Doctors call for NICE to change guidance on how prostate biopsies are performed
Addressing the UK Imaging and Oncology Conference in Liverpool, Dr Oliver Hulson (Leeds Teaching Hospitals NHS Trust) said:
NICE is currently evaluating the clinical evidence and cost-effectiveness of Transperineal biopsies – their decision was due on 22nd June, but this has been delayed. 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”.
Prostate cancer is the most common cancer in men in the UK, with around 47,000 cases every year, and nearly 12000 annual deaths. By 2030 it will probably be the most common cancer overall in the UK. Testing for prostate cancer requires a biopsy, with Prostate Cancer UK estimating that there are around 190,000 prostate cancer biopsies in the UK every year.
Dr Hulson continued:
“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. Around 5% of men end up with an infection after a transrectal biopsy, and around 1% need hospital treatment. Ideally, patients worried about a possible cancer shouldn’t have to worry about ending up in hospital because of their test”.
Dr Hulson continued:
“The clinical evidence for this novel biopsy technique is strong, and growing all the time. The European Association of Urology has recently issued a statement confirming that “Transperineal biopsies are preferred over transrectal biopsies”. The significant benefits that prostate MRI and Transperineal biopsy offer may mean that we see a targeted screening programme for men at risk of prostate cancer in the not too distant future”.
Chiara De Biase, Director of Support and Influencing at Prostate Cancer UK says:
“Transperineal biopsies have been available on the NHS for several years and are a quick andeffective 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. That’s why we’re pleased that this technique is being made available to men where clinically appropriate. We’re also proud to be working with brilliant clinicians across the country like Dr Hulson, who is helping transform biopsy services for men as one of our new Clinical Champions.”
The ‘TRexit’ initiative aims to replace transrectal biopsies in the UK (this has already happened in Norway). Supporting the call, TRexit member Dr Rick Popert (Guy’s & St Thomas’ Hospital) said:
“The move to eradicate Transrectal Prostate Biopsies from clinical practice and to adopt transperineal biopsies has become known as TRexit. 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
Transperineal biopsy techniques can be adopted by Nurse Specialists and Radiographers, making them easier to provide. 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 are an expensive resource the NHS cannot afford the real question is whether the NHS can afford NOT to do it”.
Source: UK Imaging and Oncology Congress (UKIO)
