Surgery (RMH) - Research Publications

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    Changing face of robot-assisted radical prostatectomy in Melbourne over 12 years
    Sathianathen, NJ ; Lamb, AD ; Lawrentschuk, NL ; Goad, JR ; Peters, J ; Costello, AJ ; Murphy, DG ; Moon, DA (WILEY, 2018-03)
    BACKGROUND: This study aims to characterize the trends in disease presentation for robot-assisted radical prostatectomy (RARP) over a 12-year period in Melbourne, Australia. METHODS: All patients undergoing an RARP between 2004 and October 2016 while under the care of six high-volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer. RESULTS: Over the 12-year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high-risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016. CONCLUSION: Our analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease.
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    An online psychological intervention can improve the sexual satisfaction of men following treatment for localized prostate cancer: outcomes of a Randomised Controlled Trial evaluating My Road Ahead
    Wootten, AC ; Meyer, D ; Abbott, J-AM ; Chisholm, K ; Austin, DW ; Klein, B ; McCabe, M ; Murphy, DG ; Costello, AJ (WILEY, 2017-07)
    BACKGROUND: Prostate cancer treatment often results in significant psycho-sexual challenges for men following treatment; however, many men report difficulty in accessing appropriate care. METHODS: A randomized controlled trial was undertaken to assess the efficacy of a 10-week self-guided online psychological intervention called My Road Ahead (MRA) for men with localized prostate cancer in improving sexual satisfaction. Participants were randomized to 1 of 3 conditions MRA alone or MRA plus online forum, or forum access alone. Pre, post, and follow-up assessments of overall sexual satisfaction were conducted. Mixed models and structural equation modeling were used to analyze the data. RESULTS: One hundred forty-two men (mean age 61 y; SD = 7) participated. The majority of participants had undergone radical prostatectomy (88%) and all men had received treatment for localized prostate cancer. Significant differences were obtained for the 3 groups (P = .026) and a significant improvement in total sexual satisfaction was observed only for participants who were allocated to MRA + forum with a large effect size (P = .004, partial η2  = 0.256). Structural equation modeling indicated that increases in sexual function, masculine self-esteem, and sexual confidence contributed significantly to overall sexual satisfaction for the MRA + forum plus forum condition. CONCLUSIONS: This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men with prostate cancer. The findings indicate the potential for MRA to deliver support that men may not otherwise receive and also highlight the importance of psychological intervention to facilitate improved sexual outcomes.
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    Validation of the novel International Society of Urological Pathology 2014 five-tier Gleason grade grouping: biochemical recurrence rates for 3+5 disease may be overestimated
    van den Bergh, RCN ; van der Kwast, TH ; de Jong, J ; Zargar, H ; Ryan, AJ ; Costello, AJ ; Murphy, DG ; van der Poel, HG (WILEY-BLACKWELL, 2016-10)
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    Use of prostate-specific membrane antigen positron-emission tomography/CT in response assessment following upfront chemohormonal therapy in metastatic prostate cancer
    Anton, A ; Kamel Hasan, O ; Ballok, Z ; Bowden, P ; Costello, AJ ; Harewood, L ; Corcoran, NM ; Dundee, P ; Peters, JS ; Lawrentschuk, N ; Troy, A ; Webb, D ; Chan, Y ; See, A ; Siva, S ; Murphy, D ; Hofman, MS ; Tran, B (WILEY, 2020-10)
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    Error rates in a clinical data repository: lessons from the transition to electronic data transfer - a descriptive study
    Hong, MKH ; Yao, HHI ; Pedersen, JS ; Peters, JS ; Costello, AJ ; Murphy, DG ; Hovens, CM ; Corcoran, NM (BMJ PUBLISHING GROUP, 2013)
    OBJECTIVE: Data errors are a well-documented part of clinical datasets as is their potential to confound downstream analysis. In this study, we explore the reliability of manually transcribed data across different pathology fields in a prostate cancer database and also measure error rates attributable to the source data. DESIGN: Descriptive study. SETTING: Specialist urology service at a single centre in metropolitan Victoria in Australia. PARTICIPANTS: Between 2004 and 2011, 1471 patients underwent radical prostatectomy at our institution. In a large proportion of these cases, clinicopathological variables were recorded by manual data-entry. In 2011, we obtained electronic versions of the same printed pathology reports for our cohort. The data were electronically imported in parallel to any existing manual entry record enabling direct comparison between them. OUTCOME MEASURES: Error rates of manually entered data compared with electronically imported data across clinicopathological fields. RESULTS: 421 patients had at least 10 comparable pathology fields between the electronic import and manual records and were selected for study. 320 patients had concordant data between manually entered and electronically populated fields in a median of 12 pathology fields (range 10-13), indicating an outright accuracy in manually entered pathology data in 76% of patients. Across all fields, the error rate was 2.8%, while individual field error ranges from 0.5% to 6.4%. Fields in text formats were significantly more error-prone than those with direct measurements or involving numerical figures (p<0.001). 971 cases were available for review of error within the source data, with figures of 0.1-0.9%. CONCLUSIONS: While the overall rate of error was low in manually entered data, individual pathology fields were variably prone to error. High-quality pathology data can be obtained for both prospective and retrospective parts of our data repository and the electronic checking of source pathology data for error is feasible.
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    My Road Ahead study protocol: a randomised controlled trial of an online psychological intervention for men following treatment for localised prostate cancer
    Wootten, AC ; Abbott, J-AM ; Chisholm, KE ; Austin, DW ; Klein, B ; McCabe, MP ; Meyer, D ; Costello, AJ ; Murphy, DG (BMC, 2014-02-11)
    BACKGROUND: There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis, treatment and recovery. In addition, interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services, a shortage of adequately trained professionals, geographical distance, perceived and personal stigma and a preference for consumer-centric and self-directed learning. My Road Ahead is an online cognitive behaviour therapy (CBT) intervention for prostate cancer. This protocol describes a randomised controlled trial (RCT) that will evaluate the efficacy of this online intervention alone, the intervention in combination with a moderated online forum, and the moderated online forum alone. METHODS/DESIGN: This study utilises a RCT design with three groups receiving: 1) the 6-module My Road Ahead intervention alone; 2) the My Road Ahead intervention plus a moderated online forum; and 3) the moderated online forum alone. It is expected that 150 men with localised prostate cancer will be recruited into the RCT. Online measures will assess men's psychological distress as well as sexual and relationship adjustment at baseline, post-intervention, 3 month follow-up and 6 month follow-up. The study is being conducted in Australia and participants will be recruited from April 2012 to Feb 2014. The primary aim of this study is to evaluate the efficacy of My Road Ahead in reducing psychological distress. DISCUSSION: To our knowledge, My Road Ahead is the first self-directed online psychological intervention developed for men who have been treated for localised prostate cancer. The RCT will assess the efficacy of this intervention in improving psychological well-being, sexual satisfaction, relationship satisfaction and overall quality of life. If successful, this intervention could provide much needed support to men receiving treatment for localised prostate cancer in a highly accessible manner. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000278932.
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    Abstracts of 4th World Robotic Urology Symposium, Orlando, Florida, 6-8 April 2009.
    Murphy, DG ; Challacombe, B ; COSTELLO, A (Springer Science and Business Media LLC, 2009-06)
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    Robotic assisted radical prostatectomy in older men
    Challacombe, B ; Kyle, C ; Bradford, T ; Murphy, D ; Peters, J ; Kerger, M ; COSTELLO, A ( 2009)
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    Salvage robotic-assisted laparoscopic radical prostatectomy following failed primary high-intensity focussed ultrasound treatment for localised prostate cancer
    Murphy, DG ; Pedersen, J ; Costello, AJ (SPRINGER LONDON LTD, 2008-09)
    We report the first case of salvage robotic-assisted laparoscopic radical prostatectomy (RALP) following failed primary high-intensity focussed ultrasound (HIFU) for localised carcinoma of the prostate. A 66-year-old male with a presenting prostate-specific antigen (PSA) of 5 ng/ml was diagnosed with T1c Gleason 3 + 4 prostate cancer. He underwent transurethral resection of the prostate and HIFU. His PSA dropped to 2.0 ng/ml and repeat biopsy revealed upgrading of his prostate cancer to Gleason 4 + 3. He was referred to us for a second opinion and, following discussion of his options, he underwent RALP. The total operative time was 159 min. There were no intra- or postoperative complications. He was discharged on postoperative day two and was fully continent 10 days following removal of his catheter. His PSA remained undetectable 6 months postoperatively. Salvage RALP was feasible in this case with good functional and short-term oncological outcomes for the patient.