Treating Prostate Cancer

1. Robotic Surgery.

  • The most experienced robotic surgeon in Sydney and NSW (>2500 cases )
  • One of the lowest positive margin rates in the country (as documented by Douglass Hanly Moir Pathology results and the New South Wales Cancer Registry ).
  • One of the highest potency rates, recovery of erections after surgery (as documented by the New South Wales Cancer Registry and the Garvan Institute ). International reputation on nerve sparing techniques to maximise erection recovery.
  • One of the highest continence rates (as documented by the New South Wales Cancer Registry and the Garvan Institute ).
  • The most experienced team working with me including my clinical manager, Jayne Matthews, with 30 years experience, Michael Lowy - sexual health physician with 30 years experience, Stuart Baptist for pelvic floor physiotherapy with 20 years experience, my administrative team headed up by Angela Papazoglou, with over 20 years experience, my research team headed up by Anne-Maree Haynes and Shikha Agrawal with over 30 years experience and all the resources of the official St Vincent's Prostate Cancer Research Centre which has now been in existence for 25 years.
  • Received an AO for my pioneering work and teaching in robotic surgery.

Focal NanoKnife ablation for prostate cancer.

  • Currently the world leader and teacher and pioneer of this technology.
  • 400 cases to date - the highest published in the world.
  • 97% clearance rate with less than 1% incontinence and less than 10% impotence rate. A teacher and mentor in Australia, United States of America, New Zealand and Europe.
  • Fifteen international publications to date.

Brachytherapy for prostate cancer.

  • 25 years of experience as a teacher and pioneer.
  • Over 1500 cases.
  • Has been performing high-dose-rate brachytherapy and low-dose-rate brachytherapy for over 20 years.
  • I work with an outstanding radiotherapy team at St Vincent's and Genesis Health care headed up by Raj Jagavkar.

The latest prostate cancer radiotherapy technique with the MR-Linac machine.

  • Pioneer with Genesis Healthcare.
  • Highest case numbers in Australia.
  • The most accurate current radiotherapy technique worldwide delivering targeted Radiotherapy within an MRI machine

Active surveillance.

  • The most experienced and largest series in Australasia.
  • Over 1400 cases.
  • Pioneered noninvasive monitoring with MRI and PSMA PET scanning
  • Pioneered transperineal & MRI Fusion biopsies.

Tailoring and personalising the treatment for prostate cancer.

  • The first second opinion service in Australasia.
  • Currently the elected head and chairman of the multidisciplinary team Meetings for urology cancers at the St Vincent's campus  ( including 8 urologists , 3 Medical oncologists , 3 radiation oncologists , 3 imaging experts , 2 pathology experts , Councellors , researchers , fellows and others ).
  • Supported by the medical oncology team (headed by Prof Anthony Joshua), the radiotherapy team headed by Raj Jagavkar and Jeremy De Leon, the genomics team headed by Vanessa Hayes, the epigenomics team headed by Sue Clark, the genetic counselling team headed by Prof Allan Spigelman, the nuclear medicine physicians headed by Prof Louise Emmett, the MRI imaging team headed by A/Prof Ron Shnier and Dr Sonny Ho, the pathology team headed by Professor Warick Delprado, the support team headed by clinical manager Jayne Matthews, Physiotherapist Stuart Baptist, Sexual physician Michael Lowy and the mens health clinical support team at St Vincent's and the clinical research team headed by Anne- Maree Haynes & Shikha Agrawal, the clinical trials coordinator and our research urology fellows.

The treatment of high-risk prostate cancer

  • 30 years experience.
  • A unique ability to tailor the latest surgical and radiotherapy techniques and systemic treatments either in a trial or as standard of care as well as the latest in imaging techniques to personalise treatment for high-grade prostate cancer, Gleason 8 to 10.
  • The head of the DETECT trial using radioguided imaging for cancer detection during surgery.
  • One of the chief investigators of many trials of systemic treatment such as the Proteus trial to improve the effectiveness of surgery and radiotherapy in the treatment of high-risk prostate cancer.
  • Working closely with Professor Joshua in incorporating systemic therapies, both chemotherapy, super anti-androgens and immunotherapy in combination with surgery and radiotherapy.

The most accurate assessment of the extent of prostate cancer

  • Transperineal biopsy of the prostate - world pioneer, commenced in 1996.
  • Over 10,000 cases of transperineal biopsy.
  • Commenced the MR fusion biopsy technique over a decade ago with the largest experience.
  • An early pioneer and one of the highest levels of experience with MRI in prostate cancer.
  • With Professor Emmett - a pioneer, an early developer and one of the highest levels of experience with PSMA PET scanning.
  • A developer with James Thompson and Pim Van Leewan of the algorithm ( formula ) for predicting the likelihood of cancer based on clinical facts and MRI.

Extensive experience in the management of impotence and incontinence in association with prostate cancer.

  • Previously ran the largest Sexual Dysfunction Clinic in the southern hemisphere at the Australian Centre for Sexual Health.
  • Over 500 operations on penile prostheses.
  • Over 200 patients with artificial urinary sphincter for incontinence.
  • Over 200 cases of slings both AdVance and InVance slings for incontinence.
  • Fully trained with 20 years of experience of urodynamics.
  • Over 200 cases of ProACT device for incontinence.

Treating Benign Prostate Condition

Transurethral prostate resection ( TURP  ) in all methods including bipolar and unipolar treatment

  • 30 years of experience
  • Still the gold standard
  • Uses the latest technology
  • Popularised the short hospital stay procedure (2 days )

Laser prostatectomy

  • Extensive experience in GreenLight laser prostatectomy (Brought it to Australia.)
  • Highly experienced with Holmium YAG laser therapy for benign bladder and prostatic conditions.

UroLift device

  • One of the first in Australia to use Urolift with almost ten years of experience.
  • Avoids retrograde ejaculation
  • Pioneered the Hybrid combination of Urolift and Mini-TURP
  • A teacher and mentor of the urolift technique.

Rezum procedure, one of the early pioneers in Australia to use Rezum

  • Set up one of the first units in Australia at St Vincent's.
  • Extensive experience in Rezum technique
  • Avoids retrograde ejaculation

Medical therapy for benign prostatic conditions

  • Over 30 years of experience of using all of the medications for benign prostatic enlargement and written multiple reviews of tailoring medications to the individual

Prostate Arterial Embolisation

  • Works closely with Dr Schlapoff to use this minimally invasive technology in selected suitable cases

Personalising and Tailoring therapy

  • Well positioned to individualise the treatment of benign prostate conditions by offering all the latest treatment options