A systemic review of AS by Dr. Klotz

Perhaps you can also tell us a little about yourself and you "relationship" with PCa since, although not a rule, it is kind of customary here. Do you have prostate cancer? if so what did you do or what are you doing about it? Do you have a role in the industry, caring for a loved one?

Your explanation of what Dr. Klotz "meant" was not said on the hour long program. He talke dabout his group which I believe her referenced earlier int he program as being mad eup of 1000 men. So either you can read minds, or you have a specific interest in Klotz and perhaps AS.

Pointing out the hypocrisy of things is not anger.

I guided my dad towards AS. I have no issue with it and my position on it for 65+ probably differs from that of most men here and more closely resembles the opinion of Klotz in fact.

The segment was promotional in nature and there were the problems I mentioned in my first post. My son and I listened to the entire segment, which is probably saying more than 95% of the people here and I intended to forward it to my dad if good. I didn't because I didn't think it was good or informative.

As a man who studied and research Active Surveillance, and has completed five years of being a patient of an Active Surveillance treatment protocol, I am grateful to Dr. Klotz, a pioneer in developing the AS treatment choices, who had published information that I was fortunate to read, and gave me reassurance to continue with my decision in the face of the negative comments that were made by professionals and lay people, especially when I was diagnosed five years ago when the climate for the Active Surveillance decision was very low.

During the last five years, I researched prostate cancer and various active treatment decisions, and have been able to make an educated choice of the active treatment that is best for me, in the event that there is progression of disease that requires active treatment. Of course I hope that I will continue with AS for the rest of my life.

I did watch the presentation by Dr. Klotz. I thought that it was very well done and informative. I took away some additional knowledge from the show. I only wish that it had continued longer.

At any rate, I was very impressed with the program that was able to showcase Dr. Klotz. In the past I have read from various publications and internet sites where he presented. In my opinion, he has done more than anyone to develop this treatment type, and I am very thankful to Dr. Klotz who has been a great influence in my selecting Active Surveillance.

Turp,

I hope that we both die with the disease, not because of it.

The quality of each of our lives have not degenerated during the last years from potential side effect of an active treatment. So far we are winners.

By the way, your prostate size must have been gigantic to have a 9.6 PSA before your turp.

Sorry, Shiny. It wasn't supposed to phase you or intended to question choices. It's just a statistic that has been posted here in the past. As I recall it included folks who needed treatment and folks who couldn't deal with it mentally. I do recall reading the study though and it was a little different than how Klotz portrays it. I don't think the group who couldn't hack it mentally in that study was just 5% and I don't think they were either social loners or the wolf of wall street.

I think the logic of enjoying a few more years with no potential side effects before treatment is just as valid as the exact opposite, wanting it out sooner so as to counter the potential side effects while fitter and healthier and to avoid fears of potential spread. Both legitimate approaches and I don't think anyone here is judging the AS approach. I think you should also remember that there are many G6 and G7 who treat it and have no or minimal side effects. There are plenty of men who treat and have no issues with side effects.

Everyone seems to need their choice of treatment validated. I think it gives us a sense of security in our choices. Just loo at the how the AS crowd responded in this thread. You'd get the same thing in surgery or radiation threads.

I'm glad my dad is on AS, I thought it was a no-brainer that my grandpa would be on it. I was not comfortable with it at 40 for the reasons given above and like you, Turp and Hopeful I did incredibly well with my choices and treatment.

Robin - what is your relationship to PCa? I know you can state a lot about Klotz and AS, but I don't know anything about your cancer.

The 40% statistic was not from a Klotz reference. It was a study posted here by a pro AS poster.

There is plenty online with similar figures:

"At the 3 North American centers with the most experience using active surveillance, about one third of men cited "anxiety" as the reason for dropping out of surveillance and moving on to definitive treatment, noted Dr. Mohler during his presentation."

www.medscape.com/viewarticle/718574

Post Edited (davidg) : 3/23/2014 5:37:46 AM (GMT-6)

I have another view of the controversies that periodically arise in this forum. I find them, for the most part, entertaining and informative. The passion and knowledge that people like JohnT, Tall Allen, and davidg, among others bring to this forum have helped me to understand better this cursed disease.

My only regret is that in the process we lost the voices of other passionate and knowledgeable people like casey59 and Tony Crispino.

Finally, one of the main reasons I came to this forum is that I want to understand more fully the various pros and cons of the various active treatments available. As a man using AS as my approach to PCA, I know that I may be only one biopsy away from seeking treatment.

Lack of doctor's support is another cause of anxiety for some men to stay on AS. It is difficult for a patient to go against a doctor's recommendation to seek immediate radical treatment. Unfortunately, some urologists still use life expectancy as the criteria for determining treatment instead of disease condition.

Doctor selection is important in AS ... no different from any other treatments.

David,

I remember when you joined the forum people aggressively questioned who you were and why you were seemingly so attached to Dr Samedi. I thought that was wrong as to me it seemed that you were clearly a genuine newbie here at healing well with your own reasons for supporting your doctors approach.

It is clear to me that robin is here knowledgable and polite and I am sure when he is ready he will share his history. He has not tried to sell a wonder cure. He has not broken forum rules. Until then he should be allowed to share his views without aggressive questioning as to his intent and history.

Regards,
An

Robin - the quote comes directly from Dr. James Mohler (Courtesy of NCCN). Ask him for details.

"At the 3 North American centers with the most experience using active surveillance, about one third of men cited "anxiety" as the reason for dropping out of surveillance and moving on to definitive treatment, noted Dr. Mohler during his presentation."

www.medscape.com/viewarticle/718574

I see you refuse to disclose what your relationship to PCa is and your purpose here. Fine, I expected that.

RobinDH said...
Lack of doctor's support is another cause of anxiety for some men to stay on AS. It is difficult for a patient to go against a doctor's recommendation to seek immediate radical treatment. Unfortunately, some urologists still use life expectancy as the criteria for determining treatment instead of disease condition.

Doctor selection is important in AS ... no different from any other treatments.

I hear that loud and clear!

I'm currently on AS and am being supervised by Dr. Scholz. I believe I was 51 when I was diagnosed and I'm now into my sixth year of going the AS route. (If I'm hazy on the years, it's because I don't think about being on AS or stress about it. I just follow Scholz's advice and let him do the calculations as to whether I should be off AS or not. (After all, that's what I'm paying him for . )

My regular doctor, however, HAD been on my case for these past six years about "doing something about your prostate cancer." He would often say, "Don't you think it's about time that you take care of this?" Finally, this year he's come around to thinking that AS is not a bad way to deal with my disease. Somewhere along the way he became enlightened and saw that AS is a legitimate way to to deal with prostate cancer.

But before I embarked on AS, I sought out the opinions of six doctors (three from Cedars of Los Angeles) who all decided that surgery or radiation was my best course of action. Then, I stumbled upon this forum and the postings of JohnT who showed me one more possible way to deal with this disease. (I was two weeks away from starting my photon radiation treatments (at Loma Linda) before I booked an appointment with Dr. Scholz who sent me to Dr. Bahn for a second opinion--just to make sure.)

End result: I'm alive, I'm healthy, very active in sports and my job, and my cancer is minimal and is not progressing or is progressing minimally if it is. Had I listened to those six other doctors, who knows what physical shape I'd be in right now. AS isn't for men with advanced cases of prostate cancer. I get that. But hopefully, AS will continue to be my treatment of choice.

(Consequently, the doctor that performs my colonscophies (also a Cedars doctor) remarked that AS was a smart choice and would be his preferred method of treatment.)

As you posted "Doctor selection is important in AS."

Tony, thanks for the nice comment.

 

davidg, are you serious?  You expect me to “address” a quote from a doctor without any details and then tell me to contact him?  He didn’t even say which 3 N. American centers they were.  Can’t help you there.

 

Klotz’s “5%” is based on his experience; it’s “3% patient preference” and “2% other” according to the published results of his study.  It may be different from what you have seen online before but that does not make them “unrealistic”, “questionable” or “make little sense” … or he was fudging numbers to promote AS.  Both sets of statistics could be correct.  The difference could be due to different measurement criteria, definitions or ways of tracking used in the respective studies.  It could also be due to the different climate for AS between Canada and U.S. 

 

In the radioblog show last week, Dr. Klotz mentioned that in Canada, AS is widely embraced and he estimates that 75% of eligible low-grade patients were offered AS.  In U.S., AS is rejected by a lot of doctors.  In a California study, half of the AS patients were put on it by 3% of the urologists, and half of the urologists never offered AS to a single patient.  He said there could be many drivers for this including the different health care systems and fear of litigation (high in U.S.).  So with greater acceptance of AS in Canada, it’s very likely that their AS patients have more support from patient community, family and friends ... and were given more information, more assurances and more support from their urologists upfront and during treatment so they can calmly continue on AS until intervention is needed… resulting in a lower drop out rate.  I think this is an area the advocacy group for AS can further explore.

 

(Anyone who likes to hear this in full context can go to the radioblog linked by Tudpock/Jim @ 39:52.  He was responding to a question about how to get the medical community to meet Dr. Scandino’s expectation to expand AS to more than half of the diagnosed patients.)