The Operating Theatre journal April 2021

The Operating Theatre Journal
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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 nurseled
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 postoperative
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.”
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