The South West Cancer Alliance’s Moves Towards Eradication of ‘TRUS’ Prostate Cancer Biopsy

Bristol Urological Institute at Southmead Hospital eradicates all transrectal biopsies in favour of the latest method of transperineal prostate cancer diagnosis 

As part of a national campaign (#TRexit) to completely remove transrectal (TRUS) prostate biopsies from the prostate cancer pathway, the South West of England has, during 2020, widely adopted the PrecisionPoint™ Transperineal Access System, which enables freehand transperineal targeted and systematic prostate biopsies to be conducted under a local anaesthetic in an outpatient setting.

Since January 2020, Mr Stefanos Bolomytis and Professor Raj Persad, Consultant Urologists at North Bristol NHS Trust, and Mr Angus Maccormick, Somerset NHS Foundation Trust, have established a regional service for the roll-out of transperineal biopsies under local anaesthetic (LA TP), with the initiative supported and part-funded by the South West Cancer Alliance’s regional fund.

To date, 40 consultants and clinical nurse specialists across the region have been trained, with outcomes including an overall cancer detection rate of 60.7%, significantly reduced incidence of sepsis, as well as total theatre time and overall cost savings. Indeed, initial audit data suggests theatre time savings of 450 hours and the potential to achieve significant income  and resource benefits compared the traditional TRUS method, are readily achievable.

Professor Persad comments: “Our data highlights the clear benefits of LA TP over TRUS biopsy methods, which include 0% sepsis from the biopsies undertaken at Southmead Hospital and improved cancer detection. “Traditional prostate biopsies involve using a transrectal probe. We know this would put some men off the procedure. This is a thing of the past at Southmead where biopsies are now undertaken virtually painlessly through the ‘perineum’.

“Moving biopsies out of the operating theatre and into nurse-led local outpatient clinics also frees up theatre time.”

Mr Stefanos Bolomytis adds: “The evidence is clear: LA TP has a vastly positive impact on both patient experience and hospital resources.”

“Along with improved accuracy and reduced risk of infection, we are working with scientists at the University of Bristol to develop a biopsy technique to surpass others in accuracy, in turn reducing the need for unnecessary biopsies.”

The TRexit initiative aims to change the existing paradigm of outpatient prostate cancer diagnostics for transrectal prostate biopsies to transperineal biopsies. The initiative is currently backed by leading urologists from around the country, as well as Prostate Cancer UK and the British Association of Urological Nurses (BAUN).

Since January 2019, when Mr Bolomytis and Professor Persad first started using the PrecisionPoint™ Transperineal Access System at the Bristol Urological Institute, the team has carried out 1100 LA TP biopsies.

Beatriz Mora is a Surgical Care Practitioner at the Bristol Urological Institute at Southmead Hospital, who has undertaken 120 of these LA TP biopsies during 2020. She explains: “My role is both an interesting and evolutionary one. I work in clinical practice as a member of the extended surgical team and perform surgical intervention, pre-operative care and post-operative care under the direction and supervision of a Consultant surgeon. It’s been a privilege to have the opportunity to enhance patient care and support the department in maintaining our prostate cancer services through LA TP during the COVID-19 pandemic and lay a foundation for a better prostate cancer pathway moving forward.”

The South West Cancer Alliances are made up of the Peninsula Alliance covering Devon and Cornwall and the Somerset, Wiltshire, Avon and Gloucestershire Alliance who aim to have fully eradicated TRUS biopsies by the end of the year, with adoption of LA TP in all 13 Acute Trusts.

Sarah-Jane Davies, Programme Manager at Peninsula Cancer Alliance, who has supported the adoption of the regional LA TP service across the south-west region, concludes: “The significant benefits that transperineal biopsies offer over TRUS have been recognised for some time. The challenge has been to adopt them within an outpatient setting, something that is now achievable with the latest PrecisionPoint methodology. We are delighted of the progress the south-west has made in making this technology available to patients, healthcare professionals and the local healthcare economy.”