CANCE R DIAGNOS TICS
TRexit: tackling delays in cancer diagnosis
‘TRexit’ is a national initiative that could see a move away from transrectal (TRUS) biopsy, requiring an anaesthetic, to performing transperineal biopsy under local anaesthetic. Technology developments in this field have the potential to lower costs, shorten waiting lists and improve patient safety.
Statistics1 released by NHS England
have shown that hundreds of thousands of patients across the country are now waiting more than a year to receive hospital treatment – a direct result of the COVID-19 pandemic. Many of these include cancer patients. Analysis of NHS England data2 shows that 1.85 million urgent cancer referrals were made by GPs between March last year and January this year – a 16% drop on the 2.2 million in the same period the year before.
This backlog is concerning to many healthcare professionals, with a recent survey3
finding that 70% of respondents are concerned about the backlog of procedures at their hospital Trust, and 68% believing that delays to surgical procedures are having a negative impact on patient outcomes. However, the backlog is not just associated with treatment for patients diagnosed with cancer. In many cases – and particularly with regard to prostate cancer, where symptoms may be ignored due to sensitivity and/or simply considered a bi-product of ageing – patients may have put off getting diagnosed out of an unwillingness to put pressure on NHS resources, or out of fear to go into a hospital setting and being exposed to the virus. When it comes to prostate cancer, the current standard practice is for most men to be offered a transrectal (TRUS) biopsy. Yet, the procedure has a high risk of sepsis, serious infection and bleeding, as well as inaccurate identification of potential cancer cells. The alternative transperineal or template (TP) biopsy has, in the past, typically only been available to men at greater risk of infection from certain medical conditions and had to be done under general anaesthetic because of the need for multiple biopsy punctures. Now the picture has changed.
AUGUST 2021
of 29 March 2020 – to eliminate TRUS procedures, and in their place, LA TP biopsies are being safely carried out by nurses and clinicians in outpatient settings – which was a success. Jonah Rusere, advanced nurse practitioner for South East London Accountable Cancer Network, explains how this makes a difference to prostate cancer pathways: “The urology pathway story at South
Saheed Rashid, BXTAccelyon
The prostate biopsy no longer has to wait, despite continued pressure on hospital resources. With the latest methodology, such as the PrecisionPoint transperineal access system, prostate biopsies can be conducted under local anaesthetic (LA TP), in an outpatient setting, minimising the impact on theatre space and hospital beds, while maximising patient safety. Saheed Rashid, managing director at
BXTAccelyon highlights that it is imperative that patients, GPs and specialists act now to ensure the backlog of potential cancer referrals does not continue, and that they use innovative solutions in order to undertake safer, better and more accurate biopsies.
What is TRexit? TRexit is the name given to a national initiative for hospitals to phase out TRUS biopsies and replace them with transperineal biopsies under local anaesthetic (LA TP). The roots of the initiative lie in the South East London Accountable Cancer Network, where hospitals previously set a deadline
East London (SEL) Accountable Cancer Network is a great example of collaborative, multi-disciplinary change management. Last November, having been a urology Clinical Nurse Specialist (CNS) in London for many years, I took on a new role as an Advanced Nurse Practitioner (ANP) for the network on a one-year secondment to establish fully operational LA TP clinics across all our hospitals; Guy’s & St. Thomas’, King’s College, Queen Elizabeth Lewisham & Greenwich, Beckenham Beacon and the Princess Royal University. The appointment, championed by consultant urologist and NHS Innovation Accelerator Mr Rick Popert, made me the first ANP to work for the whole Network, rather than a single Trust. Mr Popert is a leading advocate of LA TP biopsies and has done much to raise awareness of their clinical and operational benefits.
“It’s increasingly recognised that there are risks in traditional TRUS biopsies compared to LA TP; there’s evidence that TRUS biopsies can yield inaccuracies in identifying potential cancer cells, while the nature of the procedure brings an increased likelihood of infection. Uptake of the alternative, transperineal (TP) approach – while providing a more thorough sampling of the prostate with less risk of infection – has historically been hampered by its need to be conducted under a general anaesthetic, leading to increased costs, longer waiting lists and subsequent delays
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