Pleomorphic adenoma is the most common parotid gland tumour. It is benign, usually presents as a painless, slow-growing lump near the jaw, and was first described by surgeon Theodor Billroth in 1859. In Episode 112, ENT surgeon Dr Rowan Valentine explains how it is assessed and managed.

Meet the mixed tumour. In 1859, German-born Austrian surgeon Theodor Billroth gave the first medical description of a slow-growing, painless, encapsulated tumour that occurs mainly in the parotid gland, beside the jaw. Under the microscope it showed a mix of tissue types, so he called it a “mixed tumour”. Today we know it as a pleomorphic adenoma.

Billroth also performed the first laryngectomy and the first successful partial gastrectomy for gastric cancer, and he was a friend of the composer Johannes Brahms. Dr Travis Brown tells his story at the start of the episode.

Jaw lumps raise worry. Dr Valentine walks through what he asks, what he examines, and what he recommends when a patient presents with a parotid lump.

• History: how long the lump has been there, whether it hurts, whether it changes in size, and whether the patient has noticed any weakness of the face.
• Examination: mobility of the lump, the overlying skin, tenderness, sensation near the ear, and the function of each branch of the facial nerve.
• Red flags: pain, skin involvement, a history of skin cancer excisions on the head and neck, and facial nerve paralysis.
• Biopsy limits: in Dr Valentine’s words, fine needle aspirates and core biopsies have about 90% accuracy in separating benign from cancerous lumps.
• Surgery: what the operation involves, how the facial nerve is protected, and the risks Dr Valentine quotes to patients.
• Follow-up: why recurrence can follow if the capsule of the tumour is breached, and how that shapes surveillance.

Long-standing lumps are easy to set aside. Dr Valentine explains why a lump that has been present for years still deserves a plan, and his closing advice for doctors is that a parotid lump is cancerous until proven otherwise. The episode introduces you to the questions, examination findings and red flags an ENT surgeon looks for, so you can feel more prepared for the patient who says, “I’ve had this for years.”

This is the story of pleomorphic adenomas.

Our Special Guest:

Dr Rowan Valentine is an adult and paediatric ear, nose and throat (ENT) surgeon. He trained in Adelaide, completed a PhD during his surgical training, and spent a year at the University of Florida on an anatomy fellowship. He supervises surgical trainees and medical students, and he is a regular guest on This Medical Life.

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New guidelines are here. The Prostate Cancer Foundation of Australia and the Australian Government Department of Health, Disability and Ageing have released the 2026 Guidelines for the Early Detection of Prostate Cancer. One in seven Australian men will be diagnosed with prostate cancer. The aim is to find early prostate cancer in the men most at risk, while sparing low-risk men tests they do not need.

The story starts in forensic science. In the 1960s, crime labs needed a better way to detect semen than finding sperm, which break down within minutes to an hour. Dr Travis Brown explains how the Japanese forensic scientist Mitsuhara identified a protein he called gamma-seminoprotein. Teams at Cornell and the University of California found the same protein under other names. Today we call it PSA. By the 1970s, researchers saw it was raised in advanced prostate cancer, and its long, debated path as a screening test began.

The last guidelines came out in 2016. Since then, two things have shifted the balance of risk and benefit: access to multiparametric MRI, and the move from transrectal to transperineal biopsy. In this episode, Ken walks through the key changes:

• Free-to-total PSA ratio is no longer needed. MRI is better at sorting risk. About 80% of men with a confirmed PSA above 3 already have a free-to-total ratio below 25%.
• Ages 45 to 49 (higher risk): refer when PSA is above 1 ng/mL. This group includes men with a brother with prostate cancer, a father diagnosed at 65 or younger, or a BRCA mutation.
• Ages 50 to 69: the threshold stays at 3 ng/mL, or 2 ng/mL for higher-risk men.
• Ages 70 and over: for men likely to live more than seven years, the threshold is 5.5 ng/mL. Men below 5.5 can reasonably stop testing.
• Repeat the test in one to three months. About 30% of men with a PSA above 3 will test well below 3 on repeat, often due to BPH-related variation.
• GPs should now start the conversation. The 2016 guidelines had GPs respond when a man raised it. The new guidelines, endorsed by the RACGP, ask GPs to raise PSA testing with men aged 50 to 69.

Not for prostate cancer screening. In the evidence, rectal exams by non-specialists added as many false positives as false negatives. Ken notes that urologists still gain useful information from it, and a rectal exam remains relevant when you are looking for rectal cancer.

Men with a first-degree relative with prostate cancer, men with BRCA mutations, and men of African ancestry. The guidelines also name Aboriginal and Torres Strait Islander men as a priority population because of poorer access to care. Ken adds that men in regional Victoria have worse prostate cancer outcomes than men in the city.

This is the story of the 2026 Early Detection of Prostate Cancer.

Useful Link:

2026 Guidelines for the Early Detection of Prostate Cancer in Australia

Our Special Guest:

Professor Ken Sikaris is a chemical pathologist and head of clinical integration at Dorevitch Pathology. He is a NATA laboratory assessor, a founding fellow of the RCPA Faculty of Science and a principal examiner in pathology informatics. Ken was one of the first people to measure PSA in Australia, bringing in some of the first test kits around 1989. He helped write the new guidelines.

Listen:

This Medical Life podcast is available on all podcasting services, Apple Podcasts, YouTube, and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.

In 1880, a French physician described a patient having up to 200 sleep attacks a day, some triggered by nothing more than a good hand of cards or the sight of his own wine barrels. That case, and an earlier 1877 description from German psychiatrist Carl Westphal, gave the condition its name and its first clinical picture. Dr Travis Brown reads from both original case reports before turning to two guests for where narcolepsy stands today.

Di Spillaine, an Australian narcolepsy advocate and lived experience educator, describes going almost 40 years undiagnosed, mistaking her symptoms (childhood hallucinations, cataplexy triggered by laughter, sleep paralysis) for ordinary tiredness until a multiple sleep latency test finally confirmed narcolepsy. Professor Robert Adams, a respiratory and sleep physician at Flinders Medical Centre and medical director of the Adelaide Institute for Sleep Health, explains the underlying orexin deficiency behind narcolepsy type 1, how it differs from everyday tiredness and other sleep disorders, and the diagnostic pathway, including the Epworth Sleepiness Scale and multiple sleep latency testing.

What to listen for: the questions Professor Adams suggests a GP ask beyond “are you tired”, and why narcolepsy sits, in his words, at the end of the queue of likely causes but should still be considered in young patients with long-standing, profound sleepiness.

This is the story of narcolepsy.

Useful Link:

Epworth sleepiness scale: https://www.cdc.gov/niosh/work-hour-training-for-nurses/02/epworth.pdf

Our Special Guests:

Di Spillaine is an Australian narcolepsy advocate, lived experience educator and creator of the podcast Waking Up Tired: Narcolepsy Symptoms Explained

Professor Robert Adams is a respiratory and sleep physician at Flinders Medical Centre and medical director of the Adelaide Institute for Sleep Health at Flinders University

Listen:

This Medical Life podcast is available on all podcasting services, Apple Podcasts, YouTube, and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.