INNOVAT ION
Reducing risks of prostate biopsy
Dr. Alice Green, Health Enterprise East (HEE), provides an insight into innovation in prostate biopsy that could reduce the risk of infection and make diagnosis safer for patients.
With more than 47,500 men diagnosed each year, prostate cancer is the most diagnosed male cancer in the UK, representing around 25% of all male cancers in the UK. The current mainstay method of diagnosing prostate cancer is with a needle biopsy of the prostate guided by a transrectal (TRUS) ultrasound probe inserted into the rectum. This method is commonly referred to as a transrectal ultrasound guided prostate biopsy (TRUSBx).
The problem, however, is that the TRUSBx method for prostate biopsies carries a significant risk of harmful side effects. This is because the needle traverses the rectal wall a number of times on the way to the prostate, which poses a large risk of infection. Despite preventative antibiotics, bacteria in the bowel inevitably enter the urinary system and blood stream, meaning a number of men develop infections. In addition to the clinical ramifications this has for the patients, 10% report fever and chills and 1-2% severe sepsis, which both come with significant cost associations. In
fact, costs associated with UK hospitalisation episodes for biopsy-related sepsis alone are estimated to be £7-11 million annually. With the number of men being referred increasing each year combined with the rise in antibiotic resistance, a new long-term method for carrying out prostate biopsies is urgently required.
The solution
The need for a safe, simple and affordable method for taking prostate biopsies prompted the development of the Cambridge Prostate Biopsy Device – the CamProbe. Mr Gnanapragasam and colleagues at the University of Cambridge and Cambridge University Hospitals NHS Trust, set out to develop a new device that could safely access the prostate through the perineum
It was hoped that by designing a low-cost device that could be deployed through the transperineal route this would significantly reduce the risk of infection in these men while still being a well-tolerated procedure under local anaesthetic in an outpatient setting.
FEBRUARY 2021
(the area under the testicles) instead of via the current trans-rectal route. Transperineal biopsies are not a new concept but, in the UK at the time, there was a lack of a fast, well tolerated method that yielded adequate clinical samples for testing when using the transperineal access route. While it was well documented that this route has a significantly lower risk of infection, there was no device available to clinicians to make this procedure simple and easy to perform. Instead, two options were in existence. The first was to access the perineum while the patient was under general anaesthesia (GA). However, this had problems with lengthy patient pre-preparation, as well as the additional risks posed by patients undergoing a GA. The second method was a free-hand ‘fan technique’ under local anaesthesia (LA). However, this procedure was not standardised, nor commonly practiced in the UK. For this reason, Mr Gnanapragasam wanted to develop a device that allowed surgeons to confidently access the perineum, with the least amount of pain possible with just an LA. It was hoped that, by designing a low-cost device that could be deployed through the transperineal route, this would significantly reduce the risk of infection in these men while still being a well-tolerated
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