A new research paper recently published in the peer-reviewed urology journal, BJU International, gives further weight to the eradication of the transrectal (TR) prostate biopsy from the prostate cancer pathway.

The study, in which the authors evaluated nearly half a million prostate biopsies in the NHS over the last decade, gives sufficient evidence for the distinct advantages of the transperineal (TP) route over the TR route in terms of reduced infections and burden of expenditure. In addition, the authors conclude that there is a potential for savings both in upstream and downstream costs if biopsy is performed under a local anaesthetic, which is now possible in an outpatient setting.

Consultants from the Department of Urology, East and North Hertfordshire NHS Trust, and Guy’s and Saint Thomas’ NHS Foundation Trust, analysed national Hospital Episode Statistics (HES) data on the 86,467 prostate biopsies conducted in the NHS between 2008 and 2019.

Of the 387,879 TR and 98,588 TP biopsies, rates of infection and sepsis were higher for men who had undergone transrectal biopsies, where the biopsy needle passes through the faecally contaminated rectal wall, compared to those who had transperineal biopsies.

The cost estimates for non-elective readmissions for the entire decade were £33,589,527.00 and £7,179,926.00 respectively, for transrectal and transperineal cohorts, with the estimated costs per patient readmission were £2,225.00 and £1,758.00 respectively.

As prostate cancer incidence and prevalence rise every decade, the scope for diagnosis and treatment is expanding every year. With an estimated 12% increase between 2014 and 2035, translating to around 233 cases of prostate cancer per 100,000 men by 2035, the importance of better and safer biopsies is clear.

Historically, transperineal biopsies have needed to be carried out under general anaesthetic, accounting for the smaller number compared to transrectal biopsy. However, new innovations mean that TP biopsies can now be carried out under local anaesthetic in an outpatient setting.

The study calculates that – considering estimations for the upstream cost of the biopsy procedures throughout the decade – the approximate cost incurred by the NHS for all these biopsies would be nearly £243,335,084 as per the UK national tariff system for 2019– 2020. However, if all the biopsies were carried out via a local anaesthetic TP route, approximate upstream costs would have been £182,425,125.00, translating into an upstream saving of approximately £60,909,959.00 in comparison to the current estimated expenditure.

In conclusion, in addition to patient safety implications, transperineal biopsies under local anaesthetic offer a substantial cost saving for the NHS and UK tax payers.