29
November
2014

Nick Brook Urology Moving to New Location

Nick Brook Urology Moving to New Location

The North Adelaide practice has grown rapidly, and we are moving the rooms to a new location. We will be moving on the 16th December, and will be sending details through the post to all our patients.


Where are we moving to?

The new address for the the practice is Calvary North Adelaide Hospital (Ground Floor), 89 Strangways Terrace, North Adelaide SA 5006. The new telephone number is 08 8267 1424

The email address and website will stay the same; email: This email address is being protected from spambots. You need JavaScript enabled to view it., website www.nickbrookurology.com


Why are we moving?

The practice has grown significantly and the new location at Calvary North Adelaide Hospital has more space to allow for staff expansion, but importantly will offer many benefits for patients:

  • Located in a major private hospital
  • Easy ground floor access for patients, with 2 hour parking
  • Direct access for patients to radiology and pathology - located on the same corridor
  • On-site access for patients to Continence Nurse expertise
  • Immediate booking of procedures from clinic
  • In-patients have access to our office facilities and support

When are we moving?

16th December 2014. If you have an appointment prior to this date, then please come to the old 175 Ward Street address. After the 16th December, all consulting will be at Calvary North Adelaide Hospital. We are on the ground floor. Just ask at reception, and they will point you to the new rooms.


What if I need further information?

We are writing to all our patients and their GPs to let them know about the move, with all the details of the new location. If you have any questions, Jane or Heather will be pleased to help. Before 16th December, call them on 8267 2200, after that date, call them on 82671424. We apologise for any inconvenience, and we are confident that you will find the new location is able to meet your expectations as a customer of the practice.


Categories: Updates

30
November
2014

Enzalutamide available on the PBS

Enzalutamide available on the PBS

From 1 December 2014, a new drug for advanced prostate cancer will be available and listed on the PBS. Enzalutamide is an oral drug used for advanced prostate cancer (metastatic castration resistant prostate cancer). It works by inhibiting binding of androgens (such as testosterone) to the androgen receptor (AR), as well as inhibiting the AR from entering the cell nucleus and from binding to DNA. It has had encouraging results in clinical trials.


What are the PBS criteria for enzalutamide?

The treatment cannot be used in combination with chemotherapy (docetaxel in the common chemotherapy agent used in advanced prostate cancer)

AND

The patient must have failed treatment with docetaxel due to resistance (this generally means progression of disease or non-response to docetaxel) or intolerance

OR

The patient must be unsuitable for docetaxel treatment on the basis of predicted intolerance to docetaxel

AND

Patient must have a World Health Organisation Performance Status of 2 or less (this means good performance)

AND

The patient must not receive PBS-subsidised treatment with this drug if progressive disease develops while on this drug

AND

The patient must not have received prior treatment with abiraterone

OR

Patient must have developed intolerance to abiraterone of a severity necessitating permanent withdrawal of abiraterone.

Categories: Updates, Prostate Cancer

30
November
2014

Abiraterone PBS listing changed from 1st December 2014

Abiraterone PBS listing changed from 1st December 2014

From December 2014 , the PBS criteria for abiraterone acetate changed, meaning that patients deemed unsuitable for chemotherapy with doxetaxel can be prescribed PBS-subsidised abiraterone.


What is abiraterone?

Abiraterone is an oral drug for metastatic prostate cancer that is castration resistant (meaning the cancer that is no longer sensitive to other forms of testosterone suppression). It works by inhibiting an enzyme involved in the production of androgens (testosterone is one of the body’s androgens).


What are the new amended PBS criteria?

Treatment must be in combination with a steroid (prednisolone)

Treatment can’t be given in combination with chemotherapy

Patients must have failed treatment with docetaxel because of resistance or intolerance, or be considered unsuitable for docetaxel chemotherapy because of proven or predicted intolerance to the chemotherapy.

Patients must have a good performance status (WHO status of 2 or less)

If progressive disease develops whilst on abiraterone, PBS-subsidised treatment with abiraterone cannot continue.

Patients cannot have previously received treatment with enzalutamide, or they must have developed intolerance to enzalutamide, which was bad enough to require that enzalutamide was stopped.

Categories: Updates, Prostate Cancer

28
November
2014

Should I have a PSA test?

Should I have a PSA test?

This short article may help you with the decision about having a PSA test (also known as PSA screening) to look for prostate cancer

Australia has one of the highest rates of prostate cancer in the developed world. The PSA test is the first investigation that can be done to look for prostate cancer. It is not a perfect test, and there are problems associated with the test, which is why you should be as well informad as possible about PSA.

Information for Patients Considering Prostate Cancer Screening

Background

  • Prostate cancer is common. Most men will develop prostate cancer if they live long enough. Despite this, only about 3% of all men will die of prostate cancer.

  • This indicates that most prostate cancers do not cause trouble in a man’s lifetime (‘low-risk’ or ‘indolent’ cancers). However, there are some more aggressive cancers that can cause trouble, and these benefit from detection and treatment.

  • Screening studies do show that the number of prostate cancer deaths can be reduced by screening with PSA. However, quite a large number of men need to be diagnosed by screening and treated to prevent one prostate cancer death.

  • One study (the Goteborg study) showed that 12 men need to be diagnosed to prevent one prostate cancer death. That means that 11 men were unnecessarily diagnosed. Another larger study demonstrated that (ERSPC) that 781 men need to be screened and 27 men need to be diagnosed to prevent one prostate cancer death. Thus 26 men are unnecessarily diagnosed.

  • Screening will detect many of these indolent cancers, and if they are detected, they may go on to be treated, perhaps unnecessarily.

  • Treatment is associated with long term complications in men, such as incontinence, erectile dysfunction (impotence) and bowel problems. Therefore, some men (indolent cancers that are treated) may have unnecessary treatment and suffer side effects.

The aim of screening

  • The aim of screening should be to identify aggressive or high-risk prostate cancers early, before they have spread beyond the prostate.

  • Some men are at higher risk of aggressive prostate cancer than others. These are men with a family history of prostate cancer, or with a strong family history of breast or ovarian cancer in females of the family, men of African-American decent, and men who have been exposed to some environmental agents (fire-fighters possibly, and veterans exposed to Agent Orange).

  • Most prostate cancers found by screening are low risk and do not need to be treated, and can just be closely followed by active surveillance (click for link to AS).

  • If you choose to be screened, there is a reasonable chance you will be diagnosed with low-risk prostate cancer, and may be in a position where you have to consider treatment that may be unnecessary.

Your decision to be screened – what sort of person are you?

  • If you have risk factors for prostate cancer (see above), your risk of prostate cancer may be higher than the general population, and this may impact your decision to be screened.

  • If you are the sort of person who would be uncomfortable not being treated if low risk prostate cancer was discovered, screening may not be the right decision for you.

  • If you are the sort of person who would accept treatment for aggressive prostate cancer, but would be happy to observe (active surveillance) things if you just had low risk prostate cancer, then you may be a good candidate for screening.

Categories: Updates, Prostate Cancer

28
May
2014

Video TeleHealth for Distant Patients

Video TeleHealth for Distant Patients

Video consultation is now available at Nick Brook Urology, to reduce the need for long distance travel for rural and country patients in South Australia. This service offers a real time consultation over a video link from your GP’s practice, so you can talk directly with a Urologist.


How does it work?


If your GP has made a new referral and has requested a video consult (‘video telehealth’), this will be sent to Nick Brook, who will review the referral and see if it is suitable for a video consultation. If so, the staff at Nick Brook Urology will contact you and your GP and a time will be arranged for you to attend your GP practice for the video consultation. One of the staff from your GP practice will be with you during the consultation to help you. You do not need to do anything special – all of the organisation will be taken care of, and all you need to do is talk with Mr Brook, as per a normal consult.

Any investigations, such as blood tests or X-rays, can be arranged easily, and will be faxed to the GP practice so you can have them done near to your home. Follow up appointments can be arranged by video as well.

Are all consults suitable for video telehealth?


You need to live in an area that is deemed appropriate for telehealth by the Government. In South Australia, this means you need to live outside of the central area coloured in red in the map below:

Map outlining Adelaide metro area

What happens if I need a physical examination by the Specialist?


Because examination cannot be done at the time of video consults, it may be that your consult may not be suitable for telehealth. You may still need to travel so that this examination can be done. Likewise, some specialised investigations may need to be done in person. However, an initial discussion by video can reduce the need for multiple visits, even if you do have to come to Adelaide for a face-to-face consult at some point.

Is the video recorded?


No, there is no video recording made. However, medical notes are made as with a standard face-to-face consultation.

How do I request a video consultation?


Ask your general practitioner if they have the facilities available for a video telehealth consultation. You can also contact Nick Brook Urology to help arrange this.

Can I have a family member or friend in the room for the consultation?


Yes you can. It is helpful if you let your GP know about this prior to the consultation.

Is your privacy respected?


Just as in a standard face-to-face consultation, your privacy is absolutely respected. The only people involved in the consultation are you, Mr Brook, and one of the staff members from your GP practice. Contact will be made before and after the consultation by practice staff, to arrange investigations and follow-up. Your medical records are recorded and stored in exactly the same way as if you had a standard consultation, on our secure electronic record system.

Generally, a program called Facetime is used, and this is an encrypted system. Facetime is streamed via Secure Real Time Protocol (SRTP) using AES-256 encryption. Likewise, WiFi and wired systems at the practice are encrypted. Both of these encryptions work separately so it would be very difficult indeed for these systems to intercepted by a third party.

A video telehealth consultation has been suggested, but I do not want one. What do I do?


You are absolutely free to decline a video consultation and have a face-to-face consultation instead. Please let your GP and Specialist know about this, and this will be arranged for you.

Categories: Updates

29
April
2014

Stereotactic Ablative Body Radiotherapy (SABR)

Stereotactic Ablative Body Radiotherapy (SABR)

Our First Guest Blog for May 2014 is by Dr Shankar Siva, a Radiation Oncologist from The Peter MacCallum Cancer Centre in Melbourne. He discusses the new technique of Sterotactic Ablative Body Radiotherapy for kidney cancer in patients who are not medically fit for surgery. This new approach is still in a study period, but may offer cancer control to patients who do not have other treatment options.


Shankar, can you explain what Stereotactic Ablative Body Radiotherapy (SABR) is, and what advantages it has over other forms of radiotherapy?


Stereotactic ablative body radiotherapy (SABR) is a high precision radiotherapy technique that involves between 1 and 5 treatments. This is very different from conventional radiotherapy that involves daily radiotherapy for up to 8 weeks. It is non-invasive, painless, delivered without any need for anaesthetic, and conveniently does not require in-patient hospitalisation. SABR requires high-tech radiotherapy equipment for safe delivery, such as motion management for the tumour, accurate image guidance, and robust immobilisation. When delivered correctly, SABR can achieve submillimetre accuracy. Because of its precision, the SABR technique allows for much higher biological doses than can be safely delivered using conventional radiotherapy techniques. As such, most studies in sites such as the brain, lung and spine report cancer control rates in the order of 90% or greater after SABR.


Sterotactic radiotherapy for some other types of tumour has been around for some time. Why has it only recently been looked at for kidney tumours?


Stereotactic radiotherapy was first devised for brain tumours by Swedish neurosurgeon Lars Leksell in 1951, who termed it “radiosurgery”, so yes, it has been around for a very long time! Cranial "radiosurgery" was performed by using a rigid frame around the skull which allowed for accurate delivery of the radiation dose. However, tumours in other organs such as the lung, liver, and kidney are all highly mobile due to normal breathing or from the pumping of the heart. Only recently have technological advances allowed us to account for and manage tumour motion during radiotherapy delivery. The kidney in particular is a challenging organ, as it is quite mobile and surrounded by many sensitive organs.


Which group of patients is likely to be suitable for this treatment for kidney tumours?


Surgery is still the standard of care for patients with kidney cancer. However, kidney cancer is typically a disease of the older population, with the average age of diagnosis being 65 years of age. Some patients have other medical conditions which make invasive procedures potentially risky, particularly those patients who may have significant pre-existing kidney dysfunction, are risky anaesthetic candidates, or have heart disease and are reliant on blood thinners. In light of this risk, other procedures such as SABR and radiofrequency or microwave ablation have emerged as treatment alternatives for inoperable patients. In contrast to SABR, the disadvantage of radiofrequency ablation and microwave ablation is that those techniques can typically treat only treat smaller tumours, require the insertion of electrodes through the skin into the kidney (invasive), and are not as effective when tumours are close to blood vessels. On the other hand, the disadvantage of SABR is that it is typically restricted to patients who have not previously received radiotherapy to the upper abdomen. Otherwise, we expect that most patients who are not suitable for surgery on medical grounds may be eligible for treatment using the SABR technique.


What are the potential side effects?


In the early period after treatment, we expect that most patients feel tired. There may be some nausea, or loose bowel actions. Some patients may experience some reflux or heartburn. We typically prescribe preventative medications to help with these side effects. There may be a mild skin reaction, similar to a very light sunburn, particularly around the back. These side effects usually resolve within the first 2-3 weeks, and we expect all of these side effects to be resolved by around 6 weeks post treatment. The longer term effects of SABR in the kidney are less well understood. There is a potential for decline in kidney function, rise in blood pressure, scarring or narrowing of the bowel, or very rarely ulceration of the bowel or stomach. To date, studies have shown that the risk of severe side effects to be less than 5%.


This treatment is currently part of a study at the Peter Mac. What do you think the future holds for this treatment for kidney tumours?


We have pioneered this technique in Australia through the FASTRACK clinical trial, one of the few clinical trials using SABR for localised kidney cancer in the world. This study is expected to be complete later in 2014, and to date the results have been very promising. We would like to make this treatment accessible to all patients in Australia. However, the problem is that technology is very complex and varies from centre to centre. The Peter Mac is one of the largest radiation oncology institutions in the southern hemisphere and an Australian leader in the SABR technique, so we are not certain whether our results can be immediately reproduced in other institutions across Australia.

The next phase in our research program is to lead a multicentre study of SABR for kidney cancer involving multiple cancer centres across Australia. All the treatment plans will be centrally reviewed by our team at the Peter Mac for quality assurance, in order for this new treatment to be safely introduced across Australia. If this study is successful, I imagine that stereotactic radiotherapy will become a readily available treatment alternative for inoperable patients with primary kidney cancer.


Click this link to display a news item and video on the SABR technique.


Dr Siva is a Radiation Oncologist, Research Staff Specialist and NHMRC Scholar at the Peter MacCallum Cancer Centre in Melbourne. His major research interests are in high-tech radiation delivery and radiation biology. He is the lead clinician of the stereotactic body radiotherapy program at the Peter MacCallum Cancer Centre, and coordinates the first dedicated Stereotactic Ablative Body Radiotherapy (SABR) clinic in Australia. He published the first original research using the SABR technique in Australia. He serves on the Radiation Oncology Research Committee (RORC) of the Royal Australian and New Zealand College of Radiologists, on the renal subcommittee of the Australian and New Zealand Urogenital and Prostate (ANZUP) trials group, and as the radiation oncologist on the Management Advisory Committee (MAC) of the Australasian Lung Cancer Trials Group (ALTG). He is the principal investigator of multiple radiotherapy clinical trials of SABR in the context of lung, kidney and prostate malignancies.

Follow this link for more information on Dr. Shankar Siva


Categories: Video, Updates, Kidney Cancer

Affiliations

Urology Affiliations

Latest Tweets

Contact Us

  • Nick Brook Urology
    Calvary North Adelaide Hospital
    89 Strangways Tce,
    North Adelaide,
    Adelaide SA 5006
  • 08 8267 1424
  • 08 8267 1370