On Tuesday 17^th November, we were delighted to attend a presentation by Rick Popert, Consultant Urologist, Guy’s and St Thomas’ Hospital and a Fellow on the NHS Innovation Accelerator, and Advanced Nurse Practitioner, Jonah Rusere, at the annual – albeit virtual – conference of the British Association of Urological Nurses (BAUN).

Rick and Jonah’s joint presentation discussed Local Anaesthetic Transperineal (LA TP) Prostate Biopsy as it relates to nursing practice. Specifically, this includes an understanding of safe LA TP within an outpatient setting and how the free hand transperineal approach can optimise systemic and targeted sampling of the peripheral zone of the prostate.

As Rick Popert commented: “The current prostate cancer diagnostic pathway was predicated on transrectal biopsies and we know that these have a tendency to undersample the anterior prostate. We know they are associated with the risk of sepsis. This is why we have started a UK-wide initiative – “TRexit” – to exit transrectal biopsies.”

However, transperineal biopsy under general anaesthetic generates waiting lists and delays to the patient pathway. TP grid based biopsies under local anaesthetic are limited to small areas that can be targeted, are not really practical, and are considered “tolerable”, but not “comfortable”.

He continued: “I genuinely thought there was no solution until I was introduced to a new technique, the PrecisionPoint™ Transperineal Access System, which allows you to do LA TP systematic and targeted biopsy, but in an outpatient setting.”

At the time, Jonah Rusere had been conducting all TRUS biopsies at Guy’s and St Thomas’ Hospital. When the Trust decided to stop these in September 2017, it started him on a revolutionary career path, starting with retraining in LA TP biopsy and since teaching and training others, supporting Guy’s own service and supporting wider pathway transformation.

Together, Rick and Jonah developed an LA TP biopsy course, specifically designed for nurses and registrars. The first course took place on 9^th February 2018, endorsed by BAUN and supported by Prostate Cancer UK. To date, 95 nurses have been trained in LA TP.

The team also expanded the service by giving nurses across the UK the opportunity to shadow and follow the list at Guy’s, and then providing them support in starting their own list at their local hospital. 15 Nurses across the country have been trained in this way, who are now independently delivering the service in outpatients.

Jonah concluded: “Our experience at Guy’s shows that nurses are key to achieving “TRexit”, as they are the ones delivering the majority of the work in outpatients. Our objective for the future is to continue to support nurses across the country to allow us to fully eradicate TRUS biopsies from the patient pathway.”

To listen to the full presentation and hear more about Jonah’s journey, please visit the BAUN conference website.