Oncology
waiting lists and subsequent delays in diagnosis.” He continues: “The latest developments in
transperineal biopsies – 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 more accurate and safer 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 three years and has transformed clinical practice.” One of the major benefits of the LA TP
technique is that it does not need to be carried out by doctors or surgeons, as it can be conducted by nurses in outpatient settings. The emergence of LA TP biopsy, therefore, presents a brilliant 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 pressure. Moreover, the TRexit initiative is not restricted
to South-East London – it’s a national initiative, designed to support and drive the adoption of LA TP across the entire NHS. To support this transition, advocates have developed a BAUN accredited national training programme to increase the number of NHS nurses skilled in LA TP. 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. With the consensus and support of leading urologists, clinical nurse specialists and thought leaders in prostate cancer diagnosis, TRexit is building a national – indeed, international – momentum that is helping other hospitals, such as those across the South-West Cancer Alliances, replicate that SEL success.
The South-West eradicates TRUS biopsies
Over the past two years, the South-West of England has widely adopted the PrecisionPoint Transperineal Access System. The South-West Cancer Alliances are made up of the Peninsula Alliance, covering Devon and Cornwall, and the Somerset, Wiltshire, Avon and Gloucestershire Alliance. Since January 2020, Mr Stefanos Bolomytis
and Professor Raj Persad, Consultant Urologists at North Bristol NHS Trust, and Mr Angus Maccormick, formerly of Somerset NHS Foundation Trust, have established a regional service for the roll-out of LA TP, with the initiative supported and part-funded by the South-West Cancer Alliance’s regional fund.
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The regional initiative started at Southmead Hospital, where having conducted a total of 14,000 TRUS prostate biopsies over the years, in September 2019 the hospital moved to a default of LA TP. Since then, the hospital’s first 755 cases have seen no evidence of sepsis and just three cases of retention. Moreover, at Somerset NHS Foundation Trust,
of 410 procedures carried out by Mr Maccormick, there have been only three general anaesthetic transperineal biopsies, and one general anaesthetic template biopsy. Here, the overall cancer detection rate with LA TP was 76% (as opposed to 70% for TRUS biopsies,) and 72% of patients had a Gleason score of 3+4 and above. Additionally, at Somerset NHS Foundation
Trust, from September 2019 to January 2020, antibiotic prophylaxis was given before LA TP prostate biopsies (n=149). Following a change to routine care, from January to July 2020, prophylactic antibiotics were not given before LA TP prostate biopsies (n=164). In turn, a comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation. The results found that patient and disease
characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of prostate biopsy and prostate cancer cohorts described in urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis – with the overall complication rate being 0.64%, and 0.61% for those not receiving antibiotic prophylaxis.
Additionally, there were no severe complications (clavien-dindo3-4
), with unplanned hospital
admissions being at a low rate of 0.64%. Mr Angus Maccormick comments: “Our
retrospective cohort of patients undergoing LA TP prostate biopsies is the largest UK series to date. Our data highlights the clear benefits of LA TP over TRUS biopsy methods, which includes a high rate of cancer detection, and a very low complication rate. Overall, there were no infection-related complications in patients who did not receive antibiotic prophylaxis, which is supporting evidence towards the widespread discontinuation of routine prophylactic antibiotics before transperineal prostate biopsies. This is important given the context of increasing antibiotic resistance globally – with WHO declaring that AMR (Antimicrobial resistance) is one of the top ten global public health threats facing humanity.”4
A patient perspective: Angus Watson’s prostate cancer story Angus Watson, a 61-year-old man from Scotland, did not show any symptoms of prostate cancer. In fact, he only went to his local GP back in 2020 due to having signs of a hernia. However, his doctor, who was in training at the time, asked him whether he had any family history of prostate complications – and this is when he revealed that a close relative had prostate cancer. The trainee-GP advised Angus to undertake
a prostate-specific antigen (PSA) blood test, which came back with a low-borderline score of 2.66ng/ml. Typically, levels over 4 ng/ml are
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