Laurence Klotz, MD, FRCSC, presented “Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions” for the Grand Rounds in Urology audience in March 2021.
How to cite: Klotz, Laurence. “Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions” March 2021. Accessed Nov 2024. https://grandroundsinurology.com/active-surveillance-2021-patient-selection-monitoring-and-innocuous-interventions/
Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions: Summary
In the third part of a Platinum Lecture trilogy on active surveillance, Laurence Klotz, MD, FRCSC, Professor of Surgery and holder of the Sunnybrook Chair of Prostate Cancer Research at the University of Toronto, discusses patient selection, monitoring, and innocuous interventions for active surveillance of prostate cancer.
He begins by summarizing the evidence against treating young men differently in terms of placing them on active surveillance or not. He explains that younger men have a lower risk of upgrading on active surveillance and a relatively greater risk of sexual side effects from treatment compared to older men. Dr. Klotz then considers whether active surveillance is safe in Black men, citing a study that found higher rates of progression in treatment and progression in Black patients compared to white patients, but no difference in metastasis or mortality, indicating that active surveillance is safe for this group. Dr. Klotz also looks at whether active surveillance is safe for patients with grade group 2 cancer, summarizing several studies which indicate that careful patient selection is pivotal in this group, but also that active surveillance can be a good option for some patients in this cohort. Dr. Klotz observes that biomarkers are helpful in patient selection here, and emphasizes the benefits of compliance with active surveillance biopsy protocols. Dr. Klotz continues his presentation with a discussion of innocuous interventions for patients on active surveillance. Regardless of whether these interventions actually prevent prostate cancer progression, these interventions, including smoking cessation, dietary modification, and regular exercise, can help patients feel proactive, and most of them have other health benefits. There is also some evidence that simple interventions like taking vitamin D, a low-dose statin, and metformin on a daily basis could reduce prostate cancer progression. Dr. Klotz concludes with a summary of all three parts of his lecture trilogy.
For more on active surveillance for prostate cancer, check out our collection page for the 2020 International Prostate Cancer Update!
ABOUT THE AUTHOR
Laurence Klotz, MD, FRCSC, is a professor of surgery at the University of Toronto and the Sunnybrook Chair of Prostate Cancer Research. Dr. Klotz was the founding editor-in-chief of both the Canadian Journal of Urology and the Canadian Urology Association Journal (CUAJ), and he is now editor emeritus of the CUAJ. Dr. Klotz obtained his medical degree and completed his residency at the University of Toronto. He was also a uro-oncology fellow at Memorial Sloan Kettering Cancer Center in New York.
Dr. Klotz has 550 peer review publications and eight books. He coined the phrase “active surveillance” and successfully championed this approach for men with favorable-risk prostate cancer against substantial resistance. He was the associate editor of the Journal of Urology, responsible for prostate cancer, for eight years. Dr. Klotz received the Queen’s Jubilee Medal for outstanding public service, the University of Toronto's Lister Prize, the Society of Urologic Oncology’s SUO Medal, the American Urological Association’s Richard Williams Award, the University of Toronto's Lifetime Achievement Award, the Canadian Urological Association Lifetime Achievement Award, and the Harold Warwick Award from the Canadian Cancer Society for “outstanding contributions to cancer control.” In 2015 he was inducted as a Member of the Order of Canada, Canada’s highest civilian award.
