired or sort of acquired their company, Windows software was not particularly fashionable, but they were really passionate about mapping and we had made a local search product that was kind of middling in terms of popularity, sort of like a yellow page of search product. So we wanted to really go into mapping.[00:07:36] Bret: We'd started working on it. Their small team seemed passionate about it. So we're like, come join us. We can build this together.[00:07:42] Technical Challenges and Innovations[00:07:42] Bret: It turned out to be a great blessing that they had built a windows app because you're less technically constrained when you're doing native code than you are building a web browser, particularly back then when there weren't really interactive web apps and it ended up.[00:07:56] Bret: Changing the level of quality that we [00:08:00] wanted to hit with the app because we were shooting for something that felt like a native windows application. So it was a really good fortune that we sort of, you know, their unusual technical choices turned out to be the greatest blessing. So we spent a lot of time basically saying, how can you make a interactive draggable map in a web browser?[00:08:18] Bret: How do you progressively load, you know, new map tiles, you know, as you're dragging even things like down in the weeds of the browser at the time, most browsers like Internet Explorer, which was dominant at the time would only load two images at a time from the same domain. So we ended up making our map tile servers have like.[00:08:37] Bret: Forty different subdomains so we could load maps and parallels like lots of hacks. I'm happy to go into as much as like[00:08:44] swyx: HTTP connections and stuff.[00:08:46] Bret: They just like, there was just maximum parallelism of two. And so if you had a map, set of map tiles, like eight of them, so So we just, we were down in the weeds of the browser anyway.[00:08:56] Bret: So it was lots of plumbing. I can, I know a lot more about browsers than [00:09:00] most people, but then by the end of it, it was fairly, it was a lot of duct tape on that code. If you've ever done an engineering project where you're not really sure the path from point A to point B, it's almost like. Building a house by building one room at a time.[00:09:14] Bret: The, there's not a lot of architectural cohesion at the end. And then we acquired a company called Keyhole, which became Google earth, which was like that three, it was a native windows app as well, separate app, great app, but with that, we got licenses to all this satellite imagery. And so in August of 2005, we added.[00:09:33] Bret: Satellite imagery to Google Maps, which added even more complexity in the code base. And then we decided we wanted to support Safari. There was no mobile phones yet. So Safari was this like nascent browser on, on the Mac. And it turns out there's like a lot of decisions behind the scenes, sort of inspired by this windows app, like heavy use of XML and XSLT and all these like.[00:09:54] Bret: Technologies that were like briefly fashionable in the early two thousands and everyone hates now for good [00:10:00] reason. And it turns out that all of the XML functionality and Internet Explorer wasn't supporting Safari. So people are like re implementing like XML parsers. And it was just like this like pile of s**t.[00:10:11] Bret: And I had to say a s**t on your part. Yeah, of[00:10:12] Alessio: course.[00:10:13] Bret: So. It went from this like beautifully elegant application that everyone was proud of to something that probably had hundreds of K of JavaScript, which sounds like nothing. Now we're talking like people have modems, you know, not all modems, but it was a big deal.[00:10:29] Bret: So it was like slow. It took a while to load and just, it wasn't like a great code base. Like everything was fragile. So I just got. Super frustrated by it. And then one weekend I did rewrite all of it. And at the time the word JSON hadn't been coined yet too, just to give you a sense. So it's all XML.[00:10:47] swyx: Yeah.[00:10:47] Bret: So we used what is now you would call JSON, but I just said like, let's use eval so that we can parse the data fast. And, and again, that's, it would literally as JSON, but at the time there was no name for it. So we [00:11:00] just said, let's. Pass on JavaScript from the server and eval it. And then somebody just refactored the whole thing.[00:11:05] Bret: And, and it wasn't like I was some genius. It was just like, you know, if you knew everything you wished you had known at the beginning and I knew all the functionality, cause I was the primary, one of the primary authors of the JavaScript. And I just like, I just drank a lot of coffee and just stayed up all weekend.[00:11:22] Bret: And then I, I guess I developed a bit of reputation and no one knew about this for a long time. And then Paul who created Gmail and I ended up starting a company with him too, after all of this told this on a podcast and now it's large, but it's largely true. I did rewrite it and it, my proudest thing.[00:11:38] Bret: And I think JavaScript people appreciate this. Like the un G zipped bundle size for all of Google maps. When I rewrote, it was 20 K G zipped. It was like much smaller for the entire application. It went down by like 10 X. So. What happened on Google? Google is a pretty mainstream company. And so like our usage is shot up because it turns out like it's faster.[00:11:57] Bret: Just being faster is worth a lot of [00:12:00] percentage points of growth at a scale of Google. So how[00:12:03] swyx: much modern tooling did you have? Like test suites no compilers.[00:12:07] Bret: Actually, that's not true. We did it one thing. So I actually think Google, I, you can. Download it. There's a, Google has a closure compiler, a closure compiler.[00:12:15] Bret: I don't know if anyone still uses it. It's gone. Yeah. Yeah. It's sort of gone out of favor. Yeah. Well, even until recently it was better than most JavaScript minifiers because it was more like it did a lot more renaming of variables and things. Most people use ES build now just cause it's fast and closure compilers built on Java and super slow and stuff like that.[00:12:37] Bret: But, so we did have that, that was it. Okay.[00:12:39] The Evolution of Web Applications[00:12:39] Bret: So and that was treated internally, you know, it was a really interesting time at Google at the time because there's a lot of teams working on fairly advanced JavaScript when no one was. So Google suggest, which Kevin Gibbs was the tech lead for, was the first kind of type ahead, autocomplete, I believe in a web browser, and now it's just pervasive in search boxes that you sort of [00:13:00] see a type ahead there.[00:13:01] Bret: I mean, chat, dbt[00:13:01] swyx: just added it. It's kind of like a round trip.[00:13:03] Bret: Totally. No, it's now pervasive as a UI affordance, but that was like Kevin's 20 percent project. And then Gmail, Paul you know, he tells the story better than anyone, but he's like, you know, basically was scratching his own itch, but what was really neat about it is email, because it's such a productivity tool, just needed to be faster.[00:13:21] Bret: So, you know, he was scratching his own itch of just making more stuff work on the client side. And then we, because of Lars and Yen sort of like setting the bar of this windows app or like we need our maps to be draggable. So we ended up. Not only innovate in terms of having a big sync, what would be called a single page application today, but also all the graphical stuff you know, we were crashing Firefox, like it was going out of style because, you know, when you make a document object model with the idea that it's a document and then you layer on some JavaScript and then we're essentially abusing all of this, it just was running into code paths that were not.[00:13:56] Bret: Well, it's rotten, you know, at this time. And so it was [00:14:00] super fun. And, and, you know, in the building you had, so you had compilers, people helping minify JavaScript just practically, but there is a great engineering team. So they were like, that's why Closure Compiler is so good. It was like a. Person who actually knew about programming languages doing it, not just, you know, writing regular expressions.[00:14:17] Bret: And then the team that is now the Chrome team believe, and I, I don't know this for a fact, but I'm pretty sure Google is the main contributor to Firefox for a long time in terms of code. And a lot of browser people were there. So every time we would crash Firefox, we'd like walk up two floors and say like, what the hell is going on here?[00:14:35] Bret: And they would load their browser, like in a debugger. And we could like figure out exactly what was breaking. And you can't change the code, right? Cause it's the browser. It's like slow, right? I mean, slow to update. So, but we could figure out exactly where the bug was and then work around it in our JavaScript.[00:14:52] Bret: So it was just like new territory. Like so super, super fun time, just like a lot of, a lot of great engineers figuring out [00:15:00] new things. And And now, you know, the word, this term is no longer in fashion, but the word Ajax, which was asynchronous JavaScript and XML cause I'm telling you XML, but see the word XML there, to be fair, the way you made HTTP requests from a client to server was this.[00:15:18] Bret: Object called XML HTTP request because Microsoft and making Outlook web access back in the day made this and it turns out to have nothing to do with XML. It's just a way of making HTTP requests because XML was like the fashionable thing. It was like that was the way you, you know, you did it. But the JSON came out of that, you know, and then a lot of the best practices around building JavaScript applications is pre React.[00:15:44] Bret: I think React was probably the big conceptual step forward that we needed. Even my first social network after Google, we used a lot of like HTML injection and. Making real time updates was still very hand coded and it's really neat when you [00:16:00] see conceptual breakthroughs like react because it's, I just love those things where it's like obvious once you see it, but it's so not obvious until you do.[00:16:07] Bret: And actually, well, I'm sure we'll get into AI, but I, I sort of feel like we'll go through that evolution with AI agents as well that I feel like we're missing a lot of the core abstractions that I think in 10 years we'll be like, gosh, how'd you make agents? Before that, you know, but it was kind of that early days of web applications.[00:16:22] swyx: There's a lot of contenders for the reactive jobs of of AI, but no clear winner yet. I would say one thing I was there for, I mean, there's so much we can go into there. You just covered so much.[00:16:32] Product Management and Engineering Synergy[00:16:32] swyx: One thing I just, I just observe is that I think the early Google days had this interesting mix of PM and engineer, which I think you are, you didn't, you didn't wait for PM to tell you these are my, this is my PRD.[00:16:42] swyx: This is my requirements.[00:16:44] mix: Oh,[00:16:44] Bret: okay.[00:16:45] swyx: I wasn't technically a software engineer. I mean,[00:16:48] Bret: by title, obviously. Right, right, right.[00:16:51] swyx: It's like a blend. And I feel like these days, product is its own discipline and its own lore and own industry and engineering is its own thing. And there's this process [00:17:00] that happens and they're kind of separated, but you don't produce as good of a product as if they were the same person.[00:17:06] swyx: And I'm curious, you know, if, if that, if that sort of resonates in, in, in terms of like comparing early Google versus modern startups that you see out there,[00:17:16] Bret: I certainly like wear a lot of hats. So, you know, sort of biased in this, but I really agree that there's a lot of power and combining product design engineering into as few people as possible because, you know few great things have been created by committee, you know, and so.[00:17:33] Bret: If engineering is an order taking organization for product you can sometimes make meaningful things, but rarely will you create extremely well crafted breakthrough products. Those tend to be small teams who deeply understand the customer need that they're solving, who have a. Maniacal focus on outcomes.[00:17:53] Bret: And I think the reason why it's, I think for some areas, if you look at like software as a service five years ago, maybe you can have a [00:18:00] separation of product and engineering because most software as a service created five years ago. I wouldn't say there's like a lot of like. Technological breakthroughs required for most, you know, business applications.[00:18:11] Bret: And if you're making expense reporting software or whatever, it's useful. I don't mean to be dismissive of expense reporting software, but you probably just want to understand like, what are the requirements of the finance department? What are the requirements of an individual file expense report? Okay.[00:18:25] Bret: Go implement that. And you kind of know how web applications are implemented. You kind of know how to. How databases work, how to build auto scaling with your AWS cluster, whatever, you know, it's just, you're just applying best practices to yet another problem when you have areas like the early days of mobile development or the early days of interactive web applications, which I think Google Maps and Gmail represent, or now AI agents, you're in this constant conversation with what the requirements of your customers and stakeholders are and all the different people interacting with it.[00:18:58] Bret: And the capabilities of the [00:19:00] technology. And it's almost impossible to specify the requirements of a product when you're not sure of the limitations of the technology itself. And that's why I use the word conversation. It's not literal. That's sort of funny to use that word in the age of conversational AI.[00:19:15] Bret: You're constantly sort of saying, like, ideally, you could sprinkle some magic AI pixie dust and solve all the world's problems, but it's not the way it works. And it turns out that actually, I'll just give an interesting example.[00:19:26] AI Agents and Modern Tooling[00:19:26] Bret: I think most people listening probably use co pilots to code like Cursor or Devon or Microsoft Copilot or whatever.[00:19:34] Bret: Most of those tools are, they're remarkable. I'm, I couldn't, you know, imagine development without them now, but they're not autonomous yet. Like I wouldn't let it just write most code without my interactively inspecting it. We just are somewhere between it's an amazing co pilot and it's an autonomous software engineer.[00:19:53] Bret: As a product manager, like your aspirations for what the product is are like kind of meaningful. But [00:20:00] if you're a product person, yeah, of course you'd say it should be autonomous. You should click a button and program should come out the other side. The requirements meaningless. Like what matters is like, what is based on the like very nuanced limitations of the technology.[00:20:14] Bret: What is it capable of? And then how do you maximize the leverage? It gives a software engineering team, given those very nuanced trade offs. Coupled with the fact that those nuanced trade offs are changing more rapidly than any technology in my memory, meaning every few months you'll have new models with new capabilities.[00:20:34] Bret: So how do you construct a product that can absorb those new capabilities as rapidly as possible as well? That requires such a combination of technical depth and understanding the customer that you really need more integration. Of product design and engineering. And so I think it's why with these big technology waves, I think startups have a bit of a leg up relative to incumbents because they [00:21:00] tend to be sort of more self actualized in terms of just like bringing those disciplines closer together.[00:21:06] Bret: And in particular, I think entrepreneurs, the proverbial full stack engineers, you know, have a leg up as well because. I think most breakthroughs happen when you have someone who can understand those extremely nuanced technical trade offs, have a vision for a product. And then in the process of building it, have that, as I said, like metaphorical conversation with the technology, right?[00:21:30] Bret: Gosh, I ran into a technical limit that I didn't expect. It's not just like changing that feature. You might need to refactor the whole product based on that. And I think that's, that it's particularly important right now. So I don't, you know, if you, if you're building a big ERP system, probably there's a great reason to have product and engineering.[00:21:51] Bret: I think in general, the disciplines are there for a reason. I think when you're dealing with something as nuanced as the like technologies, like large language models today, there's a ton of [00:22:00] advantage of having. Individuals or organizations that integrate the disciplines more formally.[00:22:05] Alessio: That makes a lot of sense.[00:22:06] Alessio: I've run a lot of engineering teams in the past, and I think the product versus engineering tension has always been more about effort than like whether or not the feature is buildable. But I think, yeah, today you see a lot more of like. Models actually cannot do that. And I think the most interesting thing is on the startup side, people don't yet know where a lot of the AI value is going to accrue.[00:22:26] Alessio: So you have this rush of people building frameworks, building infrastructure, layered things, but we don't really know the shape of the compute. I'm curious that Sierra, like how you thought about building an house, a lot of the tooling for evals or like just, you know, building the agents and all of that.[00:22:41] Alessio: Versus how you see some of the startup opportunities that is maybe still out there.[00:22:46] Bret: We build most of our tooling in house at Sierra, not all. It's, we don't, it's not like not invented here syndrome necessarily, though, maybe slightly guilty of that in some ways, but because we're trying to build a platform [00:23:00] that's in Dorian, you know, we really want to have control over our own destiny.[00:23:03] Bret: And you had made a comment earlier that like. We're still trying to figure out who like the reactive agents are and the jury is still out. I would argue it hasn't been created yet. I don't think the jury is still out to go use that metaphor. We're sort of in the jQuery era of agents, not the react era.[00:23:19] Bret: And, and that's like a throwback for people listening,[00:23:22] swyx: we shouldn't rush it. You know?[00:23:23] Bret: No, yeah, that's my point is. And so. Because we're trying to create an enduring company at Sierra that outlives us, you know, I'm not sure we want to like attach our cart to some like to a horse where it's not clear that like we've figured out and I actually want as a company, we're trying to enable just at a high level and I'll, I'll quickly go back to tech at Sierra, we help consumer brands build customer facing AI agents.[00:23:48] Bret: So. Everyone from Sonos to ADT home security to Sirius XM, you know, if you call them on the phone and AI will pick up with you, you know, chat with them on the Sirius XM homepage. It's an AI agent called Harmony [00:24:00] that they've built on our platform. We're what are the contours of what it means for someone to build an end to end complete customer experience with AI with conversational AI.[00:24:09] Bret: You know, we really want to dive into the deep end of, of all the trade offs to do it. You know, where do you use fine tuning? Where do you string models together? You know, where do you use reasoning? Where do you use generation? How do you use reasoning? How do you express the guardrails of an agentic process?[00:24:25] Bret: How do you impose determinism on a fundamentally non deterministic technology? There's just a lot of really like as an important design space. And I could sit here and tell you, we have the best approach. Every entrepreneur will, you know. But I hope that in two years, we look back at our platform and laugh at how naive we were, because that's the pace of change broadly.[00:24:45] Bret: If you talk about like the startup opportunities, I'm not wholly skeptical of tools companies, but I'm fairly skeptical. There's always an exception for every role, but I believe that certainly there's a big market for [00:25:00] frontier models, but largely for companies with huge CapEx budgets. So. Open AI and Microsoft's Anthropic and Amazon Web Services, Google Cloud XAI, which is very well capitalized now, but I think the, the idea that a company can make money sort of pre training a foundation model is probably not true.[00:25:20] Bret: It's hard to, you're competing with just, you know, unreasonably large CapEx budgets. And I just like the cloud infrastructure market, I think will be largely there. I also really believe in the applications of AI. And I define that not as like building agents or things like that. I define it much more as like, you're actually solving a problem for a business.[00:25:40] Bret: So it's what Harvey is doing in legal profession or what cursor is doing for software engineering or what we're doing for customer experience and customer service. The reason I believe in that is I do think that in the age of AI, what's really interesting about software is it can actually complete a task.[00:25:56] Bret: It can actually do a job, which is very different than the value proposition of [00:26:00] software was to ancient history two years ago. And as a consequence, I think the way you build a solution and For a domain is very different than you would have before, which means that it's not obvious, like the incumbent incumbents have like a leg up, you know, necessarily, they certainly have some advantages, but there's just such a different form factor, you know, for providing a solution and it's just really valuable.[00:26:23] Bret: You know, it's. Like just think of how much money cursor is saving software engineering teams or the alternative, how much revenue it can produce tool making is really challenging. If you look at the cloud market, just as a analog, there are a lot of like interesting tools, companies, you know, Confluent, Monetized Kafka, Snowflake, Hortonworks, you know, there's a, there's a bunch of them.[00:26:48] Bret: A lot of them, you know, have that mix of sort of like like confluence or have the open source or open core or whatever you call it. I, I, I'm not an expert in this area. You know, I do think [00:27:00] that developers are fickle. I think that in the tool space, I probably like. Default towards open source being like the area that will win.[00:27:09] Bret: It's hard to build a company around this and then you end up with companies sort of built around open source to that can work. Don't get me wrong, but I just think that it's nowadays the tools are changing so rapidly that I'm like, not totally skeptical of tool makers, but I just think that open source will broadly win, but I think that the CapEx required for building frontier models is such that it will go to a handful of big companies.[00:27:33] Bret: And then I really believe in agents for specific domains which I think will, it's sort of the analog to software as a service in this new era. You know, it's like, if you just think of the cloud. You can lease a server. It's just a low level primitive, or you can buy an app like you know, Shopify or whatever.[00:27:51] Bret: And most people building a storefront would prefer Shopify over hand rolling their e commerce storefront. I think the same thing will be true of AI. So [00:28:00] I've. I tend to like, if I have a, like an entrepreneur asked me for advice, I'm like, you know, move up the stack as far as you can towards a customer need.[00:28:09] Bret: Broadly, but I, but it doesn't reduce my excitement about what is the reactive building agents kind of thing, just because it is, it is the right question to ask, but I think we'll probably play out probably an open source space more than anything else.[00:28:21] swyx: Yeah, and it's not a priority for you. There's a lot in there.[00:28:24] swyx: I'm kind of curious about your idea maze towards, there are many customer needs. You happen to identify customer experience as yours, but it could equally have been coding assistance or whatever. I think for some, I'm just kind of curious at the top down, how do you look at the world in terms of the potential problem space?[00:28:44] swyx: Because there are many people out there who are very smart and pick the wrong problem.[00:28:47] Bret: Yeah, that's a great question.[00:28:48] Future of Software Development[00:28:48] Bret: By the way, I would love to talk about the future of software, too, because despite the fact it didn't pick coding, I have a lot of that, but I can talk to I can answer your question, though, you know I think when a technology is as [00:29:00] cool as large language models.[00:29:02] Bret: You just see a lot of people starting from the technology and searching for a problem to solve. And I think it's why you see a lot of tools companies, because as a software engineer, you start building an app or a demo and you, you encounter some pain points. You're like,[00:29:17] swyx: a lot of[00:29:17] Bret: people are experiencing the same pain point.[00:29:19] Bret: What if I make it? That it's just very incremental. And you know, I always like to use the metaphor, like you can sell coffee beans, roasted coffee beans. You can add some value. You took coffee beans and you roasted them and roasted coffee beans largely, you know, are priced relative to the cost of the beans.[00:29:39] Bret: Or you can sell a latte and a latte. Is rarely priced directly like as a percentage of coffee bean prices. In fact, if you buy a latte at the airport, it's a captive audience. So it's a really expensive latte. And there's just a lot that goes into like. How much does a latte cost? And I bring it up because there's a supply chain from growing [00:30:00] coffee beans to roasting coffee beans to like, you know, you could make one at home or you could be in the airport and buy one and the margins of the company selling lattes in the airport is a lot higher than the, you know, people roasting the coffee beans and it's because you've actually solved a much more acute human problem in the airport.[00:30:19] Bret: And, and it's just worth a lot more to that person in that moment. It's kind of the way I think about technology too. It sounds funny to liken it to coffee beans, but you're selling tools on top of a large language model yet in some ways your market is big, but you're probably going to like be price compressed just because you're sort of a piece of infrastructure and then you have open source and all these other things competing with you naturally.[00:30:43] Bret: If you go and solve a really big business problem for somebody, that's actually like a meaningful business problem that AI facilitates, they will value it according to the value of that business problem. And so I actually feel like people should just stop. You're like, no, that's, that's [00:31:00] unfair. If you're searching for an idea of people, I, I love people trying things, even if, I mean, most of the, a lot of the greatest ideas have been things no one believed in.[00:31:07] Bret: So I like, if you're passionate about something, go do it. Like who am I to say, yeah, a hundred percent. Or Gmail, like Paul as far, I mean I, some of it's Laura at this point, but like Gmail is Paul's own email for a long time. , and then I amusingly and Paul can't correct me, I'm pretty sure he sent her in a link and like the first comment was like, this is really neat.[00:31:26] Bret: It would be great. It was not your email, but my own . I don't know if it's a true story. I'm pretty sure it's, yeah, I've read that before. So scratch your own niche. Fine. Like it depends on what your goal is. If you wanna do like a venture backed company, if its a. Passion project, f*****g passion, do it like don't listen to anybody.[00:31:41] Bret: In fact, but if you're trying to start, you know an enduring company, solve an important business problem. And I, and I do think that in the world of agents, the software industries has shifted where you're not just helping people more. People be more productive, but you're actually accomplishing tasks autonomously.[00:31:58] Bret: And as a consequence, I think the [00:32:00] addressable market has just greatly expanded just because software can actually do things now and actually accomplish tasks and how much is coding autocomplete worth. A fair amount. How much is the eventual, I'm certain we'll have it, the software agent that actually writes the code and delivers it to you, that's worth a lot.[00:32:20] Bret: And so, you know, I would just maybe look up from the large language models and start thinking about the economy and, you know, think from first principles. I don't wanna get too far afield, but just think about which parts of the economy. We'll benefit most from this intelligence and which parts can absorb it most easily.[00:32:38] Bret: And what would an agent in this space look like? Who's the customer of it is the technology feasible. And I would just start with these business problems more. And I think, you know, the best companies tend to have great engineers who happen to have great insight into a market. And it's that last part that I think some people.[00:32:56] Bret: Whether or not they have, it's like people start so much in the technology, they [00:33:00] lose the forest for the trees a little bit.[00:33:02] Alessio: How do you think about the model of still selling some sort of software versus selling more package labor? I feel like when people are selling the package labor, it's almost more stateless, you know, like it's easier to swap out if you're just putting an input and getting an output.[00:33:16] Alessio: If you think about coding, if there's no ID, you're just putting a prompt and getting back an app. It doesn't really matter. Who generates the app, you know, you have less of a buy in versus the platform you're building, I'm sure on the backend customers have to like put on their documentation and they have, you know, different workflows that they can tie in what's kind of like the line to draw there versus like going full where you're managed customer support team as a service outsource versus.[00:33:40] Alessio: This is the Sierra platform that you can build on. What was that decision? I'll sort of[00:33:44] Bret: like decouple the question in some ways, which is when you have something that's an agent, who is the person using it and what do they want to do with it? So let's just take your coding agent for a second. I will talk about Sierra as well.[00:33:59] Bret: Who's the [00:34:00] customer of a, an agent that actually produces software? Is it a software engineering manager? Is it a software engineer? And it's there, you know, intern so to speak. I don't know. I mean, we'll figure this out over the next few years. Like what is that? And is it generating code that you then review?[00:34:16] Bret: Is it generating code with a set of unit tests that pass, what is the actual. For lack of a better word contract, like, how do you know that it did what you wanted it to do? And then I would say like the product and the pricing, the packaging model sort of emerged from that. And I don't think the world's figured out.[00:34:33] Bret: I think it'll be different for every agent. You know, in our customer base, we do what's called outcome based pricing. So essentially every time the AI agent. Solves the problem or saves a customer or whatever it might be. There's a pre negotiated rate for that. We do that. Cause it's, we think that that's sort of the correct way agents, you know, should be packaged.[00:34:53] Bret: I look back at the history of like cloud software and notably the introduction of the browser, which led to [00:35:00] software being delivered in a browser, like Salesforce to. Famously invented sort of software as a service, which is both a technical delivery model through the browser, but also a business model, which is you subscribe to it rather than pay for a perpetual license.[00:35:13] Bret: Those two things are somewhat orthogonal, but not really. If you think about the idea of software running in a browser, that's hosted. Data center that you don't own, you sort of needed to change the business model because you don't, you can't really buy a perpetual license or something otherwise like, how do you afford making changes to it?[00:35:31] Bret: So it only worked when you were buying like a new version every year or whatever. So to some degree, but then the business model shift actually changed business as we know it, because now like. Things like Adobe Photoshop. Now you subscribe to rather than purchase. So it ended up where you had a technical shift and a business model shift that were very logically intertwined that actually the business model shift was turned out to be as significant as the technical as the shift.[00:35:59] Bret: And I think with [00:36:00] agents, because they actually accomplish a job, I do think that it doesn't make sense to me that you'd pay for the privilege of like. Using the software like that coding agent, like if it writes really bad code, like fire it, you know, I don't know what the right metaphor is like you should pay for a job.[00:36:17] Bret: Well done in my opinion. I mean, that's how you pay your software engineers, right? And[00:36:20] swyx: and well, not really. We paid to put them on salary and give them options and they vest over time. That's fair.[00:36:26] Bret: But my point is that you don't pay them for how many characters they write, which is sort of the token based, you know, whatever, like, There's a, that famous Apple story where we're like asking for a report of how many lines of code you wrote.[00:36:40] Bret: And one of the engineers showed up with like a negative number cause he had just like done a big refactoring. There was like a big F you to management who didn't understand how software is written. You know, my sense is like the traditional usage based or seat based thing. It's just going to look really antiquated.[00:36:55] Bret: Cause it's like asking your software engineer, how many lines of code did you write today? Like who cares? Like, cause [00:37:00] absolutely no correlation. So my old view is I don't think it's be different in every category, but I do think that that is the, if an agent is doing a job, you should, I think it properly incentivizes the maker of that agent and the customer of, of your pain for the job well done.[00:37:16] Bret: It's not always perfect to measure. It's hard to measure engineering productivity, but you can, you should do something other than how many keys you typed, you know Talk about perverse incentives for AI, right? Like I can write really long functions to do the same thing, right? So broadly speaking, you know, I do think that we're going to see a change in business models of software towards outcomes.[00:37:36] Bret: And I think you'll see a change in delivery models too. And, and, you know, in our customer base you know, we empower our customers to really have their hands on the steering wheel of what the agent does they, they want and need that. But the role is different. You know, at a lot of our customers, the customer experience operations folks have renamed themselves the AI architects, which I think is really cool.[00:37:55] Bret: And, you know, it's like in the early days of the Internet, there's the role of the webmaster. [00:38:00] And I don't know whether your webmaster is not a fashionable, you know, Term, nor is it a job anymore? I just, I don't know. Will they, our tech stand the test of time? Maybe, maybe not. But I do think that again, I like, you know, because everyone listening right now is a software engineer.[00:38:14] Bret: Like what is the form factor of a coding agent? And actually I'll, I'll take a breath. Cause actually I have a bunch of pins on them. Like I wrote a blog post right before Christmas, just on the future of software development. And one of the things that's interesting is like, if you look at the way I use cursor today, as an example, it's inside of.[00:38:31] Bret: A repackaged visual studio code environment. I sometimes use the sort of agentic parts of it, but it's largely, you know, I've sort of gotten a good routine of making it auto complete code in the way I want through tuning it properly when it actually can write. I do wonder what like the future of development environments will look like.[00:38:55] Bret: And to your point on what is a software product, I think it's going to change a lot in [00:39:00] ways that will surprise us. But I always use, I use the metaphor in my blog post of, have you all driven around in a way, Mo around here? Yeah, everyone has. And there are these Jaguars, the really nice cars, but it's funny because it still has a steering wheel, even though there's no one sitting there and the steering wheels like turning and stuff clearly in the future.[00:39:16] Bret: If once we get to that, be more ubiquitous, like why have the steering wheel and also why have all the seats facing forward? Maybe just for car sickness. I don't know, but you could totally rearrange the car. I mean, so much of the car is oriented around the driver, so. It stands to reason to me that like, well, autonomous agents for software engineering run through visual studio code.[00:39:37] Bret: That seems a little bit silly because having a single source code file open one at a time is kind of a goofy form factor for when like the code isn't being written primarily by you, but it begs the question of what's your relationship with that agent. And I think the same is true in our industry of customer experience, which is like.[00:39:55] Bret: Who are the people managing this agent? What are the tools do they need? And they definitely need [00:40:00] tools, but it's probably pretty different than the tools we had before. It's certainly different than training a contact center team. And as software engineers, I think that I would like to see particularly like on the passion project side or research side.[00:40:14] Bret: More innovation in programming languages. I think that we're bringing the cost of writing code down to zero. So the fact that we're still writing Python with AI cracks me up just cause it's like literally was designed to be ergonomic to write, not safe to run or fast to run. I would love to see more innovation and how we verify program correctness.[00:40:37] Bret: I studied for formal verification in college a little bit and. It's not very fashionable because it's really like tedious and slow and doesn't work very well. If a lot of code is being written by a machine, you know, one of the primary values we can provide is verifying that it actually does what we intend that it does.[00:40:56] Bret: I think there should be lots of interesting things in the software development life cycle, like how [00:41:00] we think of testing and everything else, because. If you think about if we have to manually read every line of code that's coming out as machines, it will just rate limit how much the machines can do. The alternative is totally unsafe.[00:41:13] Bret: So I wouldn't want to put code in production that didn't go through proper code review and inspection. So my whole view is like, I actually think there's like an AI native I don't think the coding agents don't work well enough to do this yet, but once they do, what is sort of an AI native software development life cycle and how do you actually.[00:41:31] Bret: Enable the creators of software to produce the highest quality, most robust, fastest software and know that it's correct. And I think that's an incredible opportunity. I mean, how much C code can we rewrite and rust and make it safe so that there's fewer security vulnerabilities. Can we like have more efficient, safer code than ever before?[00:41:53] Bret: And can you have someone who's like that guy in the matrix, you know, like staring at the little green things, like where could you have an operator [00:42:00] of a code generating machine be like superhuman? I think that's a cool vision. And I think too many people are focused on like. Autocomplete, you know, right now, I'm not, I'm not even, I'm guilty as charged.[00:42:10] Bret: I guess in some ways, but I just like, I'd like to see some bolder ideas. And that's why when you were joking, you know, talking about what's the react of whatever, I think we're clearly in a local maximum, you know, metaphor, like sort of conceptual local maximum, obviously it's moving really fast. I think we're moving out of it.[00:42:26] Alessio: Yeah. At the end of 23, I've read this blog post from syntax to semantics. Like if you think about Python. It's taking C and making it more semantic and LLMs are like the ultimate semantic program, right? You can just talk to them and they can generate any type of syntax from your language. But again, the languages that they have to use were made for us, not for them.[00:42:46] Alessio: But the problem is like, as long as you will ever need a human to intervene, you cannot change the language under it. You know what I mean? So I'm curious at what point of automation we'll need to get, we're going to be okay making changes. To the underlying languages, [00:43:00] like the programming languages versus just saying, Hey, you just got to write Python because I understand Python and I'm more important at the end of the day than the model.[00:43:08] Alessio: But I think that will change, but I don't know if it's like two years or five years. I think it's more nuanced actually.[00:43:13] Bret: So I think there's a, some of the more interesting programming languages bring semantics into syntax. So let me, that's a little reductive, but like Rust as an example, Rust is memory safe.[00:43:25] Bret: Statically, and that was a really interesting conceptual, but it's why it's hard to write rust. It's why most people write python instead of rust. I think rust programs are safer and faster than python, probably slower to compile. But like broadly speaking, like given the option, if you didn't have to care about the labor that went into it.[00:43:45] Bret: You should prefer a program written in Rust over a program written in Python, just because it will run more efficiently. It's almost certainly safer, et cetera, et cetera, depending on how you define safe, but most people don't write Rust because it's kind of a pain in the ass. And [00:44:00] the audience of people who can is smaller, but it's sort of better in most, most ways.[00:44:05] Bret: And again, let's say you're making a web service and you didn't have to care about how hard it was to write. If you just got the output of the web service, the rest one would be cheaper to operate. It's certainly cheaper and probably more correct just because there's so much in the static analysis implied by the rest programming language that it probably will have fewer runtime errors and things like that as well.[00:44:25] Bret: So I just give that as an example, because so rust, at least my understanding that came out of the Mozilla team, because. There's lots of security vulnerabilities in the browser and it needs to be really fast. They said, okay, we want to put more of a burden at the authorship time to have fewer issues at runtime.[00:44:43] Bret: And we need the constraint that it has to be done statically because browsers need to be really fast. My sense is if you just think about like the, the needs of a programming language today, where the role of a software engineer is [00:45:00] to use an AI to generate functionality and audit that it does in fact work as intended, maybe functionally, maybe from like a correctness standpoint, some combination thereof, how would you create a programming system that facilitated that?[00:45:15] Bret: And, you know, I bring up Rust is because I think it's a good example of like, I think given a choice of writing in C or Rust, you should choose Rust today. I think most people would say that, even C aficionados, just because. C is largely less safe for very similar, you know, trade offs, you know, for the, the system and now with AI, it's like, okay, well, that just changes the game on writing these things.[00:45:36] Bret: And so like, I just wonder if a combination of programming languages that are more structurally oriented towards the values that we need from an AI generated program, verifiable correctness and all of that. If it's tedious to produce for a person, that maybe doesn't matter. But one thing, like if I asked you, is this rest program memory safe?[00:45:58] Bret: You wouldn't have to read it, you just have [00:46:00] to compile it. So that's interesting. I mean, that's like an, that's one example of a very modest form of formal verification. So I bring that up because I do think you have AI inspect AI, you can have AI reviewed. Do AI code reviews. It would disappoint me if the best we could get was AI reviewing Python and having scaled a few very large.[00:46:21] Bret: Websites that were written on Python. It's just like, you know, expensive and it's like every, trust me, every team who's written a big web service in Python has experimented with like Pi Pi and all these things just to make it slightly more efficient than it naturally is. You don't really have true multi threading anyway.[00:46:36] Bret: It's just like clearly that you do it just because it's convenient to write. And I just feel like we're, I don't want to say it's insane. I just mean. I do think we're at a local maximum. And I would hope that we create a programming system, a combination of programming languages, formal verification, testing, automated code reviews, where you can use AI to generate software in a high scale way and trust it.[00:46:59] Bret: And you're [00:47:00] not limited by your ability to read it necessarily. I don't know exactly what form that would take, but I feel like that would be a pretty cool world to live in.[00:47:08] Alessio: Yeah. We had Chris Lanner on the podcast. He's doing great work with modular. I mean, I love. LVM. Yeah. Basically merging rust in and Python.[00:47:15] Alessio: That's kind of the idea. Should be, but I'm curious is like, for them a big use case was like making it compatible with Python, same APIs so that Python developers could use it. Yeah. And so I, I wonder at what point, well, yeah.[00:47:26] Bret: At least my understanding is they're targeting the data science Yeah. Machine learning crowd, which is all written in Python, so still feels like a local maximum.[00:47:34] Bret: Yeah.[00:47:34] swyx: Yeah, exactly. I'll force you to make a prediction. You know, Python's roughly 30 years old. In 30 years from now, is Rust going to be bigger than Python?[00:47:42] Bret: I don't know this, but just, I don't even know this is a prediction. I just am sort of like saying stuff I hope is true. I would like to see an AI native programming language and programming system, and I use language because I'm not sure language is even the right thing, but I hope in 30 years, there's an AI native way we make [00:48:00] software that is wholly uncorrelated with the current set of programming languages.[00:48:04] Bret: or not uncorrelated, but I think most programming languages today were designed to be efficiently authored by people and some have different trade offs.[00:48:15] Evolution of Programming Languages[00:48:15] Bret: You know, you have Haskell and others that were designed for abstractions for parallelism and things like that. You have programming languages like Python, which are designed to be very easily written, sort of like Perl and Python lineage, which is why data scientists use it.[00:48:31] Bret: It's it can, it has a. Interactive mode, things like that. And I love, I'm a huge Python fan. So despite all my Python trash talk, a huge Python fan wrote at least two of my three companies were exclusively written in Python and then C came out of the birth of Unix and it wasn't the first, but certainly the most prominent first step after assembly language, right?[00:48:54] Bret: Where you had higher level abstractions rather than and going beyond go to, to like abstractions, [00:49:00] like the for loop and the while loop.[00:49:01] The Future of Software Engineering[00:49:01] Bret: So I just think that if the act of writing code is no longer a meaningful human exercise, maybe it will be, I don't know. I'm just saying it sort of feels like maybe it's one of those parts of history that just will sort of like go away, but there's still the role of this offer engineer, like the person actually building the system.[00:49:20] Bret: Right. And. What does a programming system for that form factor look like?[00:49:25] React and Front-End Development[00:49:25] Bret: And I, I just have a, I hope to be just like I mentioned, I remember I was at Facebook in the very early days when, when, what is now react was being created. And I remember when the, it was like released open source I had left by that time and I was just like, this is so f*****g cool.[00:49:42] Bret: Like, you know, to basically model your app independent of the data flowing through it, just made everything easier. And then now. You know, I can create, like there's a lot of the front end software gym play is like a little chaotic for me, to be honest with you. It is like, it's sort of like [00:50:00] abstraction soup right now for me, but like some of those core ideas felt really ergonomic.[00:50:04] Bret: I just wanna, I'm just looking forward to the day when someone comes up with a programming system that feels both really like an aha moment, but completely foreign to me at the same time. Because they created it with sort of like from first principles recognizing that like. Authoring code in an editor is maybe not like the primary like reason why a programming system exists anymore.[00:50:26] Bret: And I think that's like, that would be a very exciting day for me.[00:50:28] The Role of AI in Programming[00:50:28] swyx: Yeah, I would say like the various versions of this discussion have happened at the end of the day, you still need to precisely communicate what you want. As a manager of people, as someone who has done many, many legal contracts, you know how hard that is.[00:50:42] swyx: And then now we have to talk to machines doing that and AIs interpreting what we mean and reading our minds effectively. I don't know how to get across that barrier of translating human intent to instructions. And yes, it can be more declarative, but I don't know if it'll ever Crossover from being [00:51:00] a programming language to something more than that.[00:51:02] Bret: I agree with you. And I actually do think if you look at like a legal contract, you know, the imprecision of the English language, it's like a flaw in the system. How many[00:51:12] swyx: holes there are.[00:51:13] Bret: And I do think that when you're making a mission critical software system, I don't think it should be English language prompts.[00:51:19] Bret: I think that is silly because you want the precision of a a programming language. My point was less about that and more about if the actual act of authoring it, like if you.[00:51:32] Formal Verification in Software[00:51:32] Bret: I'll think of some embedded systems do use formal verification. I know it's very common in like security protocols now so that you can, because the importance of correctness is so great.[00:51:41] Bret: My intellectual exercise is like, why not do that for all software? I mean, probably that's silly just literally to do what we literally do for. These low level security protocols, but the only reason we don't is because it's hard and tedious and hard and tedious are no longer factors. So, like, if I could, I mean, [00:52:00] just think of, like, the silliest app on your phone right now, the idea that that app should be, like, formally verified for its correctness feels laughable right now because, like, God, why would you spend the time on it?[00:52:10] Bret: But if it's zero costs, like, yeah, I guess so. I mean, it never crashed. That's probably good. You know, why not? I just want to, like, set our bars really high. Like. We should make, software has been amazing. Like there's a Mark Andreessen blog post, software is eating the world. And you know, our whole life is, is mediated digitally.[00:52:26] Bret: And that's just increasing with AI. And now we'll have our personal agents talking to the agents on the CRO platform and it's agents all the way down, you know, our core infrastructure is running on these digital systems. We now have like, and we've had a shortage of software developers for my entire life.[00:52:45] Bret: And as a consequence, you know if you look, remember like health care, got healthcare. gov that fiasco security vulnerabilities leading to state actors getting access to critical infrastructure. I'm like. We now have like created this like amazing system that can [00:53:00] like, we can fix this, you know, and I, I just want to, I'm both excited about the productivity gains in the economy, but I just think as software engineers, we should be bolder.[00:53:08] Bret: Like we should have aspirations to fix these systems so that like in general, as you said, as precise as we want to be in the specification of the system. We can make it work correctly now, and I'm being a little bit hand wavy, and I think we need some systems. I think that's where we should set the bar, especially when so much of our life depends on this critical digital infrastructure.[00:53:28] Bret: So I'm I'm just like super optimistic about it. But actually, let's go to w

Como o DeepSeek dominou a semana, dominou a OpenAI, e dominou o ADT.

Dave Scott, Chief People and Administration Officer at ADT, joined us on The Modern People Leader. We discussed ADT's evolution from a services to tech company, Dave's journey from Walmart to leading HR at ADT, and how to cut costs in HR without cutting value. ----  Submit the craziest request you've ever gotten in HR. Buy tickets for MPL Live Boston. ----  Timestamps: 06:39) Dave's professional journey: From Walmart to ADT (11:01) Dave's early career as a professional clown (12:33) ADT's mission and transition to a technology company (22:40) ADT's transformation: A product-focused mindset (27:51) Hiring strategies to attract tech talent at ADT (30:39) Transforming the HR function at ADT (35:24) Skills and organizational design for the future workforce (41:34) Cost management strategies for HR in 2024 and beyond (49:55) Rapid-fire questions ---- 

What is the role of androgen deprivation therapy (ADT) in prostate cancer treatment? In this episode of the BackTable Urology Podcast, Dr. Rana McKay, a medical oncologist from UC San Diego, joins host Dr. Aditya Bagrodia to discuss the administration of ADT and other management strategies for prostate cancer. --- This podcast is supported by: Photocure https://www.photocure.com/ --- SYNPOSIS The doctors offer a historical perspective into the evolution of ADT over time and discuss the variety of different ADT treatment options available. They compare management strategies for localized and metastatic prostate cancer and discuss how to align therapy with patient goals, focusing on the side effects. The conversation also explores the impact of prostate-specific membrane antigen (PSMA) PET imaging on management and the future directions of hormonal therapies in urologic oncology. --- TIMESTAMPS 00:00 - Introduction 05:25 - ADT Options 10:36 - Choosing an Agent and Managing Side Effects 26:42 - Continuous Versus Intermittent Therapy 30:30 - Closing Remarks --- RESOURCES Photocure https://www.photocure.com/

As we look into 2025, listen in as Jim is joined by three lively and inspiring previous guests from last year of the podcast to reflect on the major themes of the 50 episodes and felt by CMOs in 2024. Jim's guests are DeLu Jackson, the Executive VP and Chief Marketing Officer at security company ADT, Melissa Hobley, the Global Chief Marketing Officer at Tinder, and Michelle Crossan-Matos, the Chief Marketing Officer at Ulta Beauty. What a perfect panel to both reflect on past learning, and to look forward, so tune in for an ambitious episode–to reveal the central themes from CMOs in 2024, and to invite our guests to share their insights and advice on each theme. ---Listen to our previous episodes...Discovering Your Inner Joy and Beauty with Michelle Crossan-Matos - https://tinyurl.com/3sk5pybxCelebrate Black History Month with BECA - https://tinyurl.com/y559n6juSwipe Right with Melissa Hobley - https://tinyurl.com/2479sdxcSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this podcast episode, Walt Zerbe, Sr. Directror of Technology and Standards and host of he CEDIA Podcats talks with Jim Hunter, and Rich Birra discussing their experiences at CES, focusing on the evolution of smart home technology, AI, and the impact of new innovations. Jim, attending his 29th CES, notes a decline in attendance and quieter atmosphere compared to previous years. Rich highlights changes in the show's layout and the rise of localized exhibits. They explore the concept of "matter" in smart home devices, AI's role in health and wellness, and the importance of data ownership. The conversation underscores the need for user-friendly technology and effective support systems to enhance consumer experiences. Here a few Key Points: Experiences and observations at CES (Consumer Electronics Show) Evolution and changes in the CES event over the years Innovations in smart home technology and connected devices The role of AI in enhancing user experiences and health applications Challenges and implications of implementing "matter" standards for smart home devices The impact of regulatory frameworks on technological advancements The importance of data ownership and compensation in hyper-personalization The need for skilled professionals in the installation and maintenance of smart home technologies The influence of patents on innovation in the tech industry Future trends in technology, including AI integration and user-friendly systems Here are the mentions with timestamps arranged by topic: Tools and Technologies "Matter": "00:05:42" "Cosmos OS": "00:08:54" "Coder": "00:10:45" "Crestron Systems": "00:13:20" "Lutron Systems": "00:13:20" "Control4": "00:13:20" "SmartThings (by Samsung)": "00:14:21" "ChatGPT": "00:18:00" "Neural Networks": "00:19:28" "Large Language Models": "00:19:28" "Time Series Data": "00:21:39" "Wellness Platform": "00:25:54" "Hyper Personalization": "00:26:39" "Checkbox Piracy": "00:27:20" "Wearables and Sensors": "00:29:10" "Large Language Models": "00:34:13" "Ontologies": "00:35:31" "Model Cards": "00:38:17" "Google": "00:40:23" "ADT": "00:40:23" "Ultra Human": "00:44:07" "NVIDIA": "00:44:15" "LG": "00:45:24" "Bubble": "00:50:26" "Halliday": "00:50:26" "Google Glass": "00:52:04" "Samsung XR Glasses": "00:52:56" "Instacart": "00:53:24" "Control4": "00:54:46" "Aura Ring": "00:58:27" "Cal AI": "01:00:48" Companies and Brands "LG": "00:06:16" "Samsung": "00:06:35" "Humane": "00:08:15" "SoftBank Services": "00:10:29" "A16Z": "00:12:46" "Microsoft Azure": "00:16:37" "Tesla": "00:19:28" "Waymo": "00:19:28" "T-Mobile": "00:22:38" "Starlink (by SpaceX)": "00:22:58" "Delta Airlines": "00:24:02" Events "CES (Consumer Electronics Show)": "00:00:07" "CES (Consumer Electronics Show)": "00:14:22" Notable Mentions "Black Mirror": "00:07:44" "Vivaro": "00:01:52" "Tom Brady": "00:25:54" "Poppy Crum": "00:30:21" "CTO of Panasonic": "00:32:16" "Jensen Huang's Vision": "00:58:59"

Hackers got into ADT's systems, stealing customer info, and they waited months to tell anyone. Plus, why cash apps aren't safe, Roblox's kid safety problems, and flip phones making a comeback.

Hackers got into ADT's systems, stealing customer info, and they waited months to tell anyone. Plus, why cash apps aren't safe, Roblox's kid safety problems, and flip phones making a comeback.

In the latest installment of his series examining private equity in the tech sector, LionTree's Antal Runnebom speaks with Reed Rayman, a Partner in Private Equity at Apollo Global Management. Making his first-ever podcast appearance, Reed discusses his 15-year career at Apollo, and the “value on the buy, growth once we own” philosophy that has guided the firm's deals with companies including Western Digital, Intel, Shutterfly, Expedia, Cimpress, ADT and Yahoo. Tune in to find out why 2025 will be the “new 2024,” and learn about Reed's approach to investing in the space.This podcast is for information purposes only. The opinions and views expressed in this material are solely the participant's personal opinions and do not necessarily reflect the opinions of LionTree or its affiliates. This material should not be copied, distributed, published, or reproduced, in whole or in part, or disclosed by any recipient to any other person without the express written consent of LionTree. The information contained in this material does not constitute a recommendation, offer or solicitation from any LionTree entity to the recipient with respect to the purchase or sale of any security, and LionTree is not providing any financial, economic, legal, investment, accounting, or tax advice through this material or to its recipient. Neither LionTree nor any of its affiliates makes any representation or warranty, express or implied, as to the accuracy or completeness of the statements or any information contained in this material and any liability therefore (including in respect of direct, indirect, or consequential loss or damage of any kind whatsoever) is expressly disclaimed. LionTree does not undertake any obligation whatsoever to provide any form of update, amendment, change or correction to any of the information, statements, comments, views, or opinions set forth in this material.Third-party content may be published on LionTree pages in response to this material. Such content is not reviewed by LionTree before it is displayed and LionTree cannot guarantee the accuracy or completeness of such content. The opinions and views expressed by the authors of such third-party content are solely the author's personal opinions and do not necessarily reflect the opinions of LionTree or its affiliates. LionTree reserves the right to remove, alter or edit any third-party content published on LionTree pages. LionTree expressly disclaims any liability (including in respect of direct, indirect, or consequential loss or damage of any kind whatsoever) arising out of, or in connection with, the access or use of any social media platform or LionTree page. Use of a social media platform or LionTree page is at your own risk.Securities of any investment funds managed by LionTree are privately offered to selected investors only by means of each such fund's governing documents and related subscription materials. Listeners and viewers should not assume that companies identified in this audio and/or video are representative of all investments made or recommended by LionTree on behalf of each firm's clients. An investment with LionTree is speculative and involves significant risks including the potential loss of all or a substantial portion of invested capital and the lack of liquidity of an investment. Past performance is not indicative of future results.For further information, please see: https://liontree.com/disclaimer/. If you have questions, please go to https://liontree.com/ and select “Contact.”See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.