The Trexit initiative: transperineal prostate biopsies under local anaesthetic
A new, safer and more comfortable biopsy technique for detecting prostate cancer has been rolled-out to hospitals across south-east London.
The Precision Point transperineal biopsy, introduced by NHS Innovation Accelerator Fellow Rick Popert, Consultant Urologist at Guy’s and St Thomas’ NHS FT (GSTT), replaces the transrectal biopsy – proving faster diagnosis and reducing discomfort for patients.
There are around 40,000 new prostate cancer diagnoses each year in the UK, with two types of biopsies – the transrectal and the transperineal – used to detect abnormal cells and determine the severity of the condition.
The transrectal biopsy has a greater risk of severe infection and the transperineal biopsy is considered to be better, safer and more comprehensive. However, the transperineal biopsy has previously required a general anaesthetic – resulting in delays to the patient pathway. Mr Popert’s new precision-point transperineal technique allows comprehensive and targeted biopsies using just two single skin punctures, delivered under local anaesthetic.
The technique was first adopted by GSTT in September 2017, replacing the transrectal biopsies. The intention was to roll out the new technique across the network by 29th March 2019 – a plan dubbed ‘Trexit’ due to its coinciding with the UK’s intended departure from the European Union.
While Brexit has been postponed, Trexit has been implemented ahead of schedule, with full network coverage achieved on 7th March.
Key to this achievement is the work of Advanced Nurse Practitioner, Jonah Rusere, who has been travelling across the south-east London network, setting up local anaesthetic transperineal biopsy services.
Having successfully rolled-out the new technique in south-east London, the team now hopes to extend the initiative across the NHS. The ultimate aim is to make the NHS the first health system in the world to abandon transrectal prostate biopsies.
Case study: spread to Lewisham and Greenwich NHS Trust
Lewisham and Greenwich NHS Trust has completely phased out the standard transrectal prostate biopsy and replaced it with the gold standard transperineal biopsy.
Mr Mohamed Hammadeh, Consultant Urology Surgeon and Clinical Director of Urology, said:
“It is wonderful that we can offer patients this service. This is a more accurate way of testing for cancer than the standard transrectal biopsies, which we have phased out. We can now offer biopsies under local or sedation anaesthesia, depending on the patient’s preference.”
“This development is thanks to great work from our staff, our management team in the surgery division, our partners in the South East London Cancer Network, and the urology department at Guys and St Thomas’ NHS Foundation Trust, who provided training for our staff.”
More information about the Precision Point transperineal biopsy is available here.