Editor’s Note There are no coincidences

Laurence Klotz is one of my favorite people to chat with about clinical cancer research. LK tells it like it is and reminds me of Dr Maurice Mandelbaum, my undergraduate philosophy professor at Johns Hopkins (the “U” of college lacrosse). Both of these teachers seem more like storytellers than lecturers.

My most recent conversation with Dr Klotz is on the enclosed issue of this audio series, and even before we sat down for the interview, I was totally engaged by a new tale Laurie began telling me, this time about his father.

Laurie’s dad is a urologist, and both father and son are dedicated and passionate surgeons who love to chat about tough cases in the same way others ruminate over football. At family gatherings, Laurie’s mom often jokingly tells them to “stop talking shop over dinner.”

In 1989, the two discussed a much more urgent case — that of the elder Dr Klotz — who at the age of 64 was diagnosed with a Gleason 7 prostate cancer by Laurie’s partner. Laurie reflected on his father’s choice to receive external beam irradiation: “As a urologist, my dad had a lot of anxiety about having a radical prostatectomy, especially at that point, which was still early in the RP era.”

More problematic, however, was the emergence two years later of a new vertebral hot spot on bone scan that was thought to be a metastatic lesion. Laurie wisely functioned as a son throughout this experience and left the direct medical care to his partner. A decision was made to utilize an LHRH agonist and an antiandrogen as maximal androgen blockade, which resulted in an undetectable PSA but also bothersome vasomotor symptoms and diminished physical and mental acumen. What really got Laurie’s attention, however, was a hip fracture, believed to be secondary to the osteoporotic effects of androgen deprivation.

Coincidentally (if you believe in coincidences), Laurie had taken a leadership role in clinical prostate cancer research evaluating the potential role of intermittent androgen deprivation. His father had “poo-pooed” (sorry if this is not a real word) the concept but quickly changed his mind while recuperating from the fracture.

It is now 15 years later, and Laurie’s dad has been through several cycles of intermittent total androgen blockade. He currently experiences no symptoms from the disease, still sees patients in an outpatient setting (he no longer performs surgery), plays golf and enjoys his life.

Laurie acknowledges that intermittent androgen deprivation therapy uncommonly produces such a result in metastatic disease, and trials of this fascinating chronic disease management strategy may eventually result in slightly less effective tumor control than continuous treatment.

However, after observing the impact of androgen deprivation in his father, Laurie has come to believe that many patients may prefer intermittent therapy because of the quality-of-life benefits. Our ability to complete this critical research in an expeditious manner is clearly of enormous importance to prostate cancer patients and loved ones.

— Neil Love, MD
NLove@ResearchToPractice.net

Select publications

Albrecht W et al. Intermittent maximal androgen blockade in patients with metastatic prostate cancer: An EORTC feasibility study. Eur Urol 2003;44(5):505-11. Abstract

De Leval J et al. Intermittent versus continuous total androgen blockade in the treatment of patients with advanced hormone-naïve prostate cancer: Results of a prospective randomized multicenter trial. Clin Prostate Cancer 2002;1(3):163-71. Abstract

Dutkiewicz S. Pilot attempt of advanced prostate cancer treatment T3NxMx-1 by intermittent more complete androgen blockade. Int Urol Nephrol 2004;36(3):359-62. Abstract

Gleave M et al. Intermittent androgen suppression for prostate cancer: Rationale and clinical experience. Prostate Cancer Prostatic Dis 1998;1(6):289-96. Abstract

Higano C et al. Bone mineral density in patients with prostate cancer without bone metastases treated with intermittent androgen suppression. Urology 2004;64(6):1182-6. Abstract

Klotz L et al. The relationship between the androgen receptor CAG repeat polymorphism length and the response to intermittent androgen suppression therapy for advanced prostate cancer. Prostate Cancer Prostatic Dis 2005;8(2):179-83. Abstract

Lane TM et al. Long-term outcomes in patients with prostate cancer managed with intermittent androgen suppression. Urol Int 2004;73(2):117-22. Abstract

Pether M et al. Intermittent androgen suppression in prostate cancer: An update of the Vancouver experience. Can J Urol 2003;10(2):1809-14. Abstract

Peyromaure M et al. Intermittent androgen deprivation for biologic recurrence after radical prostatectomy: Long-term experience. Urology 2005;65(4):724-9. Abstract

Prapotnich D et al. A 10-year clinical experience with intermittent hormonal therapy for prostate cancer. Eur Urol 2003;43(3):233-9. Abstract

Rashid MH, Chaudhary UB. Intermittent androgen deprivation therapy for prostate cancer. Oncologist 2004;9(3):295-301. Abstract

Sato N et al; Chiba Prostate Study Group. Intermittent androgen suppression for locally advanced and metastatic prostate cancer: Preliminary report of a prospective multicenter study. Urology 2004;64(2):341-5. Abstract

Yamanaka H et al. Effectiveness of adjuvant intermittent endocrine therapy following neoadjuvant endocrine therapy and external beam radiation therapy in men with locally advanced prostate cancer. Prostate 2005;63(1):56-64. Abstract