Discover Who's Who

On this page, CPCN is pleased to present brief biographies of individuals who are contributing to prostate cancer research, health care, awareness, advocacy, and support -- people who are helping us win the war against prostate cancer.

Dr. Laurence Klotz: Fighting prostate cancer on many fronts

Dr. Larry Goldenberg: Helping men take an active role in their prostate cancer treatment



Dr. Laurence Klotz: Fighting Prostate Cancer on Many Fronts
Cellular research, surgical techniques and tools, treatment options and availability, prevention, and public and medical education: Dr. Laurence Klotz is fighting prostate cancer on many fronts. Klotz, who is Chief of the Division of Urology at the Sunnybrook and Women's College Health Sciences Centre in Toronto, holds an incredible number of positions and honours. He is an award-winning teacher in the faculty of the University of Toronto's Division of Surgery; the founder and editor in chief of the Canadian Journal of Urology and the Canadian Urology Association Journal; the chair of the Canadian Urology Research Consortium, the Scientific Review Board of Prostate Cancer Canada, the Global Genito-Urinary Oncology Group, and the World Uro-Oncology Group; and president elect of the Canadian Urological Association. On top of this, he gives hundreds of invited lectures on the topics of urology and prostate cancer, and he has a thriving practice in urologic oncology, receiving referrals and questions from across Canada regarding the management of challenging cases.

Describing the range and significance of Dr. Klotz's research is equally daunting. One major area of interest is in the effects of androgens and androgen deprivation on prostate cancer. (See the CPCN page on hormone therapy for more information.) An early study of his, describing the use of intermittent androgen deprivation (IAD) to treat men with advanced prostate cancer, became a landmark in the field. (Click to see an abstract of the 1986 study "Intermittent endocrine therapy for advanced prostate cancer" by Klotz and his colleagues.) The potential benefits of IAD are that it will slow tumour growth, as does the commonly used continuous androgen deprivation treatment, while allowing for a better quality of life. Klotz has continued to lead in this area of research; he is currently the principal investigator of an international clinical trial comparing the use of intermittent versus continuous androgen deprivation. A companion trial in which he is involved is considering the effects of IAD versus continuous androgen suppression on bone loss and body composition.

One interesting consistency in much of Dr. Klotz's research is that it addresses some of the thorniest issues and problems that potentially face men with prostate cancer: what are effective treatments for advanced prostate cancer, what can be done when prostate cancer stops responding to hormone therapy, and how can we develop effective treatments for prostate cancer that not only prolong a man's life but preserve his quality of life? In relation to this last question, Klotz was instrumental in research on a novel nerve-sparing surgical aid. Knowing that impotence is a common long-term side effect of prostate cancer surgery, he went looking for a way to improve the risk picture. The result was a device that helps surgeons identify the cavernous nerves during surgery, so these nerves can be spared as much as possible, which decreases the risk of impotence. (See an abstract of Klotz's 1998 or 2000 research article on this topic.)

Another foray into the battle to improve treatments so they are not only effective but also less harmful to a man's quality of life is the work Dr. Klotz has done on active surveillance with delayed intervention. (See the CPCN article "Goodbye watchful waiting. Hello active surveillance.") Improvements in early detection, such as the PSA test, mean that prostate cancer is frequently detected in younger and healthier men, and often at an early stage. These improvements give men a better chance of a cure, so Dr. Klotz supports early detection vigorously. As he comments in a Reader' Digest Canada article, "I see guys all the time who at 55 have caught their cancer in time with surgery. In the days before [PSA] screening, they would have found themselves at age 60 with an incurable disease."

However, early detection of prostate cancer often presents men and their doctors with a difficult choice. Frequently, prostate cancer grows slowly -- so slowly that, in some cases, it will never progress to a stage that threatens a man's life. And many of the most common and effective treatments for prostate cancer (e.g., surgery, radiation, and hormone therapy) can have potentially long-term side effects that reduce a man's quality of life, such as incontinence or impotence. The dilemma, then, is sorting out the life-threatening, aggressive cancers from the indolent, slow-growing type, and deciding on a rational and appropriate treatment for each man. Dr. Klotz has tested the use of prediction tools coupled with active surveillance and delayed intervention to do this sorting. Specifically, he monitored closely the PSA doubling time of "good-risk" patients -- repeating biopsies when necessary -- to decide whether and when to treat their cancer more radically. (See an abstract of his article "Active Surveillance for Prostate Cancer: For Whom?") He concludes, "The approach of active surveillance with selective delayed intervention based on PSA doubling time and repeat biopsy represents a practical compromise between radical therapy for all patients (which results in overtreatment for patients with indolent disease) and watchful waiting with palliative therapy only (which results in undertreatment for those with aggressive disease)."

Amazingly, we have only scratched the surface of Dr. Klotz's research here. He is also currently studying the role of selected micronutrients (e.g., vitamin E, selenium, and lycopene) in the prevention of prostate cancer, and he is very involved in establishing evidence-based treatment guidelines for genito-urinary cancer, so as to improve treatment options and make them more consistent across Canada. And he has a life outside of work too, pursuing interests that range from jazz piano, tennis, kite boarding, and ice hockey to geopolitics and health economics.

But we at CPCN are probably most aware of Dr. Klotz's contributions to public education. In 2000, his book Prostate Cancer: A Guide for Patients was published by Prospero Books. The text presents a concise and easily understood overview of the disease -- detecting it, treating it, and living with it. The book has helped many Canadian men. Klotz also writes and comments on prostate cancer news, without dodging controversial issues such as the accuracy and usefulness of the PSA test. (See the CPCN article "What is a False Positive?") Just recently, he was called on to give his opinion about a new prostate cancer screening test, which works by looking for the protein substance EPCA-2 (early prostate cancer antigen). (For more information, click here.)

From prevention to early detection, treatment, palliative care, and public awareness, Dr. Laurence Klotz is a good man to have on your side in the fight against prostate cancer.


Dr. Larry Goldenberg: Helping men take an active role in their prostate cancer treatment

Larry Goldenberg, Professor and Head of the UBC Department of Urologic Sciences and Co-Director of The Prostate Centre at Vancouver General Hospital, has an impressive research record. He has co-developed and tested procedures that use neoadjuvant hormone therapy prior to prostate surgery. He helped develop the science and clinical aspects of intermittent androgen suppression (IAS), a particular hormone therapy protocol. He is a principal Canadian investigator in an international study considering the effects of IAS on prostate cancer disease progression. He leads a research team investigating the role of MRI imaging in prostate cancer with a view towards developing methods of "focal therapy" or "the male lumpectomy." And he is assembling a multidisciplinary team of scientists and surgeons to advance the science of robotic surgery, nanotechnology, biophotonics, and computer science.

But, to men newly diagnosed with prostate cancer, Dr. Goldenberg is probably best known for his book Prostate Cancer: All you need to know to take an active part in your treatment, which is now in its 3rd edition.

"Patients are faced with an enormous and often confusing amount of information," says Goldenberg. "Learning about their disease can help restore a sense of control, giving them confidence to make decisions that are right for them." And Goldenberg has worked hard, in his research and through his book and public lectures, to help men sort out this information. (Click here for access to a video or PowerPoint presentation on Prostate Disease delivered by Dr. Larry Goldenberg as part of the Vancouver Coastal Health Research Institute's On Call with VGH Experts lecture series.)

Goldenberg's interest in helping men diagnosed with prostate cancer take an active and informed role in their treatment is longstanding. He also aims to help improve communication between medical professionals and people facing the prostate cancer diagnosis. The results of a study published in 2004 emphasized that it was important for physicians to discover both how men prefer to be told about a diagnosis of prostate cancer and how they wish to participate in decision making - before the "bad news" is communicated. The study also suggested that men with prostate cancer want either an active (43%) or a collaborative (47%) role in decision making and that, in patient-doctor interactions, they rated medical content (what and how much information is provided by their physician) as more important than the emotional support provided in the interview or the setting of that interview. (Click to see an abstract of the article "Patients' preferences for communicating a prostate cancer diagnosis and participating in medical decision making.")

In an early study, Goldenberg and others found that men with prostate cancer preferred overwhelmingly to play either an active or a collaborative role in decision making with their physician (92.5%) and with their partners (100%). Couples said that the top four items on their "need-to-know" list included information on prognosis, stage of disease, treatment options, and side effects. Men with prostate cancer ranked information on sexuality higher than their partners did, and partners ranked information on home self-care higher than prostate cancer patients did. (Click to see an abstract of the article "Assessing information and decision preferences of men with prostate cancer and their partners.")

Goldenberg participated in another study that aimed to determine what effect prostate cancer patients' level of involvement in medical decisions had on their level of regret after treatment for early stage prostate cancer. The study found no evidence that providing information to facilitate participation in medical decision making causes men either to regret their decisions or to experience increased psychological distress. (Click to see an abstract of the article "Decisional regret and quality of life after participating in medical decision making for early stage prostate cancer.")

Next, Goldenberg's interests turned to what kind of information the medical profession should provide to men with prostate cancer and their partners. What information would lower psychological distress levels and enable them to become active participants in decisions? In one study, men with prostate cancer and their partners received individualized information tailored to fit their preferences. This information was delivered in counselling sessions. All participants reported lower levels of psychological distress at four months. Interestingly, patients reported assuming a more active role in medical decision making than they had intended, and their partners reported assuming a more passive role than they had originally intended. (Click to see an abstract of the article "Provision of individualized information to men and their partners to facilitate treatment decision making in prostate cancer.")