Back on the 30th November, in collaboration with Rick Popert and his team, we hosted our first ‘Urologists against TRUS biopsy’, or #TREXIT meeting at Guy's and St Thomas' NHS Foundation Trust. Hosted by Rick Popert and with over 35 of the NHS’ leading urologists and prostate cancer authorities including Prostate Cancer UK and the Accountable Cancer Network in attendance, the objective for the day was to discuss how TRUS biopsy could be entirely removed from the prostate cancer diagnosis pathway across England.
Prostate cancer biopsy has seen significant advances in recent years, however, the current ‘de facto’ standard method in the UK remains the transrectal ultrasound (TRUS) guided or transrectal biopsy – a process whereby the biopsy needle goes through the wall of the back passage. It is increasingly recognised that this method is less effective than alternatives – both in terms of its ability to accurately identify potential cancer cells as well as the greater risk of infection associated with it.
It’s alternative - the transperineal technique - is an increasingly viable approach where the biopsy needle is inserted into the prostate through the skin between the testicles and the back passage (perineum). While historically conducted under general anaesthetic using a template system – according to Prostate Cancer UK guidance – the latest advances in transperineal biopsy have made this technique available under a local anaesthetic (LA TP) through a freehand approach that allows the practitioner to freely manoeuvre the ultrasound probe to align the access needle to target the desired locations with certainty for targeted and systematic biopsies.
Developed in response to the increased adoption of active surveillance and the disadvantages of transrectal biopsy approaches, PrecisionPoint™, which has been developed and patented by the US-based company Perineologic, is the first FDA & TGA approved and CE Marked device that allows a free-handed transperineal systematic or targeted biopsy of the prostate. The device removes the requirement for a stabilisation unit and disposable grid and as a low-cost, disposable device represents a new approach to prostate cancer detection at an earlier stage of progression, through its ability to allow access to the whole prostate gland.
The transperineal technique represents a safer and more accurate method for healthcare professionals to detect potential incidents of prostate cancer at an earlier stage of progression, through its ability to systematically allow access to the whole gland, with lower costs and fewer risk of side effects. Furthermore, when infection linked costs including antibiotics and hospitalisation are included, the new, outpatient-based transperineal biopsy is also less expensive than the old transrectal approach.
Join the movement
Why are patients still being subjected to transrectal biopsies with the associated risk of infection and lack of accuracy? There appears to be limited justification for using an approach that cannot reach the anterior prostate, when there is a proven, low risk, high accuracy alternative that, critically, can also be delivered in outpatient clinics for the same cost.
The outcome of this first meeting was a unanimous accord to start moving away from TRUS biopsy towards LA TP, with Prostate Cancer UK also since advising that bursaries can be applied for to support the training of Clinical Nurse Specialists in the method. This latter point is key; as Trusts struggle to cope with the increased demand for prostate cancer biopsies, it is vital that we maximise the specialist resource in the NHS to continue to deliver the optimal patient pathway and achieve the best possible outcomes.
We are calling this campaign ‘TREXIT’. The next meeting will take place on the auspicious date of 29th March 2019, if you’d like to find out more information, please contact Laura Kedzlie, Marketing Director at BXTAccelyon on firstname.lastname@example.org