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New urology procedure could ease pressures on theatre slots

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Edinburgh’s Western General Hospital has announced a new procedure to replace the general anaesthetic grid template prostate cancer biopsy procedure with a new, transperineal method carried out under local anaesthetic with the PrecisionPoint™ freehand access system.

With increased pressure on general anaesthetic theatre slots and the need to maintain essential cancer services during the current pandemic, the Western General was able to prove a ‘test of change’ case for prostate cancer patients with anterior prostate cancers, as well as patients with a prior negative TRUS biopsy result; those at risk of sepsis; and those with high PSA density in a large prostate. 

The hospital now carries out approximately 25 per cent of its prostate cancer biopsies – totalling over 100 procedures since March – using LA TP with PrecisionPoint, with no incidents of sepsis and no patients being admitted following the procedure to date. 

And patient feedback is highly positive, with patients almost all agreeing the procedure was tolerable and all but one patient out of nearly 50 who had previously had a TRUS biopsy saying it is more tolerable.

Daniel Good, Consultant Urological Surgeon at the Western General Hospital, who developed the initial business case and led the change programme, said: “As a final year registrar in 2019, I came across the PrecisionPoint LA TP method and became interested in the potential of introducing it to the hospital. 

“We know that trans-rectal ultrasound guided (TRUS) biopsies have limitations: they only sample a small volume in comparison to the rest of the gland, can miss prostate cancers which can lead to over and under-treatment of prostate cancer, and carry risks including serious infection.

“Particularly for men with anterior prostate cancer and men with other complications, this means waiting a lot longer than average because historically the alternative grid template method has required GA theatre time, obviously even more undesirable under current circumstances.”

During the ‘test of change’ phase, Daniel and two colleagues, John Brush, a senior radiologist and Tom Watcyn-Jones, a speciality doctor in urology, were trained up and undertook an initial, supervised six biopsies using the PrecisionPoint transperineal access system. After a second set of 15 biopsies, the team was able to prove that the technique was safe, tolerable to patients and providing accurate diagnoses on the anterior lesions.

Daniel Good added: “Even though we don’t have a high rate of hospital admission from TRUS biopsies for sepsis, it is still around 2-3 per cent. It has been very pleasing to have had no episodes of sepsis or UTIs since we started.

“It has been impressive to see how quickly Trusts in England have embraced the TRexit initiative. This will likely be somewhat more difficult in Scotland. However, with the training so accessible and the procedure so quick to learn, part of our next phase is to train some of our specialist nurses in the technique and to start building the capacity in our Trust which would enable us to go for a full ‘TRexit’ – the eradication of the TRUS biopsy in its entirety.

“Ultimately, I believe we have been able to show that LA TP with PrecisionPoint has the same accuracy as GA template (grid) prostate biopsies,  gives a better patient experience, and has fewer risks. 

“It has to be the way forward. Whilst I feel that the risk of infection and urinary retention is lower with LA TP with PrecisionPoint in comparison to TRUS biopsies, we look forward to the results of the TRANSLATE trial which sets out to answer the question of which is the better technique.”

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