The largest general teaching hospital in the Netherlands, Stadsziekenhuis OLVG, has fully moved away from the traditional transrectal (TRUS) prostate biopsy method, in favour of transperineal biopsy conducted under local anaesthetic (LATP).
Experts say the move has led to a reduction in sepsis and improved diagnostic accuracy.
Since April 2019, a team of three urologists and two urology assistants at the Amsterdam hospital have conducted all prostate biopsies – approximately 10-15 per week – under LATP, with improved health outcomes and clinical cost savings.
In 2018, prostate cancer was found to be the most common male cancer in the Netherlands, accounting for nearly 20 per cent of all cancers diagnosed in men. With millions of new cases each year across Europe, prostate cancer remains the largest cause of male cancer deaths.
Dr. George Van Andel, specialist urologist in diagnostics and metastatic prostate carcinoma at OLVG, has been conducting biopsies and treating men with prostate cancer for over 30 years.
“The traditional method for prostate biopsy has been the transrectal approach, where the needle goes through the wall of the back passage. The biggest problems with the method are urosepsis (average around 3%-5%), poor access to the anterior areas at the base of the prostate and not being able to take systematic prostate biopsies very well,” he said.
“However, until recently there was no cost viable alternative because the alternative approach, the transperineal biopsy, needed to be conducted under a general anaesthetic.”
When Dr. Van Andel and his colleague Dr. B Lagerveld, were introduced to Guy’s & St Thomas’ Rick Popert, the consultant urologist spearheading the ‘TRexit’ initiative to eradicate TRUS biopsy from the prostate cancer pathway in the NHS altogether, they found a game changing solution.
“We were immediately convinced that the PrecisionPoint transperineal biopsy device was a superior method compared to all others,” Dr. Van Andel says.
“Using a freehand approach, PrecisionPoint 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 prostate cancer at an earlier stage of progression, with lower costs and fewer side effects including sepsis.”
Following a series of workshops and the development of a business case, the consultants were able to demonstrate to OLVG’s investment committee and board of directors that LATP represented a substantial improvement in quality of care.
Starting initially with loan equipment, the hospital has now moved over completely to transperineal biopsies under local anaesthetic.
The results to date have been significant. There are significantly fewer complications with urosepsis rates down to under 0.5%, while the clinical hypothesis currently being confirmed is that the accuracy of the diagnosis with LATP has increased significantly.
Dr. Van Andel added: “The method really speaks for itself. Once colleagues see how simple it is to perform the procedures; how most patients see the procedures as comfortable and how precisely can be biopsied, with hardly any complications, they’re sold. We strongly urge wider adoption of this proven technique.”