RACGP Red Book PSA screening guidance has completely reversed. The 9th edition
(2016) said preventative PSA testing was not recommended for any risk group. The 10th
edition (2024) now recommends offering PSA testing — from age 50 (average risk),
45 (one first-degree relative with prostate cancer), or 40 (three first-degree
relatives) — after discussing risks and benefits. Retesting interval is now 2-yearly
(not annual) if PSA stays below 3.0 ng/mL, and testing shouldn’t be offered if life
expectancy is under 7 years. See Prostate Cancer & PSA Screening.
mpMRI now precedes prostate biopsy as standard practice, targeting biopsies to
suspicious lesions and helping avoid unnecessary procedures for clinically
insignificant disease; transperineal biopsy has largely replaced the transrectal
approach, cutting sepsis risk substantially.
Active surveillance is now well-evidenced and mainstream, not just a fallback —
recommended for low-risk (Grade Group 1) disease and selected favourable
intermediate-risk disease, distinct from palliative-intent “watchful waiting.”
Androgen receptor pathway inhibitors (abiraterone, enzalutamide, apalutamide,
darolutamide) are now added earlier in metastatic/high-risk prostate cancer, not just
after castration resistance, and PSMA-targeted radioligand therapy (lutetium-177
PSMA-617) is now PBS-listed for metastatic castration-resistant disease.
Generic tadalafil has been off-patent in Australia since ~2018, making both
on-demand and daily dosing considerably cheaper. See
Erectile Dysfunction.
Zoon’s balanitis (plasma cell balanitis) — a benign, chronic,
antimicrobial-unresponsive condition of the glans easily mistaken for infective
balanitis; treat any non-healing/indurated/ulcerated balanitis as a possible early
cancer. See Balanitis.
Penile cancer management is shifting toward organ-preserving surgery (glans
resurfacing, partial penectomy) over radiotherapy alone where feasible, with growing
use of sentinel node techniques for inguinal staging. See
Penile Cancer.
Collagenase clostridium histolyticum (Xiaflex) is TGA-approved (since 2016) as a
non-surgical option for Peyronie’s disease, though not routinely PBS-subsidised. See
Peyronie’s Disease.
New pages added
Ejaculatory Disorders & Low Sexual Desire
— premature ejaculation (stop-start/squeeze technique, dapoxetine), delayed
ejaculation, and low sexual desire (testosterone therapy).
Male Infertility — a male factor contributes to
up to ~50% of infertile couples, yet the male partner goes unevaluated in 18–27% of
cases; basic assessment, varicocele repair, and sperm retrieval techniques (MESA/
PESA/TESA, microTESE).
Vasectomy — the procedure, counselling points
(permanence, post-vasectomy semen analysis, failure rate), and vasectomy reversal
(patency achievable in ~82% even after 10+ years, though pregnancy rates are lower and
decline further with time).