Why Doctors Recommend Treatment When It Is Not Necessary | Laurence Klotz, MD


The next speaker was our piano player… Dr. Klotz. And Dr. Klotz, is there anything else you
want to add in terms of what he said? Well he, yes. The grey zone. I don’t know
if you remember, he mentioned that, you know, there were a number of questions in here about,
you know, “Why are doctors still doing this when there’s better information?” And I think
his answer, the grey zone, is the best answer I’ve heard. That the doctors don’t want to
exploit people to their disadvantage, but there’s always a section between treatment
and no treatment where people aren’t too sure what to do called the grey zone and in that
grey zone the people that do treatment for a living are going to default to treatment
in the grey zone. And in prostate, we have a fairly big grey zone between people that
don’t need treatment and those that clearly do need treatment. And so I thought that was
a nice illustration to not just paint a bad brush that all these doctors are evil and
trying to hurt people, but that there—that the people that are doing things that we wouldn’t
agree with can justifiably say this is a grey zone. You have your opinion, I have my opinion,
and there’s definitely truth to that. So it’s where the patient should be making the decision
and not be influenced by the physician. The patients need to be aware of these grey zones
so that they know that their physician is going to tilt one way based on what they do. So my concluding slides, “the grey zone.”
Those of you who are familiar with this field may know that there’s a lot of provider preference
in how patients get treated. You know, you see the radiation oncologist, the urologist—the
surgeon, and so on. Really, it’s a huge problem in the field—man with a hammer, everything’s
a nail. So my view is, the problem is the grey zone because I think very few physicians
want to make a living doing the wrong thing, but if they have treatment options. If there’s
a grey zone, their personal interests, the fact they are surgeons will influence them
to offer surgery and so on. This is kind of human nature. So we’ve had a huge gray zone
in this area until recently, but now I think we’ve moved and it’s been part of my mandate.
Make it black and white. Grade group one, Gleason 6, particularly, you know,
smaller volume. This is no longer in the grey zone. No one should be treating these patients,
it’s black and white. Now the grey zone is the intermediate-risk patients. Partial gland
ablation definitely in the grey zone. I happen to be a firm believer in the role of partial-gland
ablation for these favorable intermediate-risk patients. They have, in most cases, indolent
disease. It’s innocuous therapy, it just makes sense. And then you have the high-grade patients,
we still are going to be treating them with surgery and radiation. Those are effective
therapies for patients with aggressive disease. They need it, it’s life-saving. Still, some
overlap both with the mainly with the focal, with the partial gland ablation story. But
the whole point is kind of reduce the grey zone as much as possible so that provider
preference can’t play so much of a role.