OBJECTIVE To report the initial experience of one surgeon, with contemporary experience of both open radical prostatectomy (ORP) and reconstructive laparoscopy, in laparoscopic radical prostatectomy (LRP) in 1000 patients, and to investigate the rate of change of various outcome variables for this procedure with time. PATIENTS AND METHODS Between March 2000 and December 2007, 1000 consecutive patients with clinical stage T ≤ 3aN0M0 prostate cancer underwent LRP, either supervised (17%) or performed (83%), by one surgeon. The median prostate‐specific antigen (PSA) level was 7.0 (1–50) ng/mL and median Gleason sum 6 (4–10); the clinical stage was T1 in 46.9%, T2 in 49.8% and T3 in 3.3%. RESULTS The median (range) operative duration was 177 (78–600) min. There was one conversion (patient 8) to open surgery. The median blood loss was 200 (10–1300) mL and four patients were transfused (0.4%). The median postoperative hospital stay was 3.0 (3–28) nights. The median catheterization time was 10.0 (0.8–120) days. There were 48 complications (4.8%) requiring surgical intervention in 33 (3.3%) patients, 58% of these as a day‐case admission. The positive margin rates according to d’Amico risk groups were: low, 9.1%; intermediate, 20.3%; and high, 36.8%. The overall positive margin rate was 13.3%. The PSA level was ≤0.1 mg/L at 3 months in 99.1% of patients. At a mean follow‐up of 27.7 (3–72) months, 96.1% of patients were free of biochemical recurrence. In patients with a follow‐up of ≥24 months potency rates peaked in the series at 86% for all men and 94% for men aged ≤65 years, and continence rates at 98% before declining thereafter in men with a shorter follow‐up. CONCLUSION The learning curve for operating time and blood loss was overcome within the first 100–150 cases, but complication and continence rates took 150–200 cases to reach a plateau. The longest learning curve was for potency, which did not stabilize until 700 cases. These learning curves are likely to be considerably shorter when surgeons are taught in departments with a high throughput of cases but both surgeons and patients should be aware of them. In view of these findings, the authors recommend that LRP should not be self‐taught and should be learned within an immersion teaching programme. Even then, a large surgical volume is likely to be needed to maintain clinical outcomes at the highest level.

ObjectivesTo determine if portable video media (PVM) improves patient's knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process. Patients and MethodsIn this multi-centre randomised controlled crossover trial, patients requiring cystoscopy and stent insertion were recruited from two major teaching hospitals in Australia over a 15-month period (July 2014-December 2015. Patient information delivery was via PVM and SVC. The PVM consisted of an audio-visual presentation with cartoon animation presented on an iPad. Patient satisfaction was assessed using the validated Client Satisfaction Questionnaire 8 (CSQ-8; maximum score 32) and knowledge was tested using a true/false questionnaire (maximum score 28). Questionnaires were completed after first intervention and after crossover. Scores were analysed using the independent samples t-test and Wilcoxon signed-rank test for the crossover analysis. ResultsIn all, 88 patients were recruited. A significant 3.1 point (15.5%) increase in understanding was demonstrable favouring the use of PVM (P < 0.001). There was no difference in patient satisfaction between the groups as judged by the CSQ-8. A significant 3.6 point (17.8%) increase in knowledge score was seen when the SVC group were crossed over to the PVM arm. A total of 80.7% of patients preferred PVM and 19.3% preferred SVC. Limitations include the lack of a validated questionnaire to test knowledge acquired from the interventions. ConclusionsThis study demonstrates patients' preference towards PVM in the urological consent process of cystoscopy and ureteric stent insertion. PVM improves patient's understanding compared with SVC and is a more effective means of content delivery to patients in terms of overall preference and knowledge gained during the consent process.

Objective To assess anxiety, health‐related quality of life (HRQL) and understanding of active surveillance (AS) in a cohort of patients enrolled in AS of prostate cancer in an Australian setting. Patients and Methods Survey of 61 men currently enrolled in AS for prostate cancer, which included validated measures of sexual function using the International Index of Erectile Function (IIEF‐5), voiding using the International Prostate Symptom Severity Score (IPSS) and the Memorial Anxiety Scale for Prostate Cancer (MAX‐PC), a measure of prostate cancer specific anxiety. Three novel questions to assess patients' Understanding of AS (UAS). IIEF‐5 and IPSS scores obtained through the present survey were compared with patients' scores at initiation of AS. Results In all, 47 of 61 (77%) patients responded to the survey. There was no significant difference in patients' IIEF‐5 and IPSS scores at commencement of AS compared with the survey results. Our patients' on AS MAX‐PC scores were consistent with other published cohorts and did not suggest high rates of clinically significant anxiety amongst this cohort. Most (89%) of the patients' responses to the UAS indicated a correct understanding of AS. Conclusion Our patients on AS maintained their HRQL with low levels of anxiety, which did not differ from those reported in other groups of men with prostate cancer and most had an appropriate understanding of AS. This study represents one of the first Australasian investigations on HRQL and anxiety in men on AS of prostate cancer.

BackgroundThe increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB.MethodsPatients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management.ResultsA total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4–5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB.Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone.There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%).ConclusionsThis is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.