Laurence Klotz, MD, FRCSC

Laurence Klotz, MD, FRCSC

University of Toronto

Toronto, Ontario, Canada

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.

Talks by Laurence Klotz, MD, FRCSC

Review of Sentinel Assay for Prostate Cancer Diagnosis

Posted by | Sep 2021

Laurence Klotz, MD, FRCSC, Professor of Surgery at the University of Toronto and the Sunnybrook Chair of Prostate Cancer Research, reviews the Sentinel Assay, a urine-based assay for detecting prostate cancer currently awaiting FDA approval. He notes that there are several significant needs in the pre-biopsy setting, including the need to increase the probability of a positive biopsy, and the need to reduce overdetection and the number of unnecessary biopsies. Dr. Klotz observes that there are several commercially-available biomarker assays that seek to help with this, all of which appear to work fairly well, although perhaps not quite as well as miR Scientific’s Sentinel Assay appears to. He explains that the Sentinel Assay is based on analysis of 442 urinary exosome microRNA sequences, and that it can identify small high-grade tumors that may be missed by imaging or biopsy. Dr. Klotz then summarizes the results of the one paper published on the Sentinel Assay so far, observing that its findings that the Sentinel prostate cancer test demonstrates a sensitivity of 94% and specificity of 92% are almost too good to be true. He presents as-yet-unpublished data that supports these findings, showing a 93% concordance between the Sentinel Assay and pathology. Dr. Klotz concludes that while validation is still needed, the Sentinel Assay appears to be an extremely accurate urine-based assay that will be easy to ship and use.

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What’s New in Active Surveillance for Prostate Cancer in 2021

Posted by | Aug 2021

Laurence Klotz, MD, FRCSC, Professor of Surgery at the University of Toronto and the Chair of Prostate Cancer Research at Sunnybrook Health Sciences Centre, discusses what is new with active surveillance (AS) for prostate cancer, presenting various recent studies. He begins by considering the role of molecular genetics and observes that patients with certain kinds of disease are very safe candidates for AS noting, for instance, that only 2% of patients with Gleason grade 1 cancer are in the highest average genetic risk quartile, and that long-term outcomes for patients with Gleason grade 1 disease on AS are excellent. Dr. Klotz then looks at the safety of AS for younger patients, a group that has often been encouraged to get radical treatment, and highlights studies showing that younger men have a lower risk of upgrading while on AS and that AS is as safe for men over 60 as it is for men under 60. He comments on some other commonly-cited risk factors, noting that, with the exception of patients with BRCA mutations, a family history of prostate cancer does not increase a patient’s risk of having more aggressive prostate cancer, and also that while Black men experience higher rates of progression and treatment on AS, there is no difference in metastasis or mortality compared to White men on AS. Dr. Klotz acknowledges that radical treatment is likely necessary for patients with the BRCA2 mutation, but mentions that there is some controversy in this area. He then touches on the limitations of MRI, emphasizing that MRI progression does not correlate with upgrading and that MRI does not contribute significantly to the identification of higher-grade cancer, and that biopsy compliance is important for identifying progression. Dr. Klotz also briefly notes that active surveillance is a safe option for well-selected patients with intermediate-risk disease. He then looks at some recent research indicating a relationship between obesity and prostate cancer progression. Dr. Klotz concludes with the observation that while there is still a lot of variation in the use of active surveillance, as well as room for growth, there has been increased uptake overall in the US.

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Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions

Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions

Posted by | Mar 2021

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 argues that active surveillance is safe for appropriately-selected younger men, as well as for Black patients. Dr. Klotz also explains that placing men with intermediate-risk cancer can be safe, again with appropriate selection and careful follow-up. He then gives an overview of innocuous interventions for patients on active surveillance, including diet, exercise, smoking cessation, vitamin D, low-dose statins, and metformin.

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Active Surveillance 2021 – Imaging and Biomarkers

Active Surveillance 2021 – Imaging and Biomarkers

Posted by | Feb 2021

In the second 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, outlines recent developments in imaging and biomarkers and discusses how these are changing active surveillance for prostate cancer. He reviews the benefits and limitations of MRI targeting, considers the potential of high resolution micro-ultrasound, looks at how biomarkers that provide a continuous risk index might be more useful in active surveillance than most currently-available biomarker tests, and contemplates a future of data integration and artificial intelligence in active surveillance.

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Active Surveillance 2021 – From Bench to Bedside

Posted by | Feb 2021

In the first part of a Platinum Lecture trilogy on active surveillance, Laurence Klotz, MD, Professor of Surgery and holder of the Sunnybrook Chair of Prostate Cancer Research at the University of Toronto, discusses the history of active surveillance for prostate cancer as well as current guidance for its implementation. He first notes the major issues in early prostate cancer in the present day, including risk assessment prior to diagnosis, diagnostic evaluation of localized disease, and image-guided partial gland ablation therapy. Dr. Klotz then looks back to early papers suggesting that radical treatment may be unnecessary and ineffective in treating low-risk prostate cancers, remarking on their influence on himself and his colleagues’ 2002 feasibility study on watchful waiting. He reflects on how active surveillance has become widely accepted since that publication, and discusses what urologists have learned regarding patient selection, especially in terms of molecular genetics. Dr. Klotz then compares different studies of active surveillance, focusing on one with broad patient selection criteria and one with conservative selection criteria. The study with broader patient criteria found a raw prostate cancer-specific mortality of 1.5% and an actuarial mortality of 5% at 15 years, while the more conservative study found a prostate cancer-specific mortality of 0.5% at 15 years. Dr. Klotz notes that the 5% actuarial mortality in the first study was determined to be largely the result of the presence of pattern 4 disease at baseline. He also observes that there has been a convergence of selection criteria since those studies came out. Dr. Klotz concludes by discussing current active surveillance protocol, emphasizing the importance of doing a confirmatory biopsy.

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