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Welcome to the Macarthur Urology Website. We are a practice of four urologists who service both public and private patients of Southwest Sydney and the Southern Highlands.

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At Macarthur Urology, we aim to provide the best possible patient care with the most up to date techniques including Robotic and Laparoscopic Surgery.

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We provide management of all urological conditions including urological cancer surgery, urinary stone surgery, management of urinary dysfunction.

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PSA AND PROSTATE CANCER

Prostate cancer is the most common cancer in men affecting approximately 1 in 6 Australian men.� It accounts for the death of approximately 3% of all Australian men.  Its frequency increases as men age, but it may be present in men as young as 35 years old.  It is typically diagnosed prior to it causing symptoms, however, in some men it is only discovered in an advanced stage when it has spread to the bone and other organs.  In many cases, if prostate cancer is diagnosed early it I amenable to curative treatment.

    Diagnosis of prostate cancer is a process that begins with a blood test (PSA) and an examination (Digital rectal examination)

  • 1. PSA (Prostate Specific Antigen). This is the most commonly used blood test that urologists and GPs use to assess a patient’s risk of harboring prostate cancer. Whilst it is the best test that we have, it has three main deficiencies: it is not reproducible (that is it varies with repeat measurements from day to day); it is not specific (that is your PSA may be raised by things other than prostate cancer such as a urinary tract infection, non-cancerous enlargement of the prostate or recent ejaculation); and it is not sensitive (that is you may have prostate cancer even though your PSA is within the normal range). To increase the reliability of PSA we use other parameters such as: free to total ratio of PSA (if <10 this is suggestive of cancer); and PSA velocity (change in PSA over time). Despite some limitations, PSA is a useful test that helps your urologist determine whether you require more invasive investigations to look for prostate cancer.

  • 2. DRE (Digital Rectal Examination). This involves your urologist or GP using a finger in your back passage to feel the prostate. A cancerous prostate feels different to a non-cancerous prostate due to features such as hardness and irregularity. Like PSA it is not diagnostic, but rather gives us an idea of which patients need to progress on to further investigations to look for prostate cancer.

  • 3. Prostate Biopsy. This is the most accurate way of detecting prostate cancer as it provides us with samples of your prostate which are assessed by a Pathologist under a microscope. If there is cancer present on your biopsy, the Pathologist will determine how prevalent the cancer is and how aggressive the cancer is.

  • 4. Imaging. Unlike most cancers, prostate cancer is not readily detectable on non-invasive imaging such as ultrasound or CT. MRI is becoming more useful to us, but as yet is not accurate enough to replace prostate biopsy in the diagnosis of prostate cancer.

    Treatment of Prostate Cancer:

    The treatment of prostate cancer is determined by 2 main factors: the characteristics of each specific patient; and the characteristics of the prostate cancer itself.

  • Localised Prostate Cancer: That is cancer that appears to be confined to the prostate and its nearby surroundings

    a. Active Surveillance. This involves careful observation of the cancer without active treatment. It necessitates regular follow-up with repeat PSA testing, examinations and biopsies. If any parameters become more worrisome, active treatment (surgery or radiotherapy) can be instituted.

    b. Radiotherapy. Either external beam radiotherapy or brachytherapy (implantable radioactive seeds) can be arranged via your urologist. It is conducted in Liverpool and Campbelltown Hospitals by a specialist radiation oncologist.

    c. Radical Prostatectomy. This is surgical removal of the entire prostate (+/- localized lymph glands). It may be done by an open, laparoscopic or robotic approach all of which are offered at Macarthur Urology.


  • Advanced Prostate Cancer: That is cancer that has spread outside the prostate into the lymph glands and/or bones.

    a. Watchful Waiting. Due to patient characteristics and the lack of symptoms, we do not institute treatment immediately, but rather continue monitoring until treatment is necessary

    b. Hormonal Therapy. This involves halting the body’s production of male sex hormones (that is testosterone) which markedly slows the progress of prostate cancer.