Dr. Klotz summary of initial treatment options, results and SEs

[maley2711]

The studies referenced for RP and radiation are not latest generation, and importantly, results are averages for men in different risk groups.

[Tall_Allen]

Yeah-- very out-of-date data - but why are you posting useless stuff at all?

[maley2711 in reply to Tall_Allen]

It is interesting in that a very well known urologist is using such data in presentations.....and it is actively being disseminated to other folks on another forum! At least the study sources and dates are disclosed.

[Tall_Allen in reply to maley2711]

I am chagrinned that otherwise responsible doctors feel the need to give such a slanted sales pitch to patients via youtube videos. I'm pretty sure that any responsible peer-reviewed journal would not let that pass, or at least would have published responsive comments from more responsible doctors.

Yes, I agree that at least he provided references - but how many patients will bother to check his references as I have done? Disinformation tends to take on a life of its own. I may have to write a commentary and email it to him.

[maley2711 in reply to Tall_Allen]

I'd ask that before you do, Google the video for more context in his presentation.....it may have been from a presentation to other Docs.....I don't remember. There is a guy on the other forum who keeps posting this in support of the TULSA as a primary treatment..... SEs look favorable. I know that you do not view TULSA in the same way. Knowing you somewhat, you probably know more about Klotz than I do.....I do know he is also a talented pianist!! Have you ruled out the possibility that whole gland TULSA will eventually be shown to be an equally effective primary treatment with better SE profile??

[Tall_Allen in reply to maley2711]

Whole gland TULSA had recurrences in ⅓ of the men. If that were contemporary RP or RT, it would have been laughed out of the room. He also picked up old toxicity figures from the days before IGRT/IMRT. I think he did the presentation for PCRI knowing no one would challenge him.

[maley2711 in reply to Tall_Allen]

As you said, these type of numbers are only meaningful when characteristics are reasonably matched in different treatment groups. I hate to think that someone like Dr. Klotz is a charlatan......... but I guess he does have a vested interest in the future success of TULSA as an accepted alternative. From what I have read on Inspire, there are quite a few men shelling out $30k +...even traveling to Europe for the treatment. I believe Mayo in Florida is now offering TULSA to the general public...non-trial basis? VirginiaNorthern on Inspire is highlighting TULSA to many men who seek info from Inspire contributors. He was one of first to be treated here in trial...a good outcome for him so far, which can make someone a true believer. Reduced SEs, if true, are certainly a big draw. Avoiding the knife or radiation another big draw of course. I do give credit to Klotz for showing number of men who needed to undergo a 2nd HIFU procedure!! However, doesn't include a similar number for TULSA. It is an overwhelming decision for so many men!!

[doc1947g in reply to Tall_Allen]

And TULSA does not work if your Seminal Vesicles need to be treated.So I think that it will be usefull for G(3+3=6) PCa.

[maley2711 in reply to doc1947g]

They are proposing that and at least G 3+4, with various exceptions for things like calcification..is that also a problem for radiation??

[doc1947g in reply to maley2711]

For RT: G(3+4=7) Grade 2 = RT alone. Intermediate Favourable Risk.

G(4+3=7) Grade 3 = RT + ADT Intermediate Unfavourable Risk. That is my situation.

I had VMAT-RT 3Gy X 20FX and Lupron Depot 22.5mg/12weeks X 2.

I seem to be in the 2% for STRICTURES but got my PSA down to 0.03µg/L.

I am getting PSA testing every 3 months. And a bunch of other blood tests for my Lymphoma LNH.

[Tall_Allen in reply to maley2711]

No- radiation is not blocked by calcifications (or metal fiducials, of course)

[ASAdvocate]

The stats for radiation must be ignored. They all involve studies of men treated in the 1990’s, before the era of focused, accurate, and powerful beam radiation, which became available about 2005.

[maley2711 in reply to ASAdvocate]

Yes....good news on the radiation front! Can the same be said for surgery?

[Tall_Allen]

Where did you get that misleading chart from?

[j-o-h-n]

I think my ex-wife is related to the doctor.... she happens to be a real klotz....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 01/03/2021 11:05 PM EST

[maley2711 in reply to j-o-h-n]

hahahahahaha!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Tall_Allen]

I found the source of this chart. It is from the Profound Medical Corporate website - pure PR. No wonder they quoted outdated data on radiation and surgery. It is especially telling that they used data from the 2007 AUA patient guidelines when the 2017 update has been available. The 2017 AUA patient guidelines specifically address HIFU. It says:

"21. Clinicians should inform intermediate-risk prostate cancer patients who are considering focal therapy or HIFU that these interventions are not standard care options because comparative outcome evidence is lacking.

The Panel recognizes that novel therapies including HIFU and focal prostate ablation may provide QoL advantages for patients in comparison to surgery and radiotherapy. However, there are no prospective randomized or comparative effectiveness data versus traditional treatments available. Published five year oncologic outcomes for HIFU are variable and attributable to the lack of consensus on objective response criteria.78 The Panel awaits the results of well-designed comparative clinical trials of HIFU in order to define the appropriate role of this technology in the management of intermediate risk prostate cancer.

The Panel recommends that if focal therapy or HIFU is offered as an alternative treatment modality for intermediate risk prostate cancer, it should preferably be offered within the context of a clinical trial."

auanet.org/guidelines/prost...

As far as I can tell, Dr. Klotz did nothing wrong. I listened to his video presentation on Grand Rounds in Urology, and he was measured and accurate. He did not quote outdated data like the corporate website did. I would quibble that he should have said explicitly that the technique was only FDA-approved for tissue ablation (like TURP) and not for treating prostate cancer. He said that TULSA-PRO is in early days of investigation and they are still learning.

This reinforces that patients should not be duped by corporations trying to sell their therapies.