Many malignancies metastasise to the skeleton. This often results in a relatively unique pain pro... more Many malignancies metastasise to the skeleton. This often results in a relatively unique pain process, which dramatically affects a patient's quality of life. With one in three members of the population likely to develop cancer at some stage in their lives, the prevalence of bone metastases is high. Despite the large financial investment on therapies for these patients, treatment is still suboptimal. In this article, the various treatments available are reviewed. Opiates and bisphosphonates, the mainstays in current practise, are covered in detail, and evolving therapies that may shape future management are also discussed.
We report the case of a man with idiopathic lymphocytic orchitis (LO) manifested by undifferentia... more We report the case of a man with idiopathic lymphocytic orchitis (LO) manifested by undifferentiated testicular pain and atrophy. Conventional investigation results were unremarkable. Oral ciprofloxacin only improved the pain temporarily. Scrotal exploration surgery was performed to exclude acute testicular torsion and a biopsy was taken during surgery for histological examination. Histology revealed severe LO with reduced spermatogenesis. A trial of oral steroids was initially effective but the effect was temporary. Due to chronic pain, he eventually underwent unilateral orchidectomy. Histology confirmed the initial diagnosis of LO. He was pain-free postoperatively. Idiopathic LO is a rarely reported cause of testicular atrophy.
To report on the structure and outcomes of a new 'One Stop&am... more To report on the structure and outcomes of a new 'One Stop' Prostate Clinic (OSPC) designed specifically for rural and remote men. Prospective cohort study of the first 200 rural or remote men to access a new OSPC at a public tertiary-level hospital in Western Australia between August 2011 and August 2014. Men attended for urological assessment, and proceeded to same-day transrectal ultrasonography-guided prostate biopsies, if appropriate. Referral criteria were either two abnormal age-related prostate-specific antigen (PSA) levels in the absence of urinary tract infection (UTI), or an abnormal digital rectal examination (DRE) regardless of PSA level. The median (range) distance travelled was 1545 (56-3229) km and median (range) time from referral to assessment was 33 (2-165) days. The median (range) age was 62 (38-85) years, PSA level was 6.7 (0.5-360) ng/mL and 39% (78/200) had a suspicious DRE. In all, 92% (184/200) of men proceeded to prostate biopsies, and 60% (111/184) of these men were diagnosed with prostate cancer. Our complication rate was 3.5% (6/172). Radical prostatectomy (46/111), active surveillance (28/111) and external beam radiation therapy (26/111) were the commonest subsequent treatment methods. A $1045 (Australian dollars) cost-saving per person was estimated based on the reduced need for travel with the OSPC model. The OSPC is an effective and efficient model for assessing men suspected of having prostate cancer living in rural and remote areas of Western Australia, and this model may be applicable to other areas.
Visible haematuria is the presence of blood in the urine that is apparent to the naked eye, as op... more Visible haematuria is the presence of blood in the urine that is apparent to the naked eye, as opposed to non-visible haematuria that is only noticeable on dipstick or microscopic examination. Classifying haematuria as visible or non-visible is preferable to the previous classification of macroscopic, microscopic, or dipstick-positive haematuria for three reasons. Firstly, this new classification is easier for both laymen and health professionals to understand. Secondly, the previous classification implies that microscopic haematuria is more reliable, and should therefore be taken more seriously, than dipstick-positive haematuria. In fact, the sensitivity of urine microscopy can be inferior to dipstick testing for detecting non-visible haematuria; this is particularly so when there are significant delays in the assessment of the specimen, as there often are in community-submitted samples. Thirdly, avoiding the classification of non-visible haematuria as microscopic or dipstick-posit...
Despite adequate trans-urethral resection of the bladder tumour (TURBT), non-muscle-invasive blad... more Despite adequate trans-urethral resection of the bladder tumour (TURBT), non-muscle-invasive bladder cancer (NMIBC) is associated with high rates of recurrence and progression. Instillation of Bacillus Calmette-Guérin (BCG) into the urinary bladder after TURBT (adjuvant intravesical administration) reduces the risk of both recurrence and progression, and this is therefore the standard of care for high-risk tumours. However, over 30 % of people still recur or progress despite optimal delivery of BCG. Our meta-analysis suggests that outcomes might be improved further by using an adjuvant intravesical regimen that includes both mitomycin and BCG. These promising findings require corroboration in a definitive, large scale, randomised phase III trial using standard techniques for intravesical administration. The BCG + MMC trial (ANZUP 1301) is an open-label, randomised, stratified, two-arm multi-centre phase III trial comparing the efficacy and safety of standard intravesical therapy (BC...
Parastomal hernia is a common complication of ileal conduit formation. Mesh repair of parastomal ... more Parastomal hernia is a common complication of ileal conduit formation. Mesh repair of parastomal hernia has lower rate of recurrence than nonmesh techniques but can be time-consuming to perform. The stapled mesh stoma reinforcement technique (SMART) is a novel method of rapidly constructing a reinforced stapled stoma. We report the first case utilising this technique in a urologic context. The procedure was performed on a middle-aged female with recurrent parastomal hernia of her ileal conduit. There were no perioperative complications. The resited stoma remained healthy and functioned normally. Longer term data is clearly desirable though this technique deserves consideration in the treatment of urologic parastomal hernias. This case demonstrates that SMART is an easy and convenient procedure for parastomal hernia repair.
To examine whether or not the combination of diclofenac suppository with peri-prostatic nerve blo... more To examine whether or not the combination of diclofenac suppository with peri-prostatic nerve block (PPNB) was effective in reducing the degree of pain experienced during transrectal ultrasound (TRUS)-guided prostate biopsy in a randomised single-blind placebo-controlled trial. In all, 96 patients having a planned TRUS-guided prostate biopsy were randomised into one of the following arms on a 1:1 basis: 10 mL 1% lignocaine PPNB and placebo suppository (control) or 10 mL 1% lignocaine PPNB and 100 mg diclofenac suppository (treatment). Pain scores were recorded using the Numerical Rating Scale for pain (0-10) at the following time-points: (i) introduction of probe, (ii) during biopsy, (iii) 1 h after biopsy, (iv) later that evening (≈6 h after biopsy) and (v) 1 day after biopsy. Patients were asked about their preferred method for pain control if a repeat TRUS-guided prostate biopsy was required: local anaesthetic (LA) again or intravenous sedation. There were no significant differen...
ABSTRACT Shomik Sengupta reports grants from Cancer Australia, during the conduct of the study; a... more ABSTRACT Shomik Sengupta reports grants from Cancer Australia, during the conduct of the study; and is unremunerated deputy-chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd.Peter Grimison reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Germ Cell Subcommittee of the ANZUP Cancer Trials Group Ltd.Dickon Hayne reports grants from Cancer Australia, during the conduct of the study; and is unremunerated chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd.Scott Williams is unremunerated chair of the prostate cancer subcommittee the ANZUP Cancer Trials Group Ltd.Suzanne Chambers is unremunerated chair of the Quality of Life and Supportive Care Subcommittee of the ANZUP Cancer Trials Group Ltd.Paul DeSouza is unremunerated Chair of the Translational and Correlative Research Subcommittee of the ANZUP Cancer Trials Group Ltd.Martin Stockler reports reports grants from Cancer Australia, during the conduct of the study;Margaret McJannett is an employee of the ANZUP Cancer Trials Group Ltd.Guy Toner reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Deputy-Chair of the Board of ANZUP Cancer Trials Group LtdIan Davis reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Board of ANZUP Cancer Trials Group Ltd
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2014
To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Rad... more To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Radiation Oncology departments using different imaging, delivery and recording technology. A multi-centre feasibility study of online adaptive radiotherapy, using a choice of three "plan of the day", was conducted at 12 departments. Patients with muscle-invasive bladder cancer were included. Departments were activated if part of the pilot study or after a site-credentialing visit. There was real time review of the first two cases from each department. 54 patients were recruited, with 50 proceeding to radiotherapy. There were 43 males and 7 females with a mean age of 78 years. The tumour stages treated included T1 (1 patient), T2 (35), T3 (10) and T4 (4). One patient died of an unrelated cause during radiotherapy. The three adaptive plans were created before the 10th fraction in all cases. In 8 (16%) of the patients, a conventional plan using a 'standard' CTV to PTV margin ...
To quantify the outcomes of retrograde ureteric stenting in the setting of infected hydronephrosi... more To quantify the outcomes of retrograde ureteric stenting in the setting of infected hydronephrosis secondary to ureteric calculi. Prospective analysis of all patients over 15 month period admitted with an infected obstructed kidneys secondary to ureteric calculi. Inclusion criteria were based on clinical evidence of systemic inflammatory response syndrome (SIRS) and radiological evidence of obstructing ureteric calculi. Outcome measures included success of procedure, admission to intensive care unit (ICU), length of hospital stay, morbidity, and all-cause mortality during hospital admission. 52 patients included. Success of retrograde ureteric stenting was 98%. Seventeen per cent of patients required an ICU admission, with a post ureteric instrumentation ICU admissions rate of 6%. Mean white cell count and serum creatinine improved significantly post-procedure. Major complication rate included septic shock 6%, but there were no episodes of major haemorrhage and no deaths. Retrograde...
Metastatic renal-cell carcinoma (RCC) is resistant to chemotherapy, and patients with this diseas... more Metastatic renal-cell carcinoma (RCC) is resistant to chemotherapy, and patients with this disease have a poor outlook. Immunotherapy by use of cytokines and vaccines against tumour antigens has shown encouraging results in a small group of patients. Advances in the understanding of the graft-versus-tumour effect in haematological malignant disorders have led to the use of stem-cell transplantation for treatment of solid-organ malignant diseases such as RCC. Techniques of bone-marrow ablation have been superseded by safer conditioning regimens, with occasional complete remission and partial remission in some patients. Graft-versus-host disease, engraftment failure, and disease progression remain important obstacles to the widespread use of new techniques for metastatic RCC. Here, we summarise important issues surrounding immunotherapy for RCC, the problems encountered with use of immunotherapy, and the present use of non-myeloablative techniques for treatment of this disease.
Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual d... more Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual delayed presentation of renal arteriovenous fistula following blunt trauma.A gentleman presented with hematuria and clot colic. Following initial investigations, renal arteriography showed an arteriovenous fistula in the mid-pole of the right kidney. The fistula was successfully occluded by super-selective coil embolization. Although this case is an unusual presentation, AV fistulae must be ruled out in management of patients of hematuria.
International Journal of Radiation Oncology*Biology*Physics, 2008
PURPOSE: Cancer patients who undergo radiotherapy remain at life-long risk of radiation-induced i... more PURPOSE: Cancer patients who undergo radiotherapy remain at life-long risk of radiation-induced injury to normal tissues. We conducted a randomized, controlled, double-blind crossover trial with long-term follow-up to evaluate the effectiveness of hyperbaric oxygen ...
Many malignancies metastasise to the skeleton. This often results in a relatively unique pain pro... more Many malignancies metastasise to the skeleton. This often results in a relatively unique pain process, which dramatically affects a patient's quality of life. With one in three members of the population likely to develop cancer at some stage in their lives, the prevalence of bone metastases is high. Despite the large financial investment on therapies for these patients, treatment is still suboptimal. In this article, the various treatments available are reviewed. Opiates and bisphosphonates, the mainstays in current practise, are covered in detail, and evolving therapies that may shape future management are also discussed.
We report the case of a man with idiopathic lymphocytic orchitis (LO) manifested by undifferentia... more We report the case of a man with idiopathic lymphocytic orchitis (LO) manifested by undifferentiated testicular pain and atrophy. Conventional investigation results were unremarkable. Oral ciprofloxacin only improved the pain temporarily. Scrotal exploration surgery was performed to exclude acute testicular torsion and a biopsy was taken during surgery for histological examination. Histology revealed severe LO with reduced spermatogenesis. A trial of oral steroids was initially effective but the effect was temporary. Due to chronic pain, he eventually underwent unilateral orchidectomy. Histology confirmed the initial diagnosis of LO. He was pain-free postoperatively. Idiopathic LO is a rarely reported cause of testicular atrophy.
To report on the structure and outcomes of a new 'One Stop&am... more To report on the structure and outcomes of a new 'One Stop' Prostate Clinic (OSPC) designed specifically for rural and remote men. Prospective cohort study of the first 200 rural or remote men to access a new OSPC at a public tertiary-level hospital in Western Australia between August 2011 and August 2014. Men attended for urological assessment, and proceeded to same-day transrectal ultrasonography-guided prostate biopsies, if appropriate. Referral criteria were either two abnormal age-related prostate-specific antigen (PSA) levels in the absence of urinary tract infection (UTI), or an abnormal digital rectal examination (DRE) regardless of PSA level. The median (range) distance travelled was 1545 (56-3229) km and median (range) time from referral to assessment was 33 (2-165) days. The median (range) age was 62 (38-85) years, PSA level was 6.7 (0.5-360) ng/mL and 39% (78/200) had a suspicious DRE. In all, 92% (184/200) of men proceeded to prostate biopsies, and 60% (111/184) of these men were diagnosed with prostate cancer. Our complication rate was 3.5% (6/172). Radical prostatectomy (46/111), active surveillance (28/111) and external beam radiation therapy (26/111) were the commonest subsequent treatment methods. A $1045 (Australian dollars) cost-saving per person was estimated based on the reduced need for travel with the OSPC model. The OSPC is an effective and efficient model for assessing men suspected of having prostate cancer living in rural and remote areas of Western Australia, and this model may be applicable to other areas.
Visible haematuria is the presence of blood in the urine that is apparent to the naked eye, as op... more Visible haematuria is the presence of blood in the urine that is apparent to the naked eye, as opposed to non-visible haematuria that is only noticeable on dipstick or microscopic examination. Classifying haematuria as visible or non-visible is preferable to the previous classification of macroscopic, microscopic, or dipstick-positive haematuria for three reasons. Firstly, this new classification is easier for both laymen and health professionals to understand. Secondly, the previous classification implies that microscopic haematuria is more reliable, and should therefore be taken more seriously, than dipstick-positive haematuria. In fact, the sensitivity of urine microscopy can be inferior to dipstick testing for detecting non-visible haematuria; this is particularly so when there are significant delays in the assessment of the specimen, as there often are in community-submitted samples. Thirdly, avoiding the classification of non-visible haematuria as microscopic or dipstick-posit...
Despite adequate trans-urethral resection of the bladder tumour (TURBT), non-muscle-invasive blad... more Despite adequate trans-urethral resection of the bladder tumour (TURBT), non-muscle-invasive bladder cancer (NMIBC) is associated with high rates of recurrence and progression. Instillation of Bacillus Calmette-Guérin (BCG) into the urinary bladder after TURBT (adjuvant intravesical administration) reduces the risk of both recurrence and progression, and this is therefore the standard of care for high-risk tumours. However, over 30 % of people still recur or progress despite optimal delivery of BCG. Our meta-analysis suggests that outcomes might be improved further by using an adjuvant intravesical regimen that includes both mitomycin and BCG. These promising findings require corroboration in a definitive, large scale, randomised phase III trial using standard techniques for intravesical administration. The BCG + MMC trial (ANZUP 1301) is an open-label, randomised, stratified, two-arm multi-centre phase III trial comparing the efficacy and safety of standard intravesical therapy (BC...
Parastomal hernia is a common complication of ileal conduit formation. Mesh repair of parastomal ... more Parastomal hernia is a common complication of ileal conduit formation. Mesh repair of parastomal hernia has lower rate of recurrence than nonmesh techniques but can be time-consuming to perform. The stapled mesh stoma reinforcement technique (SMART) is a novel method of rapidly constructing a reinforced stapled stoma. We report the first case utilising this technique in a urologic context. The procedure was performed on a middle-aged female with recurrent parastomal hernia of her ileal conduit. There were no perioperative complications. The resited stoma remained healthy and functioned normally. Longer term data is clearly desirable though this technique deserves consideration in the treatment of urologic parastomal hernias. This case demonstrates that SMART is an easy and convenient procedure for parastomal hernia repair.
To examine whether or not the combination of diclofenac suppository with peri-prostatic nerve blo... more To examine whether or not the combination of diclofenac suppository with peri-prostatic nerve block (PPNB) was effective in reducing the degree of pain experienced during transrectal ultrasound (TRUS)-guided prostate biopsy in a randomised single-blind placebo-controlled trial. In all, 96 patients having a planned TRUS-guided prostate biopsy were randomised into one of the following arms on a 1:1 basis: 10 mL 1% lignocaine PPNB and placebo suppository (control) or 10 mL 1% lignocaine PPNB and 100 mg diclofenac suppository (treatment). Pain scores were recorded using the Numerical Rating Scale for pain (0-10) at the following time-points: (i) introduction of probe, (ii) during biopsy, (iii) 1 h after biopsy, (iv) later that evening (≈6 h after biopsy) and (v) 1 day after biopsy. Patients were asked about their preferred method for pain control if a repeat TRUS-guided prostate biopsy was required: local anaesthetic (LA) again or intravenous sedation. There were no significant differen...
ABSTRACT Shomik Sengupta reports grants from Cancer Australia, during the conduct of the study; a... more ABSTRACT Shomik Sengupta reports grants from Cancer Australia, during the conduct of the study; and is unremunerated deputy-chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd.Peter Grimison reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Germ Cell Subcommittee of the ANZUP Cancer Trials Group Ltd.Dickon Hayne reports grants from Cancer Australia, during the conduct of the study; and is unremunerated chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd.Scott Williams is unremunerated chair of the prostate cancer subcommittee the ANZUP Cancer Trials Group Ltd.Suzanne Chambers is unremunerated chair of the Quality of Life and Supportive Care Subcommittee of the ANZUP Cancer Trials Group Ltd.Paul DeSouza is unremunerated Chair of the Translational and Correlative Research Subcommittee of the ANZUP Cancer Trials Group Ltd.Martin Stockler reports reports grants from Cancer Australia, during the conduct of the study;Margaret McJannett is an employee of the ANZUP Cancer Trials Group Ltd.Guy Toner reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Deputy-Chair of the Board of ANZUP Cancer Trials Group LtdIan Davis reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Board of ANZUP Cancer Trials Group Ltd
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2014
To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Rad... more To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Radiation Oncology departments using different imaging, delivery and recording technology. A multi-centre feasibility study of online adaptive radiotherapy, using a choice of three "plan of the day", was conducted at 12 departments. Patients with muscle-invasive bladder cancer were included. Departments were activated if part of the pilot study or after a site-credentialing visit. There was real time review of the first two cases from each department. 54 patients were recruited, with 50 proceeding to radiotherapy. There were 43 males and 7 females with a mean age of 78 years. The tumour stages treated included T1 (1 patient), T2 (35), T3 (10) and T4 (4). One patient died of an unrelated cause during radiotherapy. The three adaptive plans were created before the 10th fraction in all cases. In 8 (16%) of the patients, a conventional plan using a 'standard' CTV to PTV margin ...
To quantify the outcomes of retrograde ureteric stenting in the setting of infected hydronephrosi... more To quantify the outcomes of retrograde ureteric stenting in the setting of infected hydronephrosis secondary to ureteric calculi. Prospective analysis of all patients over 15 month period admitted with an infected obstructed kidneys secondary to ureteric calculi. Inclusion criteria were based on clinical evidence of systemic inflammatory response syndrome (SIRS) and radiological evidence of obstructing ureteric calculi. Outcome measures included success of procedure, admission to intensive care unit (ICU), length of hospital stay, morbidity, and all-cause mortality during hospital admission. 52 patients included. Success of retrograde ureteric stenting was 98%. Seventeen per cent of patients required an ICU admission, with a post ureteric instrumentation ICU admissions rate of 6%. Mean white cell count and serum creatinine improved significantly post-procedure. Major complication rate included septic shock 6%, but there were no episodes of major haemorrhage and no deaths. Retrograde...
Metastatic renal-cell carcinoma (RCC) is resistant to chemotherapy, and patients with this diseas... more Metastatic renal-cell carcinoma (RCC) is resistant to chemotherapy, and patients with this disease have a poor outlook. Immunotherapy by use of cytokines and vaccines against tumour antigens has shown encouraging results in a small group of patients. Advances in the understanding of the graft-versus-tumour effect in haematological malignant disorders have led to the use of stem-cell transplantation for treatment of solid-organ malignant diseases such as RCC. Techniques of bone-marrow ablation have been superseded by safer conditioning regimens, with occasional complete remission and partial remission in some patients. Graft-versus-host disease, engraftment failure, and disease progression remain important obstacles to the widespread use of new techniques for metastatic RCC. Here, we summarise important issues surrounding immunotherapy for RCC, the problems encountered with use of immunotherapy, and the present use of non-myeloablative techniques for treatment of this disease.
Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual d... more Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual delayed presentation of renal arteriovenous fistula following blunt trauma.A gentleman presented with hematuria and clot colic. Following initial investigations, renal arteriography showed an arteriovenous fistula in the mid-pole of the right kidney. The fistula was successfully occluded by super-selective coil embolization. Although this case is an unusual presentation, AV fistulae must be ruled out in management of patients of hematuria.
International Journal of Radiation Oncology*Biology*Physics, 2008
PURPOSE: Cancer patients who undergo radiotherapy remain at life-long risk of radiation-induced i... more PURPOSE: Cancer patients who undergo radiotherapy remain at life-long risk of radiation-induced injury to normal tissues. We conducted a randomized, controlled, double-blind crossover trial with long-term follow-up to evaluate the effectiveness of hyperbaric oxygen ...
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Papers by Dickon Hayne