CANCE R DIAGNOS TICS
in diagnosis. Patients whose biopsies are delayed are more likely to breach.” He continues: “However, the latest advances in transperineal biopsy – such as PrecisionPoint – have made this technique available under local anaesthetic 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. It represents a safer and more accurate method to detect potential cancer cells at an earlier stage of progression, with lower costs and fewer side effects including sepsis. The procedure has been operational at St. Guy’s & St. Thomas’ Hospital for over two years and has transformed clinical practice. The opportunity to spread this innovation – and
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.
all its inherent gains – across the NHS is something we cannot afford to squander.” A major advantage of the LA TP technique is that it does not need to be carried out by doctors or surgeons – it can also be conducted by nurses in outpatient settings. As such, the emergence of LA TP biopsy presents a fantastic opportunity to put clinical nurse specialists at the forefront of
clinical practice to add huge value to a cancer pathway that – at the national level – is under increasing demand. To make the most of it, urology nurses – particularly those already well-versed in TRUS guided biopsies – require specialist training in LA TP techniques. This training and giving nurses the confidence to carry out the procedure is at the heart of Jonah’s role as ANP for the network.
A Patient perspective: Paul Ricketts’ prostate cancer story
Having lost his father to prostate cancer quite traumatically back in 2000, the disease has never been far from motorcycle mechanic and racing enthusiast Paul Ricketts’ mind. Despite not showing any symptoms at all, it was the memory of his father’s agonising deterioration that prompted Paul to get himself checked out with a PSA test at his local GP surgery in south- east London back in late 2018, at the age of 59.
“My reading came back at 10 ng/mL,” he recalled. “It wasn’t particularly high, but anything over a reading of 4.0 sets off alarm bells, so my GP immediately made me an appointment at Guy’s & St Thomas’ for further tests to take place the following week. “From the point of the initial PSA test result, everything happened very quickly but, at the same time, everything was fully explained to me so I knew what was taking place when and why, and what my options were.” The week after his referral to
Guy’s, Paul had a full day of further investigations, including a physical examination; a blood test; urine test; flow test; and an MRI. Following those results, he then underwent a prostate biopsy, again a week later.
“By this stage, I was pretty certain that I had prostate cancer,” Paul said. “When my father went through it, things seemed pretty random, but my experience was completely different. The consultants had everything mapped out. Using the MRI scan results, they had a good idea of where in the prostate the cancer might be and took 22 samples and targeted the area they thought was affected.”
The biopsy took place in an outpatient setting, using the PrecisionPoint Transperineal Access System. “The biopsy itself was no problem at all,” Paul commented. “In fact, the worst part of it was losing a certain amount of dignity. But to be honest, sacrificing a bit of personal dignity over surviving cancer with no problems, was a no-brainer.
“In fact, the biopsy technique was relatively new to the NHS at the time so my consultant, Mr Rick Popert, asked me if they could video the procedure for training purposes, which I was very comfortable with. I was even happy to give a running commentary, that’s how easy it was.” The biopsy results came through a week
later, confirming that Paul did indeed have prostate cancer. While the cancer was present in both sides of the prostate, it was only marginal on one side and hadn’t spread, giving Paul plenty of treatment options to consider. These options included a surgical removal of the entire prostate, or radical prostatectomy; and low-dose-rate brachytherapy.
“Given what I’d seen my dad go through, I wanted to get the treatment underway, but my consultant advised a four-week ‘cooling off’ period,” Paul said. “This was actually the best thing they could have suggested. Prostate cancer is pretty slow growing, and it gave me time to really research and understand what
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the different treatment options involved and their potential side effects.” Paul chose brachytherapy because, as he explained, “It seemed the least invasive and gave me a sporting chance of living a longer, better quality of life. “I know the cancer won’t fully go away, but that’s fine. Brachytherapy isn’t really new, but the information they gave me was so comprehensive and virtually word-for- word has happened for me – and I’ve had virtually no side effects,” he continued. Paul’s treatment took place on 9 December 2018. “Again, it was all pretty straightforward. It was a day treatment; they did everything they said they would do, and I felt good afterwards. The advances we’ve made since my father went through prostate cancer have been quite incredible.” Over two years later, Paul is confident. “My lifestyle is pretty good. I’m functioning ‘A1’ downstairs and my PSA level is 0.26. The only thing is that I take medication about once a week for pain relief when I urinate, and I don’t drink tea or coffee after 7 or 8pm, otherwise I have to get up more than once in the night. But then, many older men don’t sleep through the night so it’s not a big thing,” he added. Since his diagnosis and treatment, Paul admits he’s been on a mission with friends and family to get themselves checked and he can’t emphasise enough the importance for all men to do so. “Older men are very stubborn and most
haven’t got the reality check they need to get themselves checked out. That’s the most vital thing they can do. For the sake of a simple blood test, if you catch prostate cancer early, you can extend your life by 10 to 15 years.”
AUGUST 2021
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