Recognising Dr Adam Landau for his contribution to rural communities
Outstanding Contribution by a Rural Medical Specialist Congratulations to Dr Adam Landau, who is a finalist in the Victorian Rural Health Awards, which recognises the outstanding contributions made by health professionals working in rural communities. This nomination recognises Dr Landau’s ongoing commitment to providing exceptional care to the Bairnsdale community.
Introducing our new Urologist, Dr Briony Norris
Dr Briony Norris MBBS, BMedSci, FRACS (Urol) Urological Surgeon Dr Norris treats all aspects of general urology such as managing conditions like elevated PSA, haematuria, kidney and ureteric stones, enlarged prostates, voiding dysfunction and cancer of the prostate, bladder, testes and kidney. She specialises in minimally invasive surgery and laser for kidney stones, and in laparoscopic and robotic surgery for both benign and malignant kidney conditions. Dr Norris consults at Malvern, Box Hill, North Melbourne, and Ballarat. Urgent appointments are available.
Sexual Function. What you need to know
What causes erectile dysfunction? Erectile dysfunction (ED) is a prevalent issue among men over 40. ED can understandably impact your self-perception and overall quality of life. Addressing erectile dysfunction is a deeply personal journey. At AUA, we endeavour to understand your unique goals, while upholding professional and confidential conduct to provide you with privacy. Whether you aim to achieve erections suitable for sexual activity, maintain penile health and length, satisfy yourself, or boost your self-esteem, we have the expertise to support you throughout your journey of penile rehabilitation and sexual recovery. Furthermore, if you have a partner, their involvement is invaluable, and we encourage you to include them in your appointments if you wish. Sexual function following radical prostatectomy for prostate cancer After prostate cancer surgery, ED can occur due to the proximity of the erectile nerves to the sides of the prostate. As such, these nerves can often be damaged with prostate cancer treatments – both surgery and radiotherapy. Even with nerve-sparing surgery, nerve function may take several months and up to two years to fully recover. Recovery varies among individuals and depends on factors such as age, baseline sexual function, other medical conditions, and surgical considerations. There are several interventions available for post-prostatectomy ED, and we’ll work with you to establish your specific goals and create a tailored treatment plan. For many men, the goal is to regain erections suitable for sexual activity, while others, who may not be sexually active, aim to preserve penile length and optimize penile health. Early penile rehabilitation, including pharmacological (tablets and injections) or the use of a vacuum device, is crucial to prevent adverse structural changes like penile fibrosis and loss of length and girth. Research suggests that a penile rehabilitation program can prevent permanent damage and improve the chances of restoring normal erectile function. We strive to provide you with a fully supportive and collaborative environment to help manage any anxiety related to ED and performance issues, as high anxiety levels can further hinder the ability to achieve and sustain erections. Erectile dysfunction treatment Treatment options for ED range from non-pharmacological interventions like vacuum devices to tablet medications, injectable medications, or penile prostheses. Intracavernosal injections (ICI) involve injecting medication into the penile spongy tissue, producing a rigid erection within minutes. ICI is not dependent on functioning nerves, making it more reliable in achieving an adequate erection, but is dependent on having healthy blood vessels to the area. It’s an excellent choice for men experiencing side effects with tablet medications, or for those where the tablets are not effective, and is particularly helpful in the first few months after surgery whilst the nerves are slowly recovering. It is very common to experience some apprehension of self-injecting, and this will be addressed during the education process in our clinic, providing you with the confidence to continue with the treatment when you’re at home. Penile injections are an option whether you are sexually active or not, as many patients opt for them to maintain self-esteem, self-satisfaction, or restore bodily function. For men with post-prostatectomy ED, this treatment option is often preferred as it doesn’t depend on functional nerves like tablet medications. Therefore, it’s especially beneficial in the early weeks to months post-surgery during nerve recovery or in the case of a non-nerve sparing surgery. Our sexual function program at AUA ensures patients receive comprehensive education on medication preparation and safe self-injection. You’ll be supported throughout the process of incorporating penile injections into your life, with a point of contact for troubleshooting. Surgical options An alternative approach to addressing ED is with a penile prostheses. This is a surgically implanted device placed into the corpora cavernosa, connected to a fluid reservoir and activation button in the scrotum. It’s a viable option for men who have not responded to less invasive treatments. Penile prostheses are considered a last-line treatment option, as other options become ineffective once the prosthesis is implanted. However once implanted, satisfaction rates are extremely high in this motivated group of patients. Our Sexual Function Clinic at AUA is run by our Nurse Practitioner, Mr Adam Cuthbertson-Chin, who works in collaboration with our Urologists and possesses extensive knowledge and expertise in assisting men with erectile dysfunction. For further information, please contact our rooms on (03) 8506 3600.
Incontinence affects a quarter of us
Dr Karen McKertich has featured in an ABC News article detailing the impacts on lives that incontinence leaves in its wake. That’s a lot of lives. Did you know? 25% of Australians over 15 years of age (that’s 5 million of us) suffer incontinence, a condition defined as the inability to control the flow of urine. Incontinence encompasses lack of both bladder and bowel control with urine leakage commonly occurring from activities that put pressure on the bladder, such as sneezing, heavy lifting or exercise. It also includes other tangents, such as the inability to empty the bladder completely. When understanding incontinence, it’s easy to realise its impact “Many people suffering from incontinence find that their life is severely restricted by the condition,” confirms Dr Karen McKertich. Incontinence can be humiliating and stressful, and sadly cause sufferers to alter their daily lives or completely avoid situations — work and social events being primary examples. Then there’s the list of health impacts that come with incontinence. These include rashes and infections, urinary tract problems and even kidney failure. Luckily, there’s plenty of help available—for those who want it In 2021, the Continence Foundation of Australia found that a huge 78% of people with the condition were not discussing incontinence with their family or GP. “Often the biggest barriers to people seeking help are the sense of shame about the problem…” Dr McKertich explains. Find the full ABC News story here. If you or someone you know is struggling with or suffering from incontinence, get in touch with our team. There are many effective treatments available.
Blood in urine? Get it checked
Professor Mark Frydenberg AM, talks about the importance of seeing your GP and urologist if you notice blood in your urine. I’m Mark Frydenberg, one of the urologists at Australian Urology Associates and I wanted to talk to you about a condition called haematuria which is blood in the urine. This is in fact an extremely common urinary symptom and is something that is often not associated with serious pathology. Indeed, the most common cause of blood in the urine in both men and women is not serious in that the most common cause in the male is simply a burst blood vessel from their prostate gland and usually the most common cause in a female is from an infection. Having said that the reason that it’s very important this is investigated is that in a small five to ten percent of patients it can be due to something more serious, and this means a malignancy or a cancer in the kidney or a cancer in the bladder and these absolutely need to be excluded even if there’s only one single episode of bleeding in the urine. As such, bleeding in the urine should never be ignored and should always be presented to your general practitioner, who should refer you on to urologists such as ourselves. Typically, you will be ordered to have some sort of imaging to look at your kidneys and this would either be in the form of a CT scan or alternatively a urinary tract ultrasound and this is specific specifically done in order to try and rule out a kidney tumour. In addition to that, you will often have a urine test called the urine cytology as well as a urine culture to rule out an infection. The urine cytology is looking for malignant cells in the urine, so we want to try and determine whether there’s any of these present, which would obviously raise the possibility of a malignancy within the urinary tract. The last thing that would be recommended is a cystoscopy, which is a very simple telescopic examination of the bladder which is often done under local anaesthesia and can even be done in our offices. The purpose of this is to make sure that we’re not missing a polyp or growth within the bladder that could potentially be malignant and cause harm. If there are any questions about this, please don’t hesitate to ask the urologist at Australian Urology Associates, and thanks very much for your attention. https://youtu.be/sRVGWqByNOs Having said that the reason that it’s very important this is investigated is that in a small five to ten percent of patients it can be due to something more serious, and this means a malignancy or a cancer in the kidney or a cancer in the bladder and these absolutely need to be excluded even if there’s only one single episode of bleeding in the urine. As such, bleeding in the urine should never be ignored and should always be presented to your general practitioner, who should refer you on to urologists such as ourselves. Typically, you will be ordered to have some sort of imaging to look at your kidneys and this would either be in the form of a CT scan or alternatively a urinary tract ultrasound and this is specific specifically done in order to try and rule out a kidney tumour. In addition to that, you will often have a urine test called the urine cytology as well as a urine culture to rule out an infection. The urine cytology is looking for malignant cells in the urine, so we want to try and determine whether there’s any of these present, which would obviously raise the possibility of a malignancy within the urinary tract. The last thing that would be recommended is a cystoscopy, which is a very simple telescopic examination of the bladder which is often done under local anaesthesia and can even be done in our offices. The purpose of this is to make sure that we’re not missing a polyp or growth within the bladder that could potentially be malignant and cause harm. If there are any questions about this, please don’t hesitate to ask the urologist at Australian Urology Associates, and thanks very much for your attention.
Active Surveillance of Prostate Cancer
Professor Mark Frydenberg AM, talks about active surveillance for prostate cancer and its preference to radiation or surgery for low-grade prostate cancer. https://youtu.be/FqbRGeKbTOQ Video Transcript I’m Mark Frydenberg, one of the urologists at Australian Urology Associates, and I wanted to talk to you today briefly about active surveillance for prostate cancer. In some of our other videos in our series we would have discussed PSA based screening, what PSA is and also the Gleason grading of prostate cancer. [Follow our YouTube Channel] As you would have heard in those videos, if you’re diagnosed with a relatively small low-grade prostate cancer namely a Gleason-6 tumour or Gleason-grade group one tumour, often the likelihood of that cancer growing and spreading is actually very low. Its growth rate is likely to be measured in years, sometimes decades, and in many cases the cancer may not ever cause death of the patient. As such, rushing in to do treatments, such as radiation or surgery, that do carry some potential side effects may in fact be unnecessary and close surveillance is indicated. Now, this is an active process; this isn’t a set and forget where we just tap you on the back and say everything is fine, you do need to be monitored very carefully. This would mean having your PSA blood test done approximately three-monthly. At the end of the first year, you would need to have a repeat MRI scan, and you may in fact be advised even to have a repeat biopsy to be absolutely certain that the cancer was not progressing or growing or becoming more aggressive. Once confirmed at the one-year mark that the cancer was not becoming any more aggressive or larger, then it’s generally safer to continue on surveillance for longer periods of time, and although you’ll continue to do the blood test every three months, it is more likely that there will be greater intervals in between the MRIs and potentially repeat biopsies; and as long as your PSA remains stable, and your examinations are also normal, we can be confident that you would only need to have an MRI perhaps every three years to make sure that the cancer was not progressing. All of the urologists here at Australian Urology Associates have many patients that have successfully been on surveillance for sometimes 15, 20 years and greater, so it’s important to be very comfortable and reassured that this is a very safe way of dealing with low-risk prostate cancer. In fact, most published series have shown that the death rate of prostate cancer after 10 years on active surveillance is only in the order of one percent. As such, this is very safe, as long as you’re compliant and follow your urologist’s instructions to make sure that you do, do your blood test regularly and to follow using their instructions with regards to having repeat MRI scans and biopsies when it’s indicated. Thanks very much for your attention.
Prostate Cancer Gleason Score
Professor Mark Frydenberg AM discusses the Gleason score for prostate cancer grading and what a Gleason Score of 6, 7 and 8 signifies in terms of prostate cancer and its treatment.https://youtu.be/FuwkyvdCCo4 Video Transcript I’m Mark Frydenberg, one of the urologists at Australian Urology Associates, and I wanted to discuss with you Gleason grading of prostate cancer. Once a patient has been thought to have a level of suspicion of prostate cancer and has undergone a prostatic biopsy, the pathologist will have a look down the microscope at the tissues that he’s examining and will describe a Gleason score or Gleason grade if a cancer is detected. What this signifies is the level of aggression of the underlying malignancy, which often plays a very big role in the decision-making regarding the treatments. With a Gleason score, the three common scores are a six, a seven or an eight. If you have a Gleason score of six, it’s considered an extremely low aggression cancer and in many of these circumstances no treatment will be recommended, but close surveillance will be recommended instead. A Gleason 7 tumour is considered intermediate risk and a Gleason 8 or above is considered a high-risk prostate cancer which is aggressive. With the Gleason 7 tumours what they try and do is give us some idea about whether that seven is closer to a six, or whether it’s closer to an eight, and that is why we see the description, a Gleason three plus four equals seven which is the one that’s closer to a six, or four plus three equals seven, which is closer to an eight. Again, a three plus four equals seven will still often require treatment, but in some cases may be suitable for surveillance, whilst it would be very unlikely for a Gleason four plus three or seven or above, to be offered surveillance and in those circumstances active treatment is likely due to the risk of the cancer spreading and potentially causing harm to you in the future.
Should men be screened for Prostate Cancer with a PSA Test
Professor Mark Frydenberg AM discusses the suitability of PSA-based screening for men in the detection of prostate cancer. Video Transcript I’m Mark Frydenberg, one of the urologists at Australian Urology Associates, and I wanted to discuss with you PSA-based screening for prostate cancer. In another video in our series, I’ve described what the PSA protein is and some of the possible causes of why a PSA may be elevated. It’s become a very controversial topic over the last 20 to 30 years as to whether PSA-based testing, namely, having a blood test done every one or two years, is a worthwhile thing to assist in the early detection of prostate cancer and to potentially reduce the likelihood of dying of prostate cancer. It is important to note, that the current National Health and Medical Research Council guidelines do, in fact, recommend prostate cancer testing from age 50 every two years, or earlier if you’ve got a family history. The reason for this is that there’s a very large European study that quite definitely shows around a 20 to 30 percent decreased risk of death from prostate cancer with PSA-based testing. This is very important, however it’s equally important to identify that this is not equal across all men of all ages. If we have a man that is unlikely to survive seven to ten years, in fact there is very little benefit for PSA-based testing, but for all other men, irrespective of age, if they do have an extended life expectancy, then PSA based testing is worthwhile to discuss with your general practitioner or with your urologist. Learn more about prostate cancer.
PSA Prostate Cancer Test Explained
Professor Mark Frydenberg AM discusses the PSA blood test used to detect prostate cancer. Video Transcript My name is Professor Mark Frydenberg, and I am one of the urologists at Australian Urology Associates. I wanted to briefly discuss with you today a very common topic in urology, namely the PSA blood test, otherwise known as prostate-specific antigen test. This is a very common blood test ordered by general practitioners and urologists as a screening tool for early prostate cancer. It’s been well recognised for at least 30 years that an elevated PSA blood test does signify prostate cancer in a proportion of men, and it does lead to the early diagnosis of prostate cancer, and therefore earlier treatment. It is however important not to be alarmed if you do have an elevated PSA, because there are other non-cancerous causes that could also cause the PSA to be elevated. Such causes could be just an enlarged benign prostate, or simple things like a urinary infection, or even some activity such as bicycle riding, or if you do a blood test soon after an ejaculation. All of these things can cause a temporary rise in the PSA and as a result of that it’s important to simply repeat the PSA in the first instance to ensure that it is a consistent, elevated reading. If the PSA is elevated, however, your general practitioner is likely to refer you to urologists such as myself and my colleagues at Australian Urology Associates for investigation. Again, this is nothing to be alarmed about, as in many cases it is not related to prostate cancer. Generally what will happen is that the urologist will examine you to determine if there’s any abnormal finding within the prostate or an abnormal area of firmness or hardness within the gland, and we’ll often send you for an x-ray called the Multiparametric MRI of your prostate. This is a very simple scan, it is non-invasive, it takes about 30 to 45 minutes to complete and will often give very good information about the likelihood of cancer being present. When you have an MRI performed they will give it a risk score called a PI-RADS score and the PI-RADS score goes from two to five, with a score of two signifying essentially a normal prostate with a very low likelihood of cancer being present up to five where there’s a very high risk of cancer being present. Depending on where you fall on that risk scale, your urologist may recommend a biopsy to further investigate it. Learn more about prostate cancer.
Now consulting at Cabrini Specialist Centre, Hawthorn East
Mr Adam Landau has commenced consulting at the new Cabrini Specialist Centre at 141 Camberwell Road, Hawthorn East. Mr Landau is a Urological Surgeon with special interests in male voiding, stone disease, robotic surgery for prostate cancer, and radiological imaging of urological conditions. He consults at Malvern and Hawthorn East and operates at Cabrini and Epworth hospitals. Book an appointment online with Mr Adam Landau: BOOK NOW – Hawthorn East BOOK NOW – Malvern
