Urology FAQs

What is a urologist?

A urologist, or urological surgeon, is a surgeon who treats conditions of the urinary tract in both men and women, and the genital tract of men.

How do I make an appointment with Assoc Prof Grummet?

Once you have a referral from your GP or specialist, simply call Assoc Prof Grummet's PA on 0499 037 900.

What do I need to bring to my appointment?

Please bring your Medicare / Veterans Affairs / Pension / Private health insurance cards and any test results ordered by your referring doctor, including CDs or films of X-rays or other scans.

Room44 to design TELEHEALTH service face to face / video icon

What if I live in a remote location, can I have an appointment face to face via video?

Yes, Dr Grummet provides a Telehealth service.

Patients outside metropolitan Melbourne can have a video consultation to save hours of travel.

Since the Australian government launched the Telehealth program in 2011, Assoc Prof Grummet has been conducting Telehealth video consultations via the internet. The response from patients and their GPs in regional and remote areas has been outstanding.

Assoc Prof Grummet has been providing a regular urological service to East Gippsland for several years, with monthly visits to Bairnsdale for local consulting and operating. To supplement this, he also conducts a regular Telehealth clinic for these patients. But any patient outside metropolitan Melbourne, in any state of Australia, may be eligible for this kind of consultation.

Telehealth video consultations can prevent patients from having to travel vast distances for a straightforward review appointment. They can also expedite initial specialist management for remote patients with more urgent urological conditions.

Once a referral has been made by the GP, Assoc Prof Grummet will determine if a Telehealth consultation is appropriate. If so, patients simply attend their GP’s surgery for the video consultation at an arranged time. Alternatively, if patients have access to Skype at home, consultations can even be organised from there.

Where else can I find useful, reliable, evidence-based information on urological conditions and clinical trials?

> Urological Society of Australia and New Zealand (USANZ)
> Prostate Cancer Foundation of Australia (PCFA)
> Andrology Australia
> Australia and New Zealand Urogenital and Prostate clinical trials group (ANZUP)
> Prostate cancer risk calculator
> National Comprehensive Cancer Network (NCCN) Prostate Cancer Guidelines for Patients
> European Association of Urology (EAU) Guidelines

What is a PSA test?

PSA stands for Prostate-Specific Antigen, which is a protein produced by the prostate gland that naturally circulates in the bloodstream. The PSA test is a blood test used to determine the degree of risk of having prostate cancer. It is also helpful in monitoring prostate cancer once it has been diagnosed or treated. Elevated PSA levels can be caused by any change or insult to the prostate. The commonest such causes are benign enlargement of the prostate (benign prostatic hyperplasia - BPH), prostate cancer, or inflammation of the prostate (prostatitis).

If the PSA is elevated, the urologist's job is to determine what the cause is, and in particular to rule out significant prostate cancer. PSA testing has not been recommended for use in population screening, but men in their 50's and 60's are advised to discuss getting tested with their GP.

Learn more on PSA in Assoc Prof Grummet's article in the Medical Observer "The Pendulum Swing of PSA Testing" in the August 2013 section on the Education page, or here.

What is the Gleason score?  What are Grade Groups?

The Gleason score or Gleason sum is the rating (grade) of disease aggressiveness of prostate cancer, based on its appearance under the microscope. It is the sum of two numbers, which each represent patterns of cancer tissue. The reason a sum of two pattern numbers is used is that prostate cancer tends to be a multifocal disease within the prostate, with tumours of varying aggressiveness within the one prostate gland.

Historically, each of the two patterns could be numbered from 1 to 5, for a possible sum of between 2 and 10, for example 3+2=5, or 4+5=9. However, it was found that there was a wide variation in the reporting of low Gleason scores, so that now almost all cancers deemed low grade are given the Gleason score of 3+3=6. The Gleason score therefore now effectively ranges between 6 and 10, where 6 is low grade, 7 is intermediate, and 8, 9, and 10 are lumped together as high grade.

Gleason scores are reported for both prostate biopsy specimens and whole prostate specimens obtained in a radical prostatectomy, and are a very important determinant of cancer behaviour and prognosis.

Fortunately, the International Society of Urological Pathology (ISUP) have come up with a new grading system which makes understanding a cancer's aggressiveness much easier for patients. Grade Groups are simply from 1 to 5, with increasing aggressiveness as the number gets higher. The table below shows what the equivalent Gleason score is for each Grade Group.

Grade Group Gleason Score
1 3+3=6
2 3+4=7
3 4+3=7
4 4+4=8
5 4+5=9, 5+4=9, 5+5=10