Oncology
South-West eradicates TRUS biopsies
Transrectal (TRUS) biopsies can yield inaccuracies in identifying potential cancer cells, while the nature of the procedure brings an increased likelihood of infection. Efforts are underway to phase out the procedure and Trusts are moving to alternative approaches. Over the past two years, the South-West of England has widely adopted the PrecisionPoint Transperineal Access.
The waiting list for NHS hospital care in England has reached the highest total since records began in 2007,1
with the number of people
waiting for surgery or other procedures rising above 7.2 million. Many of these include cancer patients, as a recent analysis2
from Macmillan
Cancer Support reveals that the backlog in cancer treatment in England is set to last until September 2027 – with delays caused by the ongoing disruption from COVID-19 and existing NHS pressures. However, the backlog is not only associated with patients diagnosed with cancer and now waiting for their treatment. Frequently, patients may put off going to their GP or hospital out of fear of being exposed to COVID-19, or out of an unwillingness to put more demand on NHS resources. Currently, the NHS and Prostate Cancer UK believe that there are approximately 14,000 “missing men”3
in England, who may be
unaware that they have prostate cancer, and the concern is that this number is only going to increase. At the time of writing, the current standard
What is TRexit? TRexit is a national initiative for hospitals to phase out TRUS biopsies and replace them with transperineal biopsies under local anaesthetic
practice for prostate cancer is for most men to be offered a transrectal (TRUS) biopsy. Yet, the procedure has a high risk of serious infection, sepsis and bleeding, as well as inaccurate identification of suspected cancer cells. Alternatively, the transperineal or template (TP) biopsy has, in the past, typically only been available to men at greater risk of infection from specific medical conditions and had to be performed under a general anaesthetic, due to the requirement for multiple biopsy punctures. Now, the landscape has changed. However, with the latest methodology, such
as the PrecisionPoint transperineal access system, prostate biopsies can now be conducted under local anaesthetic (LA TP), in an outpatient setting, removing the need for theatre space and hospital beds, while maximising patient safety and bettering outcomes.
(LA TP). The roots of the initiative lie in the South- East London Accountable Cancer Network, where hospitals previously (and successfully) set a deadline of 29 March 2020 to eliminate TRUS procedures. In their place, LA TP biopsies are being safely carried out by nurses and clinicians in outpatient settings. Jonah Rusere, advanced nurse practitioner
for South-East London Accountable Cancer Network, explains how moving to LA TP biopsies makes a monumental difference and improvement to prostate cancer pathways: “The urology pathway story at South-East London (SEL) Accountable Cancer Network is a great example of collaborative, multi-disciplinary change management. Having been a urology clinical nurse specialist (CNS) in London for many years, I took on a new role in November 2020 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 – with increasing 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
February 2023 I
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