South West moves towards eradicating traditional prostate cancer biopsy method

Bristol Urological Institute at Southmead Hospital eradicates all transrectal biopsies in favour of the latest method of transperineal prostate cancer diagnosis

It is hoped the adoption of the PrecisionPoint Transperineal Access System will provide a new approach to the provision of prostate biopsies

As part of a national campaign to eradicate transrectal (TRUS) prostate biopsies from the prostate cancer pathway, the South West of England has widely adopted the PrecisionPoint Transperineal Access System, from Perineologic, which enables freehand transperineal targeted and systematic prostate biopsies to be conducted under local anaesthetic in an outpatient setting.

Since January 2020, Stefanos Bolomytis and Professor Raj Persad, consultant urologists at North Bristol NHS Trust, and Angus Maccormick of Somerset NHS Foundation Trust have established a regional service for the rollout of transperineal biopsies under local anaesthetic, with support and funding from the South West Cancer Alliance’s regional fund.

To date, 40 consultants and clinical nurse specialists across the region have been trained, with outcomes including an overall cancer detection rate of 60.7%, significantly-reduced incidence of sepsis, as well as total theatre time and overall cost savings.

And initial audit data suggests theatre time savings of 450 hours and the potential to achieve significant income and resource benefits compared the traditional TRUS methods.

It’s been a privilege to have the opportunity to enhance patient care and support the department in maintaining our prostate cancer services during the COVID-19 pandemic and lay a foundation for a better prostate cancer pathway moving forward

Professor Persad said: “Our data highlights the clear benefits of this approach over TRUS biopsy methods, which include 0% sepsis from the biopsies undertaken at Southmead Hospital and improved cancer detection.

“Traditional prostate biopsies involve using a transrectal probe and we know this would put some men off the procedure.

“But this is a thing of the past at Southmead, where biopsies are now undertaken virtually painlessly through the ‘perineum’.

“Moving biopsies out of the operating theatre and into nurse-led local outpatient clinics also frees up theatre time.”

Bolomytis adds: “The evidence is clear: this has a vastly-positive impact on both patient experience and hospital resources.”

“Along with improved accuracy and reduced risk of infection, we are working with scientists at the University of Bristol to develop a biopsy technique to surpass others in accuracy, in turn reducing the need for unnecessary biopsies.”

The TRexit initiative aims to change the existing paradigm of outpatient prostate cancer diagnostics for transrectal prostate biopsies to transperineal biopsies.

It is backed by leading urologists from around the country, as well as Prostate Cancer UK and the British Association of Urological Nurses (BAUN).

Since January 2019, when Bolomytis and Professor Persad first started using the PrecisionPoint Transperineal Access System at the Bristol Urological Institute, the team has carried out 1,100 biopsies.

The evidence is clear: this has a vastly-positive impact on both patient experience and hospital resources

Beatriz Mora, a surgical care practitioner at the Bristol Urological Institute at Southmead Hospital, has undertaken 120 of these biopsies and said: “My role is both an interesting and evolutionary one.

“I work in clinical practice as a member of the extended surgical team and perform surgical intervention, pre-operative care, and post-operative care under the direction and supervision of a consultant surgeon.

“It’s been a privilege to have the opportunity to enhance patient care and support the department in maintaining our prostate cancer services during the COVID-19 pandemic and lay a foundation for a better prostate cancer pathway moving forward.”

The South West Cancer Alliances are made up of the Peninsula Alliance covering Devon and Cornwall and the Somerset, Wiltshire, Avon and Gloucestershire Alliance and they aim to have fully eradicated TRUS biopsies by the end of the year.

Sarah-Jane Davies, programme manager at Peninsula Cancer Alliance, said: “The significant benefits that transperineal biopsies offer over TRUS have been recognised for some time.

“The challenge has been to adopt them within an outpatient setting, something that is now achievable with the latest PrecisionPoint methodology.

“We are delighted of the progress the South West has made in making this technology available to patients, healthcare professionals, and the local healthcare economy.”

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