<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40"><head><meta http-equiv=Content-Type content="text/html; charset=us-ascii"><meta name=Generator content="Microsoft Word 12 (filtered medium)"><style><!--
/* Font Definitions */
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0cm;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri","sans-serif";}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:purple;
text-decoration:underline;}
p
{mso-style-priority:99;
margin:0cm;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman","serif";}
p.MsoAcetate, li.MsoAcetate, div.MsoAcetate
{mso-style-priority:99;
mso-style-link:"Balloon Text Char";
margin:0cm;
margin-bottom:.0001pt;
font-size:8.0pt;
font-family:"Tahoma","sans-serif";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-priority:99;
mso-style-link:"Balloon Text";
font-family:"Tahoma","sans-serif";}
p.msonormal0, li.msonormal0, div.msonormal0
{mso-style-name:msonormal;
mso-style-priority:99;
margin:0cm;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman","serif";}
span.EmailStyle21
{mso-style-type:personal;
font-family:"Calibri","sans-serif";
color:windowtext;}
span.EmailStyle22
{mso-style-type:personal;
font-family:"Calibri","sans-serif";
color:#1F497D;}
span.EmailStyle23
{mso-style-type:personal;
font-family:"Calibri","sans-serif";
color:#1F497D;}
span.EmailStyle24
{mso-style-type:personal;
font-family:"Calibri","sans-serif";
color:#1F497D;}
span.EmailStyle25
{mso-style-type:personal-reply;
font-family:"Calibri","sans-serif";
color:#1F497D;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page WordSection1
{size:612.0pt 792.0pt;
margin:72.0pt 72.0pt 72.0pt 72.0pt;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]--></head><body lang=EN-CA link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='color:#1F497D'>Hi</span><span style='color:#1F497D'> all</span><span style='color:#1F497D'>:<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Please see below for the reply to my e-mail on robotic assisted prostate surgery which I had sent to the Health Minister as well as my MPP for Guelph.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>I will hold any reply in abeyance until I receive feedback from members of the various PCCN chapters with which I had shared the original e-mail.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Take care,<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Glen<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm 0cm 0cm'><p class=MsoNormal><b><span lang=EN-US style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span lang=EN-US style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Liz Sandals, MPP (Constituency Office) [<a href="mailto:lsandals.mpp.co@liberal.ola.org">mailto:lsandals.mpp.co@liberal.ola.org</a>] <br><b>Sent:</b> September 20, 2017 12:07 PM<br><b>To:</b> 'Glen Tolhurst'<br><b>Subject:</b> RE: ROBOTIC ASSISTED PROSTATE SURGERY with ATTACHMENT<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='color:#1F497D'>Dear Glen :<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Thank you for sending me a copy of the email which you sent to Minister Hoskins. I am sure that he will also respond to your email but I did want to send you some information which I received from staff at the Ministry of Health and Long Term Care.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Health Quality Ontario’s (HQO) Ontario Health Technology Advisory Committee (OHTAC) thoroughly reviewed the evidence on robot-assisted radical prostatectomies and found that although they are associated with some improved short-term procedural outcomes (eg reduced length of stay and blood loss) this did not translate to improved patient-important outcomes – HQO found that robot-assisted prostatectomies do not produce any improvements in pain, in health-related quality of life, in return to work or activity, in hospital readmission rates, or in urinary and erectile function compared to the usual, effective and safe, open surgical procedure.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>HQO also found that robot-assisted procedures cost over $6000 more per procedure than a prostatectomy done through the usual method, so the use of surgical robots is currently coming at a prohibitively high cost for little documented patient benefit.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>The Ministry agrees with OHTAC’s assessment that the use of robotic systems in prostatectomies should not receive a special, higher payment than use of the regular surgical approach.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>However, the Ministry is aware of the potential for robotic procedures to come down in cost over time and for benefits to increase with further advances in this technology. The Ministry remains open to adjusting its funding policies when new evidence emerges on this topic.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>In the interim, the Ministry acknowledges the concerns of hospitals about the need to train future Ontario surgeons on the use of cutting edge surgical technologies and is therefore working with the chairs of Ontario’s surgical training programs to understand potential ways the Ministry can further support innovation in this critical area of healthcare.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Cancer Care Ontario’s (CCO) Position Statement on Prostate Cancer Screening using the Prostate-Specific Antigen (PSA) Test on randomized controlled trials of prostate cancer screening using the PSA test have shown a small reduction in prostate cancer mortality; however, harms associated with screening are common. Given the potential harms of screening for PSA, including over-diagnosis and over-treatment, CCO does not support an organized, population-based screening program for prostate cancer. <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>In October 2014, the Canadian Task Force on Preventative Health Care (CTFPHC) released an updated guideline on screening for prostate cancer using the prostate specific antigen (PSA) test. Based on the balance between the possible benefits and potential harms of early diagnosis and treatment of prostate cancer, the CTFPHC recommends not screening for prostate cancer with the PSA test. Guideline development is based on a systematic review of available literature, a broad consultation process and scientific evidence synthesis.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Men who are concerned about their risk of prostate cancer should talk to their primary care provider. Individual decisions to screen should be made as part of a shared decision-making process involving a discussion between a man and his primary care provider.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>CCO continues to monitor emerging evidence on prostate cancer screening.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>I am pleased to hear that you are a PCa survivor. <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Sincerely,<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Liz<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span lang=EN-US style='color:#1F497D'>Office of Hon. Liz Sandals, MPP - Guelph<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='color:#1F497D'>173 Woolwich St., Suite 102<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='color:#1F497D'>Guelph, ON N1H 3V4<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='color:#1F497D'>T: 519-836-4190<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='color:#1F497D'>F: 519-836-4191<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0cm 0cm 0cm'><p class=MsoNormal><b><span lang=EN-US>From:</span></b><span lang=EN-US> Glen Tolhurst [<a href="mailto:glen46nor@gmail.com">mailto:glen46nor@gmail.com</a>] <br><b>Sent:</b> August 28, 2017 2:27 PM <br><b>Cc:</b> Sandals, Liz MPP CO <<a href="mailto:lsandals.mpp.co@liberal.ola.org">lsandals.mpp.co@liberal.ola.org</a>><br><b>To:</b> Hoskins, Eric MPP <<a href="mailto:ehoskins.mpp@liberal.ola.org">ehoskins.mpp@liberal.ola.org</a>>; Sandals, Liz MPP <<a href="mailto:lsandals.mpp@liberal.ola.org">lsandals.mpp@liberal.ola.org</a>><br><b>Subject:</b> ROBOTIC ASSISTED PROSTATE SURGERY with ATTACHMENT<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm 0cm 0cm'><p class=MsoNormal><b><span lang=EN-US style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span lang=EN-US style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Glen Tolhurst [<a href="mailto:Glen46Nor@gmail.com">mailto:Glen46Nor@gmail.com</a>] <br><b>Sent:</b> August 28, 2017 2:15 PM<br><b>To:</b> 'ehoskins.mpp@liberal.ola.org'; 'lsandals.mpp@liberal.ola.org'<br><b>Cc:</b> 'lsandals.mpp.co@liberal.ola.org'<br><b>Subject:</b> ROBOTIC ASSISTED PROSTATE SURGERY<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Hon. Eric Hoskins & Hon. Liz Sandals:<o:p></o:p></p><p class=MsoNormal>The recent recommendation by the Ontario Health Technology Advisory Committee (OHTAC) against public funding of robotic prostate cancer surgery is simply short sighted and appalling.<o:p></o:p></p><p class=MsoNormal>As Chair of the Prostate Cancer Canada Network Waterloo- Wellington (PCCN W-W) chapter, as well as being a member of 2 other Prostate Cancer Support Groups (PCSG), I have met and interacted with a number of men diagnosed with Prostate Cancer (PCa). These men cover the range from newly diagnosed, through those treated by various modalities (surgery- robotic, open radical, radiation therapy external beam –EBRT & Brachytherapy LDR & HDR, hormone therapy, chemotherapy, High Intensity Focused Ultrasound-HIFU) to active surveillance. Amongst those PCSG members are the advanced cancer “warriors” some of whom are metastatic. In fact PCCN W-W lost a member to PCa metastasis in June of 2016 and currently has several members with metastatic PCa. <o:p></o:p></p><p class=MsoNormal>Before either of you drag out the costs of robotic assisted prostate surgery, be aware of the incremental costs of $3224/case of the procedure. For 2015, there were 2400 radical prostatectomy surgeries in Ontario of which 34% (or 814) were robotic assisted for a total cost of $3224 x 814 = $2,624,336. As the President of the Treasury Board, (Hon Liz Sandals) should surmise, this is miniscule in the scope of Ontario government spending. Minister Hoskins, as a doctor, should be aware of the Quality of Life positive impact of robotic assisted surgery as well as resultant cost savings of shorter hospital stays and less blood loss. Furthermore as a doctor he should recognize that robotic surgery decreases the impact of bending over a patient during the procedure and thus aids in back stress reduction of the surgeon. <o:p></o:p></p><p class=MsoNormal>Additionally, it is incomprehensible why Ontario remains the only province where men are charged to have a PSA test, unless they are diagnosed with PCa or are a direct relative of a PCa patient, dead or alive. Early detection saves lives. In the Region of Waterloo Wellington, 8 men die from PCa every month.<o:p></o:p></p><p class=MsoNormal>The next time you & your fellow MPPs gather in the legislature resplendent in prostate cancer ties, neck scarves, & lapel pins perhaps the above communication will really mean something to you.<o:p></o:p></p><p class=MsoNormal>You should then act to eliminate the de-funding of robotic surgery and provide coverage for PSA testing.<o:p></o:p></p><p class=MsoNormal>Should you need further information, I attach the article by Dr. Neil Fleshner that appeared in the Globe & Mail 28 Aug 17 explaining “Why we need robots in our operating rooms”.<o:p></o:p></p><p class=MsoNormal>BTW - I am a PCa survivor due to having paid for establishing a baseline PSA level, being timely diagnosed with early stage PCa, and being treated at the Princess Margaret Cancer Centre, which is 1 of the top 5 cancer research centres in the world.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>I trust you will not only provide a thoughtful reply but take the action outlined above.<o:p></o:p></p><p class=MsoNormal>Remember, 2018 is a provincial election year.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Thank you,<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Glen<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:blue'>Glen N. Tolhurst P.Eng. MBA</span></b><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:blue'>Chair PCCN Waterloo- Wellington</span></b><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'>web site: </span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><a href="http://pccn-waterloo-wellington.ca/" id=LPlnk825412><span style='font-size:14.0pt;font-family:"Arial","sans-serif"'>http://pccn-waterloo-wellington.ca/</span></a></span><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'> </span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'>e-mail: </span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><a href="mailto:info@pccn-waterloo-wellington.ca"><span style='font-size:14.0pt;font-family:"Arial","sans-serif"'>info@pccn-waterloo-wellington.ca</span></a></span><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'> </span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'>answering service 226-240-9264</span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'>Direct contact via:</span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'>Tel (519) 826-0716 </span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'>Cell (519) 994-4536</span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p><p><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:black'>e-mail: </span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><a href="mailto:Glen46Nor@gmail.com"><span style='font-size:14.0pt;font-family:"Arial","sans-serif"'>Glen46Nor@gmail.com</span></a><o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>