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Post by KC on Feb 20, 2014 10:15:01 GMT -8
Our own Tony Crispino will serve as a panelist for this live online discussion, along with Mike Scott (better known to many of us a sitemaster of the "New" Prostate Cancer InfoLink site). The topic of Dr Klotz's discussion is "Active Surveillance in Prostate Cancer" Click HERE for more info on how to join the discussion. Joining is free, but you must RSVP to receive dial-in information. |
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Post by KC on Mar 13, 2014 15:45:26 GMT -8
REMINDER...this event is next Wednesday, March 19 at 6pm
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Post by Tony Crispino on Mar 13, 2014 17:11:24 GMT -8
Thanks Kurt!
That's 6:00pm Eastern Time. If anybody has any questions for Dr. Klotz, feel free to submit them to me. I'll try to get them in there if I can.
Tony
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Post by KC on Mar 17, 2014 10:30:32 GMT -8
I've got a question to tee up...
"Dr Klotz, how do you address the comment that there may be too few men involved in AS studies, for too few numbers of years, for AS to be considered a viable alternative compared to what has traditionally been the “gold standard” treatment for men with low-risk PC? Is there adequate strength behind the evidence in favor of pursuing AS for favorable-risk men?"
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Post by Tony Crispino on Mar 18, 2014 15:14:31 GMT -8
Kurt,
You'll probably notice a post from Scardino I did yesterday. There he says that as many as 50% of new Dx's should start with AS. I reframed this question to that spirit. I am asking Klotz if Scardino's comments are a moral victory and if it's the move in the right direction.
Tony
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Post by John T on Mar 19, 2014 8:35:55 GMT -8
You hear all sorts of numbers being thrown out. What is the risk of death in those starting AS vs those who choose immediate treatment? How many years of data support support AS as a viable option?
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Post by Tony Crispino on Mar 19, 2014 8:59:04 GMT -8
John,
I think Scardino is on the mark. Taking a slow roll with early diagnosis is perfectly reasonable. It is controversial no doubt but it's reasonable. I think this is the main window of opportunity to allow a patient to get educated about his condition and I think Scardino recognizes that.
Tony
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Post by Admin on Mar 19, 2014 15:59:36 GMT -8
Dr Klotz was great as usual. Here is the Cure Talk Panel discussion: Dr. Klotz speaks to the Cure PanelKlotz raises some great points: - His studies are for Gleason 3+3=6 almost exclusively.
- Re-Biopsy is necessary in the first year but re-biopsy afterward should be about 4 years apart.
- Canada has about 75% of diagnosis offered AS upon diagnosis. The US about 15%. The death rate to PCa in Canada is not higher than the US.
- The Advocacies need to continue to get the word out about AS. Patient acceptance has improved since they have.
- The US physicians are mired in over-treatment through litigation and other outside entities. It's a matter of time for them to face the reverse litigation for over-treatment.
More great points added. Enjoy the conversation
Tony
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Post by Tony Crispino on Mar 19, 2014 23:38:05 GMT -8
Well I tried to weigh in on the HW site so that the broadcast could hit more people. The CP folks were hoping we would try to post it around for the opportunity to get to more listeners. If somebody can link the broadcast there it would be helpful to those that are on AS or seeking support for their decisions. The comments I received are highly non-supportive of that community. Dr. Klotz is internationally known for his work and he gave us a great and candid interview here. I presented the video (audio) in the live support group tonight and it was very well received.
I think everyone loved it. The group has about 15% patients on AS and I know they loved it. Anyhow, it was great to be a part of it. Tom Kirk is a wonderful man that runs the worlds largest mens support group chain and it was great to hear him again. Love the guy. Mike Scott as well. He is doing a great job with these programs. We all felt it was an excellent interview.
With Scardino's comments earlier this week I do believe that we just may see 50% of every diagnosis on an initial AS plan and probably sooner rather than later. This to better judge the disease characteristics and to appropriately apply the suitable treatment if necessary. Support groups and online boards need to prepare for this. There will be sharp opposition to AS always in existence. But no matter, if what the likes of Scardino, Carroll, Thompson, Carter and many many more of the top prostate people are proposing takes place, the majority of PCa patients will end up being AS patients at least initially. And virtually all G6 low risk cases will be started with AS with a long term expected.
Tony
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Post by tudpock18 on Mar 20, 2014 6:11:59 GMT -8
Tony, I just listened to the panel discussion; it was EXCELLENT. I have posted about it on HW and linked it as well. There was one well-known naysayer who posted just before me but you have to consider the source when looking at his remarks.
I'll probably send you a separate email with some thoughts about the AUA guidelines...you can be a big help there.
Keep up the great work!
Jim
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Post by Tony Crispino on Mar 20, 2014 10:37:02 GMT -8
I saw the post just before the plane took off and I was not surprised.
I am on the ground in St. Louis right now waiting for the plane to re-board for orlando. I'll be at Sonny's later tonight. I'll get a chance to take the "online" out of my relationship with 142. Hopefully it will go well. I highly respect all those who have moderated at HW and I'll make that clear.
Anyone that is dead against AS is in for a ride. The industry professionals believe that they can reduce morbidity with very minimal if any impact on survival by using a sophisticated approach to AS. Klotz has paved that road.
In all this I am only a messenger. And I remain a student as well. My role is not to lure patients to any treatment choice or any decisions. Simply to provide the information and what I hear from the pros.
Should be acceptable! And if it isn't then I understand.
Again thank you for sharing the information.
Tony
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Post by lupronjim on Mar 25, 2014 19:42:03 GMT -8
Thanks for starting this thread KC and for the link Tony.
As a G9 with mets at initial diagnosis, I have to take the blinders off, but it is beginning to sink in.
Part way thru we got an added bonus as doctor spoke favorably about use of statins, vitamin D, Lycopene from natural sources, Metformin and Capsaicin (Cayenne Chili Pepper) where he joked in pill form it does not burn either on way down nor on way out:}
I like the way Tony worded it at Sonny's at dinner that in general great job being done identifying and treating high risk guys but equally poor job being done for low risk guys with over diagnosis and over treatment.
LupronJim
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Post by Tony Crispino on Mar 25, 2014 21:17:44 GMT -8
I'd love to take credit for that phrase, Jim, but I stole it from Oliver Sartor at Tulane. And you're right it's accurate.
Tony
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Post by Tony Crispino on Mar 26, 2014 7:58:59 GMT -8
Sartor's comment is one I extrapolated for the basis of discussing the industry. Sartor is doing his best to identify AS cases. But as Klotz indicates, half of physicians in the state of California never recommended AS to a single patient. I think it's like that in many places in the US thus my statement using Sartor's lead is that if we are doing no AS at all by half the doctors in America then we are doing a horrific job as a physician society at determining what tumors don't ever get looked at as indolent. Thus my dinner comment represents my view of the industry in the US.
If there are doctors that will never look at AS and offer it to their patients, we have scientific data that proves that these doctors are contributing to the USPSTF decision that calls for an end to screening. These are doctors that appear to need an education about AS if not a regulation that is upheld by the AUA, NCCN, AMA, and other peer organizations calling for more extensive use of AS.
So when he's says "pretty good" and "not as good" he is describing the best we can do as opposed to the typical case where I say was are doing a great job of finding tumors that need treatment and a poor job of finding tumors that do not need treatment, especially when that opportunity is present.
Tony
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