More on Dr. Klotz at PCRI
(Editor’s note: When Laurence Klotz, MD, speaks, millions of men on Active Surveillance—close monitoring of prostate cancer—listen.
Klotz, the “father” of AS, gave an important presentation Saturday to the annual patient conference for Prostate Cancer Research Institute.
I reported on Klotz’s call for the demise of the transrectal prostate biopsy, which carries unnecessary risks for deadly sepsis, and the adoption of transperineal biopsies.
I also called on readers to sign my Change.org petition to phase out transrectal biopsies. I present the facts on the risks of transrectal biopsies there. But there is NO NEED to contribute to Change.org, which I gather uses donations to promote petitions. But please sign at https://chng.it/7bQsWSfK. When we hit 1,000 signatures, we can start reaching out to Congress, Medicare, and the American Urological Association.
Meanwhile, Klotz had lots more to say. Canadian Phil Segal, a leading voice for AS , prepared a useful guide to Klotz’s presentation, which you can view at
Klotz begins 5 hours 9 minutes into the presentation with a rendition of Paul Simon’s “Still Crazy After All Those Years”
Summarizing Klotz’s presentation at PCRI
By Phil Segal
Another valuable presentation on active surveillance by Dr. Lawrence Klotz at this Saturday’s 2022 PCRI Fall Conference. Anyone on or interested in AS would be well advised to listen to this 55minute wide-ranging talk. I’ll highlight what I thought were salient points;
AS is now a worldwide standard of care for true GG1 (Grade Group 1, or Gleason 6) patients. The question is not whether the principle is correct but the focus is now on appropriate candidate selection, how to do AS optimally and when to intervene. The metastasis potential of pure GGI is virtually zero.
AS is safer for younger men since it is less likely they are harboring a higher-grade disease. This allows them to effectively monitor the disease while maintaining a satisfactory QoL.
Dr. Klotz suggested that men with a BRCA-2 mutation, even with a GG1 diagnosis, should be treated and preferably by surgery. He also discussed the familial implications for men with a BRCA-2 mutation
Dr. Klotz stated TP biopsies should be the standard of care when biopsies are performed.
For men with a Gleason 3+4 but <5% Gleason 4 AS is a realistic option. If the Gleason 4 component is +5%, further examination of the cancer to see if the genomics is favorable or not should be carried out.
In Dr. Klotz’s discussion on biomarkers, he discussed the CANARY PASS risk calculator (nomogram) in lieu of a biomarker test. He stated that the nomogram gives a very tight reading on the likelihood of a patient being upgraded on his next biopsy.
Dr. Klotz closed the presentation with a discussion on diet and exercise and some proactive interventions (Vit D, statins, metformin) which although not supported by control trials were felt to be useful.
The presentation was followed by a further 50-minute question and answer period between the ever-inquisitive Dr. Mark Moyad and Dr. Klotz which I always find both interesting and amusing since Dr. Moyad always makes it both interesting and humorous.
Klotz’s presentation was on September 10 at the annual patient conference online of the Prostate Cancer Research Institute. (Guide to Klotz session.)
Phil Segal’s prostate cancer journey
I was diagnosed in early 2007 at age 62 with a Gleason 3+3 in 1 core with approximately 10% involvement. I knew virtually nothing about prostate cancer and learned quickly about a Toronto Prostate Cancer peer support group which I joined. I have continued working with that group for over 15 years first as a regular attendee then joining their Board and serving as co-chair for a number of years. Zoom has expanded my ability to also learn from many other support organizations in Canada and the US.
I have been fortunate throughout my PCa journey. I have had four biopsies since my initial one and each has been negative. My PSA has remained relatively low within a very tight range. I believe the knowledge I have gained about Prostate Cancer in general and Active Surveillance in particular over the years has allowed me to remain on AS and avoid what many term “anxious surveillance.”
I am a facilitator of the Nationwide AS group of Prostate Cancer Support Canada. Working with others in Prostate Cancer support and awareness is very satisfying.
Don’t miss: ASPI (Active Surveillance Patients International) will be premiering the first of a new video series titled “Active Surveillance 101" at noon Eastern on September 24, 2022.
Register here: ASPI SEPTEMBER ZOOM MEETING
Like 101-level courses in colleges, AS 101 is aimed at teaching the basics. In this case, it's the basics of active surveillance, close monitoring of low- to favorable intermediate-risk prostate cancer.
The program features conversations between actual patients and their partners/spouses and leading experts. The goal of this series is to reach all AS candidates, including those who have not yet been diagnosed with prostate cancer but have rising PSAs (prostate-specific antigen) blood levels and offer them an introduction to AS and help them formulate questions when they go to their family doctors, urologists, or oncologists.
The first episode features a couple, Nancy and Larry White in a simulated office visit with Dr. Steve Spann, a top family physician and dean of the University of Houston College of Medicine. They discuss Larry's rising PSA and what it may mean.
In subsequent episodes, the couple visits Dr. Laurence Klotz, of the University of Toronto, the "father of active surveillance." Other episodes of AS 101 are being developed on biopsies, imaging, and DNA testing.
AS 101 is sponsored by the Active Surveillance Coalition, which includes Active Surveillance Patients International, the AnCan Virtual Support Group for Active Surveillance, Prostate Cancer Support Canada, Prostate Cancer Research Institute, and TheActiveSurveillor.com newsletter. We encourage you to share this series with anyone you know who is dealing with this issue, including your family physician.
Prostate Cancer Foundation is looking at physical and mental illness.
For Prostate Cancer Awareness Month, the Prostate Cancer Foundation, the 800-pound private prostate cancer researcher, is holding a webinar on “Physical and Mental Wellness in Prostate Cancer.”
Here are the details:
Join us for the first in a series of monthly webinars hosted by PCF President and CEO Dr. Charles J. Ryan.
During Prostate Cancer Awareness Month, PCF challenges everyone to Get Healthy. Dr. Ryan and guests will discuss key aspects of nutrition, exercise, and mental health in prostate cancer.
The event will be Sept. 20, 2022 04:30 PM in Pacific Time (US and Canada).
Sign up to join here.
Following each segment, there will be a live Q&A.
• Prostate 8: Simple lifestyle changes that work (Dr. Stacey Kenfield, UCSF)
Dr. Kenfield is Associate Professor in the Department of Urology and is the Helen Diller Family Professor of Population Science for Urologic Cancer. She is an expert on lifestyle, exercise, nutrition, and their impact on prostate cancer. She'll discuss research showing how specific lifestyle factors improve outcomes after prostate cancer diagnosis, and practical ways to incorporate these changes into your life.
• Mental Health and Prostate Cancer (Dr. Andrew Roth, Memorial Sloan Kettering Cancer Center)
Dr. Roth is an Attending Psychiatrist and is board-certified in Psychiatry, Geriatric Psychiatry, and Psychosomatic Medicine. He is focused on caring for the mental health needs of patients with prostate cancer and other genitourinary diseases. He'll provide an overview of the challenges patients commonly face, as well as strategies and resources for coping and living well during treatment and survivorship.
Here’s hoping Dr. Roth will cover AS as well as advanced prostate cancer.
Please send any questions for the speakers in advance to: webinar@pcf.org