Laurence Klotz, MD, FRCSC

Laurence Klotz, MD, FRCSC

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Laurence Klotz, MD, is the former Chief of Urology at Sunnybrook Health Sciences Centre and former President of the Urological Research Society and the Canadian Urological Association. He currently serves as Professor of Surgery at the University of Toronto and holds 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, and is now Editor Emeritus of the CUAJ. He is the Founder and Chairman of the Canadian Urology Research Consortium (CURC), and is also the Chair of the Global GU Oncology Group. Dr. Klotz obtained his medical degree from the University of Toronto and completed his residency at the University of Toronto Gallie Program in Surgery. He was a fellow at Memorial Sloan Kettering Cancer Center in New York in uro-oncology. Dr. Klotz is a widely published uro-oncologist with over 350 publications and several books. His main research interest has been prostate cancer. He has served on the boards of many medical/scientific organizations and journals, including the SUO, Prostate Cancer Canada, the journals Prostate Cancer and Prostatic Diseases, Brazilian Journal of Urology, Italian Journal of Urology, and World Journal of Urology. Dr. Klotz was awarded the Queen’s Jubilee Medal for meritorious public service in 2012, and the University of Toronto Department of Surgery Lister Prize and the Society of Urologic Oncology Medal in 2013. He received the Harold Warwick Award from the Canadian Cancer Society for ‘outstanding contributions to cancer control’ in 2014. He received the Order of Canada in 2015, and the Richard Williams Award from the AUA in 2016. He received the Dean’s Lifetime Achievement Award from the University of Toronto in 2017.

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Articles by Laurence Klotz, MD, FRCSC

What’s New in Active Surveillance for Prostate Cancer in 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

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

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

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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The miR Scientific Sentinel Assay

Laurence Klotz, MD, Professor of Surgery and holder of the Sunnybrook Chair of Prostate Cancer Research at the University of Toronto, explains how the miR Scientific Sentinel Assay works and its potential benefits for patients with prostate cancer. Dr. Klotz uses results from a September 2020 study to display how the Sentinel PCa, CS, and HG Tests demonstrate high levels of sensitivity and specificity in these patients. The Sentinel™ PCa Test classifies patients based on absence or presence of disease, the miR Sentinel CS Test stratifies patients based on low-risk disease (Grade Group 1) or intermediate- and high-risk disease (Grade Groups 2-5), and the miR Sentinel HG Test stratifies patients based on low- and favorable intermediate-risk disease (Grade Groups 1 or 2) or high-risk disease (Grade Groups 3-5). This is the first report of the development and performance of a platform that interrogates small noncoding RNAs (sncRNA) isolated from urinary exosomes, and highlights the utility of these non-invasive, highly precise techniques for diagnosing and classifying prostate cancer.

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