Prostate services

The San has a multidisciplinary approach to cancer care, bringing together skilled doctors, diagnosticians, specialist nurses and allied health professionals to collaboratively develop personal treatment and care plans to enable better outcomes for every individual patient.

Patient cases are referred to our multidisciplinary team (MDT) meetings where the team review all test results and discuss treatment options, taking into account the personal preferences of the patient. The surgeon then takes those recommendations back to the patient, who ultimately decides the course of treatment they wish to take.

Our multi-disciplinary team includes Surgeons, Medical Oncologists, Radiologists, Pathologists, Radiation Oncologists, Social Workers, Physiotherapists, Palliative Care Specialists, Nurses, Case Managers, and Cancer Support professionals.

 

Facing a prostate disease diagnosis can be quite a challenge physically, mentally and emotionally. At the San we are committed to making things easier for patients, their families and carers at every stage of their journey, and we are dedicated to delivering our exceptional and unique care to people living with cancer.

Your first step will be referral to one of our specialists. If you wish to find a San Specialist please see our Find a Specialist database.

As well as specialist doctors and expert diagnosticians we also provide specialist staff and services available to assist you before, during and after your admission and treatment. These specialists work specifically with prostate patients and they understand the range of physical and emotional issues you may face.

• Our Prostate Cancer Case Manager meets with patients on referral to our Pre-Admission Clinic (PAC) and walks through the admission process and all available and appropriate services.
• Specialist nursing staff including Clinical Nurse Specialists and Clinical Nurse Consultants work in our Operating Theatres and on the wards, and have specific experience, qualifications and expertise and are equipped to ensure you receive best possible care.
• Physiotherapy & Allied Health staff including Continence Physiotherapists.
• A Clinical Trials Unit continually running and recruiting for a range of prostate cancer clinical trials.
• An extensive and comprehensive cancer support service is available at the San for anyone impacted by cancer, not just our patients.
• The San's Emergency Care Unit is the largest and busiest private emergency facility in NSW and is available 24 hours / 7 days for any unforeseen circumstances.
• Other services available on site include pharmacy, social workers and a range of allied health professionals to help meet our patients’ needs

World class radiology equipment for prostate cancer diagnosis

San Radiology offers the new gold standard for prostate diagnosis and management with two new 3T mpMRI machines. Our prostate MRI radiologists and radiographers have been trained by Prof Jelle Barentz who is one of Europe’s leading Prostate MRI experts lecturing internationally on prostate cancer diagnosis.

A 3T mpMRI allows the specialist to see where the possible cancer is and direct the biopsy needle directly to that area. MRI provides accurate targeting for biopsy under either MRI or with fusion technology using ultrasound, and in comparison to a traditional ultrasound-guided biopsy, allows the specialist to see the needle going directly into the area that looks abnormal. This allows less biopsies – as little as two instead of 12 - and means a reduction in discomfort, bleeding and the risk of infection.

This targeted imaging guided biopsy has not been possible to date. mpMRI is a relatively new technique and this area of diagnosis and downstream guided biopsy and intervention options is developing at a fast pace. Like any imaging and intervention technique mpMRI quality is dependent on the quality of the equipment, the staff using the equipment and the training and experience of the radiologist interpreting the test. The latest MRI techniques provide a new pathway for prostate cancer diagnosis and intervention. Multi-parametric MRI (mpMRI) can now provide anatomical information about the location and size of the tumour and its likely aggressiveness.

Key technology 

• Multi-parametric 3T MRI (mpMRI)
• MRI in-bore guided biopsy

Gallium 68 PSMA PET scans (Nuclear Medicine)

Gallium 68 PSMA (prostate-specific membrane antigen) PET Scans are important in managing patients who have had prostate cancer in the early detection of recurrent disease to allow timely and appropriate therapy. Recently available Gallium 68 PSMA PET scans are able to detect prostate cancer relapses and metastases even at low PSA levels, and therefore help guide the most appropriate treatment for individual patients.

Urodynamics / Flow Studies

Urodynamics and flow studies are specific tests designed to obtain accurate information about bladder function, and help diagnose bladder and prostate problems. A low flow rate and incomplete emptying of the bladder often indicate a blockage, usually related to an enlarged prostate, and the need for further treatment. A flow study can also be used after treatment to check for improvement or monitor if blockages have recurred.

TRUS (Trans-rectal ultrasound) Biopsy

This technique allows surgeons to visualise the entire prostate gland with ultrasound waves. It provides information about the actual size of the prostate gland and indicating whether or not there are suspicious areas. Most importantly, the ultrasound is able to assist in focusing biopsies more accurately on areas that may be suspicious for cancer.

Transperineal Biopsy

An alternative to the TRUS biopsy, a transperineal biopsy of the prostate is carried out through the skin between the scrotum and rectum, while imaging is obtained by an ultrasound probe passed into the rectum. The transperineal biopsy may be performed if the traditional TRUS biopsy has not idenitified the cause of an elevated PSA, and is sometimes a preferred option for men resistant to antibiotics or potentially carrying resistant bacteria, due to a much lower risk of infection.

Pathology

San Pathology (operated by Douglas Hanley Moir) has various collection centres, including one in the San Integrated Cancer Centre, as well as a very comprehensive laboratory located on site. Histopathologists are key members of the multidisciplinary team - they identify tumour types, size and staging to facilitate the best treatment

Surgical Treatment for Prostate Cancer

SAH offers patients a range of surgical options. The best option for you should be determined in discussion with your surgeon.

Robotic Surgery
Our state-of-the-art da Vinci Surgical Robot is the next evolutionary step forward from Laparoscopic Surgery. The Robot enables surgeons to perform traditional open procedures such as radical prostatectomy through a minimally invasive route. Surgeons operate through just a few small incisions, with magnified 3D high-definition vision and tiny wristed instruments that translate surgeons hand movements into smaller, precise movements of tiny instruments. As a result, da Vinci enables surgeons to operate with enhanced vision, precision and control allowing surgical precision and meticulous preservation of important nerves and blood vessels.

Open Radical Prostatectomy
The traditional method of radical prostatectomy is a surgical procedure through which the prostate gland is removed through an incision in the abdomen. The aim is to remove as much of the tumour as possible, therefore the entire prostate gland, both seminal vesicles, pelvic lymph nodes as well as surrounding tissue affected by the tumour can be removed.

Radiotherapy

Radiation therapy is the use of high energy x-rays to eliminate or reduce cancer cells. Modern radiation therapy techniques focus on accurately and precisely targeting the cancer while sparing the healthy tissue and organs around the cancer as much as possible.

Icon Wahroonga has 4 bunkers with cutting edge technology – making it NSW's largest private radiotherapy treatment centre and providing patients with access to the most advanced radiation treatment in Australia.

The TomoTherapy Edge equipment provides treatment in just a few short minutes, greatly minimises side effects and can treat multiple tumours simultaneously. TomoTherapy technology allows the retreatment of patients who otherwise could not have further radiation treatment on standard equipment. It is highly accurate for prostate cancer treatment as a CT image is taken prior to every treatment which allows for much greater precision.

Icon Wahroonga is also home to two Varian Silhouette machines providing Stereotactic (focussed radiation beams to target specific areas with extreme accuracy so that other tissues are not impacted), Volumatic Modulated Arc Therapy (VMAT) which increases speed of treatment and delivers the treatment helically across many beam angles. Intensity Modulated Radiation Therapy (IMRT) allows for a more conformal dose to the tumour by modulating or controlling the intensity of the radiation beam in multiple small volumes.

Brachytherapy
Icon Wahroonga provides High Dose and Low Dose Brachytherapy for prostate patients with a dedicated brachytherapy bunker. 

Low Dose Rate (LDR) / 'Seed' Implant Brachytherapy involves the insertion of permanent radioactive 'seeds' directly into the prostate. The 'seeds' give off a localised radiation to the entire prostate with the aim of destroying the cancer cells, and the radiation is limited to the prostate and only a few millimetres around it. LDR brachytherapy is generally a treatment for men with localised prostate cancer.

High Dose Rate (HDR) Brachytherapy provides a very precise high dose radiation treatment, given over a shorter time-frame than when a course of external beam radiation therapy (EBRT) is used alone. It reduces the exposure of surrounding tissues to radiation. HDR treatment involves having a procedure to place implant catheters into the prostate gland through the perineum. Radiation is then transmitted through these implant catheters directly into the prostate gland. Unlike LDR brachytherapy, the placement of the material is temporary and for shorter periods.

Medical Treatment for Prostate Cancer

Hormone Replacement Therapy
Hormone therapy is used to suppress the progression of prostate disease, and in the treatment of cancers that have spread beyond the prostate. Hormone therapy aims to limit the cancers access to hormones that stimulate growth, such as testosterone, and therefore reduce the growth of, or shrink, the tumour. Patients receiving hormone therapy may experience a reduction in their symptoms and possibly in the size of their tumour that may last for a number of years. Reducing the size of the tumour is also used when planning radiation therapy or for surgical removal.

Chemotherapy
Your doctor may recommend medication (which can be oral or intravenous) to attack cancer cells. Some cancers can be cured by chemotherapy alone or chemotherapy can be used before or after other treatments and for palliative treatment.

Comprehensive day infusion services are provided for various chronic illnesses at our Day Infusion Centre. Located in the San Integrated Cancer Centre this new centre is spacious and restful, overlooking the Healing Garden. Specialist nursing teams care for day infusion patients in luxurious comfort with the most up-to-date equipment and treatments.

Clinical Trials
Clinical Trials can offer suitable patients access to the most up-to-date treatments which aren’t currently publicly available. Working with oncologists and MDTs, patients are referred to a clinical trial where appropriate. The San Clinical Trials Unit has many trials currently underway and in recruitment, and works with leading specialists and academics to remain at the forefront of research and treatment options.

Other Treatments for Prostate Cancer

Active Surveillance
During active surveillance a doctor monitors the tumour and its growth on a strict schedule. At each visit tests are done to check PSA (prostate-specific antigen) levels in the blood, and patients switch to other treatment options if there are signs that the disease is progressing. Active surveillance is a treatment pathway for patients with localised, low-grade prostate cancer.

Watchful Waiting
Watchful waiting is a way of monitoring prostate cancer that isn't causing any symptoms or problems. The aim is to keep an eye on the cancer over the long term, and avoid treatment unless patients get symptoms.  

Orchidectomy
Orchidectomy (or Orchiectomy) is method of surgical castration in which both testicles are removed. It is a form of hormone therapy to stop the production of testosterone.

Treatment for Enlarged Prostate (Benign Prostate Hyperplasia / BPH)

Rezum System
Rezum is a new minimally invasive treatment that relieves lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). It uses the natural thermal energy stored in water vapour, or steam, to treat the enlarged prostate tissue that causes BPH symptoms such as frequency, urgency, irregular flow, weak stream, straining and getting up at night to urinate. The water vapour is delivered into the targeted prostate tissue and when the water vapour contacts the tissue it condenses, releasing the stored thermal energy, causing the obstructive prostate tissue cells to die. The body's natural healing response then eliminates the treated tissue, shrinking the prostate. With the extra tissue removed, the urethra opens, reducing BPH symptoms and improving the patient's quality of life. Symptom relief may not be immediate but over weeks there is a gradual improvement and by three months, significant symptoms relief will be experienced.

GreenLight Laser
GreenLight Laser Prostatectomy allows the vaporisation of tissue and simultaneously seals the tissue resulting in an almost bloodless procedure with advantages including a significant reduction in the likelihood of bleeding, a significant reduction in catheterisation times, hospital stay and complication rates.

Bipolar Transurethral Resection (TURP)
TURP is a common procedure for surgical management of lower urinary tract symptoms associated with BPH. The Gyrus PlasmaKinetic system uses bipolar technology and saline solution, and has been seen to significantly reduce complications seen with the traditional monopolar system, such as bleeding and TUR syndrome. It allows patients with serious medical conditions and comorbidities, and those on certain medications such as blood-thinners to undergo the TURP procedure with fewer complications.

However, the traditional Monopolar TURP is still performed if it is deemed by surgeons to be the best treatment option for patients.

UroLift
UroLift is a new minimally invasive treatment for men suffering urinary symptoms related to BPH. The UroLift system involves the insertion of small permanent implants that create a passage in the middle of an obstructed prostate, resulting in a significant improvement in urinary function. The benefits appear to be significantly stronger than medical therapies whilst potentially avoiding some of the complications associated with surgery, bleeding, retrograde ejaculation or erectile dysfunction.

Support when you need it
Whether you need very little or a lot of support, we believe it’s comforting to know that you can access all the support services you may need from the San at any stage of your diagnosis or treatment. 

The San Cancer Support Centre in Jacaranda Lodge provides a very broad range of support for anyone in the community who is affected by cancer, not just our patients.  Linked to the San Integrated Cancer Centre by a lovely healing garden, the Centre provides educational material, lectures and information sessions, personal and family counselling, support groups and a variety of complementary therapies like reflexology and massage.  Classes such as writing therapy and life drawing are held on a regular basis at the Centre, and the comfortable home-like environment is a lovely haven for reading or resting. 

Supported by the San Foundation, a new digital scrapbooking initiative called ‘It’s About Us’ has been introduced for cancer patients, allowing them to build a personalised memoir with thoughts, reflections and photographs.  

Our prostate support groups meet regularly and are affiliated with the Prostate Cancer Foundation of Australia. 

Jacaranda Lodge offers low cost ‘home-away-from-home’ style accommodation for longer distance patients or their families who are undergoing treatment. 

Learn more about our Cancer Support services

Spiritual Care services are also available to all patients who would like a visit from one of our Chaplains or a member of their own faith.

Research is a vital element in pursuing constant improvement and clinical quality and one of the strengths of the San. Sydney Adventist Hospital is committed to providing an environment which nurtures research opportunities for our clinicians. Many of our prostate specialists are heavily involved in published research as well as teaching appointments, and the learning environment they create has a positive flow-on effect for all those involved in prostate services at the San.

San Clinical Trials Unit
The San Clinical Trials Unit is made up of a team of Medical Oncologists, Clinical Trial Coordinators, Clinical Trial Pharmacists and experienced Oncology Nurses, and offers participation in multi-centre, national and international clinical trials.

The main aim of the unit is to provide all Oncology patients treated at Sydney Adventist Hospital the best possible treatment outcomes by offering the opportunity to participate in the most current treatment options available in the field of medical oncology.

Trial Management is performed by a collaborative group of Doctors, Nurses, Pharmacy, Pathology and Radiology staff and is coordinated by experienced Clinical Trial Coordinators. Treatments are either delivered in the Poon Day Infusion Centre or as outpatient treatments.

See our current clinical trials

AHCL Research Office
The Research Office delivers support services for researchers from early career onward with functions spanning human ethics and research governance applications, policy and reporting. We provide guidance on the design of projects, the most appropriate research approval pathways, internal funding and award applications, and assist our researchers in a very approachable way to get their research ideas off the ground.

Learn more about the AHCL Research Office

Research Outputs

View a list of research outputs from the research outputs from the San Prostate Centre of Excellence in its first two years of operation.

Download the Research Outputs report

We know that even after you’ve finished your treatment, you may still need our help.

San Emergency Care
The San Emergency Care department is NSW’s largest private emergency unit and is available to you 24 x 7 should you have any medical issues after you’ve returned home.

Cancer Support services
Our Cancer Support Centre offers comprehensive education, counselling and support services for patients and their families. We have very active prostate support groups who can share information, or if you would like someone to talk to who has been through prostate treatment themselves.

Palliative Care
Should you need any additional help with pain management, our Palliative Care specialists can help provide relief from pain and other distressing symptoms. Palliative care means providing active medical care that reduces or camouflages the unpleasant effects of cancer. For some however, the only symptom is a progressive and relentless fatigue, and care is focused on providing practical, psychological, emotional and spiritual support to patients and their carers.

Outpatient Urology Clinic
Patients may be referred by their doctor to the Outpatient Urology Clinic after they leave hospital. Specialist nurses at the clinic treat the following:

• Dilatations (assist Doctors)
• Supra Pubic Catheter (SPC) changes
• Indwelling Catheter (IDC) changes
• Flow studies
• Removal of IDC and Trial of Void
• Teaching Self Catheterisation
• The San also runs a Stomal Therapy clinic and a clinic for drain care management post operation.

Patients will be given contact details for the clinic with referral information from their doctor if appropriate.

Managing side effects
The precision of new radiation technology and surgical treatments have lessened the risk of complications, however there can still be short and long-term side effects. Our multidisciplinary team will work with you to optimise your post-treatment recovery and help manage any treatment-related difficulties you may experience.

The path of the radiation beams can damage healthy tissue, and side effects can include incontinence, erectile dysfunction, bowel problems and fatigue. In some cases, radiation is delivered in combination with hormonal therapy, which can cause impotence. Both medical and surgical options are available to help reduce some of these longer-term side effects, such as a synthetic male sling or artificial urinary sphincter for incontinence and penile implant surgery or rehabilitation for erectile dysfunction.

San Physiotherapy
Rehabilitation and exercises can help in some circumstances, and our experienced Continence Physiotherapists provide individualised education and exercise programs to meet the specific needs of men preparing for, and recovering from, surgery. This program is often best started before surgery, when the Pelvic Floor Muscles required for bladder control are more easily identified with normal sensation. This gives men time to master control of these muscles before surgery, and allows more confident contraction after surgery when this sensation is reduced. The program also provides education on activity modification and allows men time to plan how physical activities may be modified during their post-operative recovery to reduce strain.

During the initial recovery from surgery, the Pelvic Floor Muscles are the only voluntary support for bladder control, and our post-operative physiotherapy sessions are individually tailored based on each man’s need. The progression of exercise and physical activity in order to regain normal functional bladder control, and the usual physical activities of work, fitness and leisure, is essential during the recovery time whether this takes weeks or months – every man is different.

San Physiotherapy aims to support each man to confidently approach surgery and help speed recovery and regain greater muscle control and strength when returning to normal function.