The way prostate cancer biopsies are performed in the UK should change, senior doctors have said.
Delegates at the UK Imaging and Oncology Conference in Liverpool heard that NICE should approve the routine use of transperineal biopsies, replacing transrectal prostate biopsies, which result in about 5% of men developing serious infection.
Dr Oliver Hulson, of Leeds Teaching Hospitals NHS Trust, said NICE delayed its decision to evaluate the clinical evidence and cost-effectiveness of transperineal biopsies.
“In the short-term transperineal biopsies are more expensive than transrectal biopsies, but the medium and long-term benefits to the patient are self-explanatory, and there are significant savings to the NHS in avoiding infection complications,” he said.
“Transperineal biopsies are more sensitive in detecting prostate cancers than transrectal biopsies and they can reach parts of the gland which are traditionally hard to access via the transrectal approach.
“However, the main advantage is that because they don’t take samples through the rectum, there is a much lower chance of infection.”
He added there is strong and growing clinical evidence for transperineal biopsies, with the European Association of Urology confirming it is preferred over transrectal biopsies.
Prostate Cancer UK backed the call, with Chiara De Biase, director of support and influencing at the charity saying: “Transperineal biopsies have been available on the NHS for several years and are a quick and effective way of detecting prostate cancer. “Most importantly, however, they result in fewer cases of infection and sepsis than more traditional TRUS biopsies, and ultimately cause less harm to men.”
The ‘TRexit’ initiative aims to replace transrectal biopsies in the UK and member Dr Rick Popert, of Guy’s & St Thomas’ Hospital, said: “Although transperineal biopsies have been available for many years they required a full general anaesthetic, which meant they were expensive and generated waiting lists.
“Before the pandemic transperineal biopsies accounted for no more than 25% of all prostate biopsies, however the introduction of local anaesthetic minimal access TP biopsies and the Covid pandemic has completely transformed the practice with in the UK.
“Hospitals had reduced access to general anaesthetics, but few wished to risk sepsis related complications of TRUS (transrectal) biopsies.”
He said transperineal biopsy techniques can be adopted by nurse specialists and radiographers, while the most recent Hospital Episode Statistics from April 2022 indicate that TP biopsies now account for 75% of all prostate biopsies.
“The outcome of the NICE review of transperineal biopsies will be of great interest and although there is a concern in some quarters that wholesale introduction of transperineal biopsies is an expensive resource the NHS cannot afford the real question is whether the NHS can afford NOT to do it,” he added.
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