For Appointments Call : 08 8267 2200

January/February 2014

NEWSLETTER
Nicholas Brook Urology

Latest

Urology News
Welcome to the Nicholas Brook Urology newsletter January 2014.

Nick Brook Urology on Ward Street

The Ward Street practice has been open for seven months, and we would like to pass on our many thanks to patients, GPs and specialists for their support in 2013. times on their schedule. A scheduled Nurse-led telephone service, to check patients are recovering well after treatment. Employment of further administrative staff to manage the very busy backoffice and reception workload. We very much look forward to working together with you and providing a first class service in 2014. Thanks again for your support.

New Services in 2014

sponsive to patients need: Telemedicine consulting for distant/ rural/country patients. Regular out-of hours consulting on request, so that patients can see a Urologist at a time that suits them, and minimise the impact of clinic

The practice has been busy, and has expanded clinics to cope with the workload and to maintain a rapid access service for urology patients who need to be seen quickly. In 2014, we will be introducing the following services to increasingly provide a medical practice that is fully re-

High Quality Care with Rapid Access for Patients

Nicholas Brook Urology provides the range of urological investigations and management for kidney stones, prostate cancer, kidney and bladder cancer, incontinence and impotence treatment, laser surgery, vasectomy, vasectomy reversal and TURP.

Vasectomy Reversal
A vasectomy reversal is an operation to re-join the vasa (the tubes from the testes) in a man who wishes to attempt further pregnancies after a vasectomy. A small number of men who have a vasectomy want the operation reversed at some point in the future. Vasectomy reversal (vaso-vasostomy) is a surgical operation to re-join the two ends of the vas on both sides, to re-establish the passage for sperm. The procedure takes about one and a half hours, and can be done as a day case procedure. around the vasa. However, the true measure of success after vasectomy reversal is pregnancy. The longer the time since vasectomy, the lower the quality of sperm, and the lower the pregnancy rate. A major factor, irrespective of the others, is the fertility status of the mans partner.

Success Rates

The Procedure

The operation is performed under general anaesthetic, with the aid of a powerful operating microscope. A cut is made in the scrotum and the cut ends of the vasa are identified. Scar tissue is removed and the ends are joined together with very fine sutures.

The success rate is measured as patency. Patency is said to be restored if sperm reappear in the ejaculate (measured by semen analysis). Patency is dependent on a number of factors, including the length of time since vasectomy, the distance left between the ends of the vas at the time of vasectomy (a larger distance can mean a technically more difficult vasectomy reversal with lower chance of success), and the degree of scar tissue

Careful Considerations

These issues need careful consideration, and can be discussed at length with your urologist. Please note that patency and pregnancy may not be achieved after this operation, despite the best efforts of your surgeon. For more information, please contact the Nick Brook Urology Practice on 08 8267 2200.

New Locations
Nick Brook now offers patients the option of services at St. Andrews Private Hospital, 350 South Terrace, Adelaide and at Flinders Private Hospital, 1 Flinders Dr, Bedford Park, Adelaide.

mpMRI in the Diagnosis of Prostate Cancer

The diagnosis of prostate cancer is plagued by two issues. The first is the potential to overdiagnose cancer, which means that small, low-grade cancers that may never cause problems are detected, and then potentially treated (also know as overtreatment). The second problem is that some more aggressive cancers may be missed with investigation. Unfortunately, these two problems are part and parcel of all tests in medicine.

Standard Approach

The standard approach to diagnosis of prostate cancer has consisted of a PSA blood test and, if necessary, a prostate TRUS biopsy. These tests, when combined, can be effective but do lead to an element of overdiagnosis & overtreatment and occasionally more aggressive cancers can be missed. There has been a lot of interest recently in the use of MRI to help with the diagnosis of prostate cancer. The hope has been that by using MRI (known as multiparametric MRI, or mpMRI) along with PSA tests (and possibly biopsy), the chance of overdiagnosis, or of missing aggressive cancers, can be reduced. It is believed that the characteristics of

aggressive prostate tumours may be unique on multiparametric MRI. By identifying the presence or absence of these MRI characteristics, biopsy may be targeted more accurately, or even avoided. As well as identifying aggressive tumours, MRI may be useful for: Finding the location of tumours, and measuring tumour volume Staging of prostate cancer Helping to guide biopsy to increase accuracy

Experience Needed

perienced centres, and that the reporting needs to be standardised.

It is important to recognise that mpMRI is not perfect, and there is a good deal of debate about its exact role in the diagnosis of prostate cancer. It is certainly clear that it should be performed in ex-

Further Information

If you would like more information on mpMRI, please contact the Nick Brook Practice on 08 8267 2200.

Prostate Cancer Seminar on the 17th February 2014

Nick is chairing a public seminar on Prostate Cancer on the 17th February, run by the Freemasons Foundation Centre for Mens Health.

Guest Speakers

Speakers will be Dr Anthony Lowe, CEO of the Prostate Cancer Foundation of Australia (his topic is Development of National Clinical Guidelines for Prostate Cancer and the Melbourne Consensus

Statement on Prostate Cancer Testing) and A/Prof Ganesh Raj, Urology Surgeon and Researcher, University of Texas South Western Medical Centre, USA and 2014 FFCMH Visiting Lecturer (Drug development Targeting the critical driver of

prostate cancer). Further information is available on this website http://blogs.adelaide.edu.au/mens-health/2013/12/19/ public-seminar-on-prostate-cancermon-17-feb-2014-dr-anthony-lowe-andassoc-prof-ganesh-raj/ where you can also register for the seminar. This will be an excellent session, and you are encouraged to come along.

PROSTATE CANCER
Dr Addie Wootten is a Clinical Psychologist with Australian Prostate Cancer Research and The Department of Urology, Royal Melbourne Hospital. She talks about the psychological impact of prostate cancer on men, and what can be done to help.

The Role of the Clinical Psychologist

The Psychological impact of prostate cancer
terms of self-esteem, ability to maintain social connections and the experience of anxiety. Self-esteem, masculine identity and self-confidence can be significantly impacted on by the experience of prostate cancer and treatment side effects.

A prostate cancer diagnosis, like all diagnoses of cancer, can have a significant impact on psychological and emotional wellbeing. Many men speak about the shock, fear, uncertainty and anxiety they experienced when told they had prostate cancer. Many men also speak about the diagnosis as feeling like it came out of the blue as many men are diagnosed with localised prostate cancer without any symptoms of warning. Unfortunately many men experience periods of depression or anxiety following a diagnosis of prostate cancer and emerging data indicates that men with prostate cancer have a higher risk of suicide than other men their age. This indicates the significant emotional impact that prostate cancer can have on some men.

Managing these challenges

Prostate cancer can have a very personal impact

While the initial shock of a cancer diagnosis can take its toll it is often the sideeffects of prostate cancer treatment that men find the most challenging. Unfortunately all treatment options come with their share of side effects, but different treatments will have different side-effects. All treatments will have an impact on sexual and erectile functioning including changes or loss of ejaculation, changes in orgasm sensation, loss of penile length and changes to penile sensitivity but at different levels and rates depending on the treatment type. These side effects can have a significant personal impact for many men as well as a direct impact on their intimate relationships. For many men the loss of sexual functioning can be even more difficult because of remaining normal sexual desire and this can compound the significant loss and associated impact on masculinity and self-esteem. Urinary incontinence can also have a very personal impact in

We know from the research literature that one of the biggest predictors of psychological distress post prostate cancer treatment is unrealistic expectations pretreatment. That is, men who are not fully informed and counseled, pre-treatment, about the impact of treatment on their physical functioning (particularly the sexual impact) will experience much higher levels of distress post-treatment. While this isnt rocket science the delivery of adequate information and support prior to treatment in preparation for these side-effects surprisingly doesnt occur all the time. Many men report feeling ill-informed, and unsupported, in navigating life with these side effects.

Dr Addie Wootten Clinical Psychologist with Australian Prostate Cancer Research and The Department of Urology, Royal Melbourne Hospital. the focus of much of my work after treatment. A clinical psychologist will also be looking out for symptoms of anxiety and depression and other mental health concerns and will provide psychological counseling that focuses on reducing these symptoms and improving emotional wellbeing.

So what role does a psycologist play in prostate cancer?

As a clinical psychologist I have the privilege of hearing the very personal experiences of men affected by prostate cancer and their partner or spouse. My role in working with these men and couples is to explore the personal impact of their experience and help them weave a new way of living, whether that be a new way of being intimate, a new outlook on life or a new level of emotional awareness. A large part of my role is to help men and their partners explore what it might mean to experience the side effects of treatment before they have treatment. I try and speak with both members of the couple before treatment to help them plan and prepare for life after treatment and to ensure they fully understand how this might impact on them personally and as a couple. These issues are also

How to access a psychologist

Seeing a psychologist is not routine in most practices but there are many psychologists available in Australia. Ask your specialist or nurse for a referral. If they dont know of anyone in your local area, check with your GP. If you still cant find the right person there is an excellent listing of psychologists on the Australian Psychological Society website www.psychology.org.au/findapsychologist/ If you would like to read more from this article, please visit www.NickBrookUrology.com/urology-information/latest-news

DO YOU HAVE A QUESTION?

Contact us on

08 8267 2200

nick@nickbrookurology.com

CYTOREDUCTIVE NEPHRECTOMY
In Clinical Practice
David Nicol is a Consultant Urological Surgeon at the Royal Marsden Hospital in London where he is also Chief of Surgery. His clinical work deals with complex kidney and testis cancer including surgery in patients with advanced and metastatic disease. Here, he explains the use of cytoreductive nephrectomy in metastatic kidney cancer. had been observed with conventional cytotoxic chemotherapy. Analysis of these studies suggested that patients who had a nephrectomy performed prior to treatment resulted in a better response to both INF-a and IL-2. The basis for this was uncertain with possibilities including a selection bias with only fitter patients, who would otherwise expect to live longer, having nephrectomy. Alternatively it was also proposed that cytoreductive nephrectomy may exert some biological effect improving the effectiveness of immunotherapy and thus overall survival. with IFN-a. These were both randomised controlled trials - in which patients, who all received IFN-a were randomly allocated to either cytoreductive nephrectomy or no surgery. Comparing the 2 groups which were of equal size revealed that patients undergoing cytoreductive nephrectomy had a median survival of 14 months compared to 8 months without. These studies also reinforced the lack of benefit in patients with poor performance status.

Which patients with metastatic kidney cancer are suitable for cytoreductive nephrectomy?

This is obviously difficult surgery. Are complication rates much higher compared to other forms of kidney cancer surgery?

Professor David Nicol, Consultant Urological Surgeon at the Royal Marsden Hospital, London

David, can you explain what is meant by cytoreductive nephrectomy?

Cytoreductive nephrectomy refers to the removal of the primary kidney tumour in patients who have metastatic disease. Historically it had been noted that occasional patients experienced spontaneous regression of metastatic disease when this was performed. This however only occurred in a very small number of cases and general opinion was that cytoreductive nephrectomy as the overwhelming majority died within 12-18 months from metastatic disease. In the late 1980s and early 1990s, drugs which stimulated the immune system(immunotherapy) had an effect on metastatic kidney cancer. Small trials with 2 agents interferonalpha (IFN-a) and interleukin-2 (IL-2) showed response rates better than what

Cytoreductive nephrectomy is really only an appropriate option for patients who are otherwise well. Patients whose performance status is impaired are at high risk of complications from major surgery and also generally have poor survival that is not improved with cytoreductive nephrectomy. Therefore patients who have noted significant weight loss, are anemic or who feel tired and generally unwell are not considered candidates for cytoreductive nephrectomy. Some patients may present with significant symptoms including pain and bleeding for which nephrectomy is recommended. This is regarded as a palliative intervention to control symptoms rather than a cytoreductive nephrectomy which is performed with the expectation that it may improve survival.

Patients with metastatic kidney cancer usually have quite large primary tumours with a rich blood supply being a common feature. Both of these factors can make surgery very difficult and associated with a higher risk of complications, particularly major bleeding, compared to other forms of kidney cancer surgery. Most patients with kidney cancer have relatively small tumours and are able to have surgery performed either laparoscopically or robotically with low risk of complications. In contrast cytoreductive nephrectomy, in almost all cases, requires major open surgery as minimally invasive procedures are usually neither feasible nor safe. Patients with metastatic cancer are also generally at higher risk of complications with major surgery. Deep venous thrombosis and pulmonary embolism are 2 specific examples of this.

Can you outline the evidence that cytoreductive nephrectomy can be beneficial in some patients?
There are 2 trials one performed in Europe and another in the United States that have demonstrated a survival benefit with cytoreductive nephrectomy in patients who are subsequently treated

Further Information

If you would like to read more from the Cytoreductive Nephrectomy in Clinical Practice article by Professor David Nicol, please visit the Nick Brook Urology website at www.NickBrookUrology.com/ urology-information/latest-news

Meet the Staff

Jane Favretto Practice Administrator
Jane has been working in administration since 1987. In more recent years worked as a Special Events and Community Relations Co-ordinator for the Royal Adelaide Hospital Research Fund the fundraising arm for the RAH and Hanson Institute. She has broad experience in administration and fundraising management and brings to the practice her skills and knowledge in providing a professional, friendly and comfortable setting for patients and their families.

Matt Carlaw Practice Finance Consultant

Matt has been working as an Accountant in Adelaide since 1997. He has a bachelor of Economics, a Graduate Diploma in Accounting and has been a member of the Institute of Chartered Accountants in Australia since 1999. From 1997 to 2011 he worked in a number of medium sized accounting practices providing business and taxation advice to a wide range of small and medium sized businesses. Since 2011 he has been working and consulting as a Management Accountant to a small number of Adelaide businesses. He likes to keep things simple and organized.

Stuart Perryman - Communication Consultant

Stuart is a web designer, online marketer and back-end web developer with over twelve years of professional experience in the web development and online marketing industry. As the owner of Web Designers Adelaide, a locally based web design and development company, Stuart specialises in creating websites that build company profiles, utilising a range of online marketing strategies. Stuart has extensive experience in server-side and client-side programming, search engine optimisation and search engine marketing. Stuart is a keen advocate for mobile web design and web accessibility.

Support Groups and Urological Information

Cancer Australia - http://canceraustralia.gov.au Kidney Cancer Australia - http://kidneycancer.org.au Prostate Cancer Foundation of Australia (PCFA) - http://www.prostate.org.au The Continence Foundation of Australia - http://www.continence.org.au Andrology Australia - https://www.andrologyaustralia.org Australian Prostate Cancer Research (3D videos) - http://vimeo.com/album/2184688 Macmillan Cancer Information (UK) - http://www.macmillan.org.uk 1800 624 973 1800 454 363 1800 220 099 1800 330 066 1300 303 878

ONLINE RESOURCE

NickBrookUrology.com
Since the practice opened in June 2013, the website has been central to providing information for patients and GPs. Stuart Perryman, our Digital Communication Consultant, has helped keep the website fresh and current.

New Online Articles

We have regularly been adding content to the various sections of the site, and it has developed into an exciting and dynamic resource. We have had regular Guest Articles from internationally renowned urologists on many topics, and we would encourage you to read these if you havent yet. They can be found at http://www.nickbrookurology.com/urology-information/latest-news

Since it was launched, it has had 16,932 visitors, and 38,011 page views, from 90 countries.

Social Media

Social media traffic has been increasing and has contributed to 1,654 visits since June 2013. Please do follow us on twitter and like us on Facebook to stay in touch with developments.

FIND US
175 Ward Street, North Adelaide, Adelaide, SA 5006

CALL US
P. 08 8267 2200 F. 08 8267 5664

EMAIL US
nick@nickbrookurology.com

OUR LOCATION

Nick Brook Urology 175 Ward Street, North Adelaide, Adelaide, SA 5006

Telephone: 08 8267 2200 Fax: 08 8267 5664

Email: nick@nickbrookurology.com Twitter: nickbrookMD Website: www.nickbrookurology.com

Disclaimer: This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients, and this document cannot be considered to contain all information on urology conditions. Not all potential treatment complications are listed, and you must talk to your urologist about the complications and implications specific to your situation. Newsletter Design by WebDesignersAdelaide.com Copyright 2014 Nick Brook Urology