PrecisionPoint Transperineal Access System
Patients with suspected prostate cancer need prostate biopsies to evaluate their cancer risk.
The standard of care for prostate biopsy practice is outpatient transrectal biopsy (needle inserted via the rectum) under local anaesthetic. Transrectal (TRUS) biopsies risk missed-diagnosis, infection and sepsis. Data from Public Health England indicates that 5% of TRUS biopsies develop urinary infection and that prostate biopsy related sepsis accounts for 10% of hospital admissions for sepsis nationally.
Transperineal biopsies (needle inserted through the perineal skin) provide more effective sampling and can virtually eliminate biopsy-related sepsis. However, they are impractical as a primary outpatient procedure because they require complex equipment and a general anaesthetic.
The challenge is to abolish transrectal biopsies across the NHS, to provide a better safer transperineal biopsy under local anaesthetic in outpatients in a timely fashion and free up general anaesthetic lists for other procedures.
The PrecisionPoint™ Transperineal Access System facilitates transperineal biopsies under local anaesthetic rather than general anaesthetic, thereby transforming the standard of care for prostate biopsy practice in the NHS and streamlining the pathway for all. It enables transperineal biopsies to be carried out in outpatients by an Advanced Nurse Practitioners (ANP), avoiding the need for general anaesthetic lists and reducing waiting times; delivering safer and more effective prostate biopsies in a timely fashion optimising cancer diagnostic resources.
Rick has provided outstanding clinical leadership to transform the South East London diagnostic prostate pathway. His vision, expertise and energy has supported the roll out of transperineal biopsies under local anaesthetic at all three South East London acute trusts.Dr Kate Haire, Clinical Director of South East London Cancer Alliance
Guy’s and St Thomas’ Hospital NHS FT stopped all transrectal biopsies in September 2017 and carried out 678 transperineal biopsies up to September 2018 – 60% of these under local anaesthetic.
- The need for general anaesthesia for transperineal prostate biopsies reduced by 70%, with only 11% requiring intravenous sedation so that general anaesthetic lists can be used for other procedures 395 patients (58%) had local anaesthetic transperineal (TP) biopsies, and of these, 168 (42%) were treated in the outpatients, improving the timed prostate cancer pathway and reducing breaches
- Proven post-operative urine infection was identified in only two patients (0.3%)
- Biopsy related income has increased because of a preferential tariff for TP biopsies compared to TRUS biopsies