A new, independent report from the York Health Economics Consortium (YHEC) on prostate cancer biopsies, has validated the improved health outcomes and economic benefits of the PrecisionPointTM transperineal prostate biopsy methodology under local anaesthetic (LA TP).

The YHEC report, which was commissioned by the NHS Innovation Accelerator (NIA), is an independent validation of data provided by Mr Rick Popert, a 2019 NIA Fellow. Incorporating HES data on transperineal and TRUS biopsies confirms that systematic and targeted LA TP biopsies delivered with the PrecisionPointTM access system are associated with fewer incidents of sepsis and infection; reduced rates of missed diagnoses; and lower input costs in terms of staff and capital resources compared to traditional prostate biopsy methods: transperineal prostate biopsies under general anaesthetic (GA TP) and transrectal biopsies (TRUS). 

The report states: “PrecisionPointTM offers a means of carrying out transperineal prostate biopsies under LA and they can be performed by trained specialist nurses or allied health professionals.  Adoption of this technique can result in savings to NHS trusts that switch from any combination of TRUS and GA TP biopsy approaches.  The amount saved increases in proportion to the percentage of biopsies previously undertaken as GA TP.  There is no reduction in the success rate of taking biopsies with LA TP compared to GA TP and there are fewer complications compared to TRUS biopsies.  This system has been adopted in a large number of NHS Trusts.

During the Covid-19 pandemic, the British Association of Urological Surgeons (BAUS) recommended that both TRUS biopsies and GA procedures be kept to a minimum. This has had a significant impact on the prostate diagnostic pathway.  A survey of 105 centres during the height of the pandemic indicated that LA TP was the preferred method for prostate biopsy by clinicians.  64% of those centres offering GA TP and 60% of those offering TRUS biopsies had to stop prostate biopsies, but only 20% of centres offering LA TP suspended their biopsy service.

The impact of the pandemic on waiting lists following the suspension of routine elective surgery means that the task that lies ahead to recover the NHS elective surgery position is challenging.  The pandemic may have provided the opportunity to increase the uptake of LA TP biopsies nationally as a cost effective alternative to GA TP biopsies, freeing up lists for other elective procedures that were suspended during the pandemic and accelerate a transition away from TRUS biopsy, providing a better and safer outpatient biopsy procedure.”

This independent report from YHEC confirms that the PrecisionPoint TM Transperineal Access System is a cost-effective way to deliver “Better, Safer” prostate biopsies with an estimated Return On Investment (ROI) of 0.51. In other words, for a centre carrying out on average 500 prostate biopsies with 50% as GA TP biopsies and 50% TRUS biopsies for every £1 spent on the PrecisionPointTM LA TP access system, a saving of £1.51 would be made. The work of Rick Popert, consultant urologist and NHS Innovation Accelerator Fellow, supported by the Advanced Nurse Practitioner Jonah Rusere of the South East London Cancer Alliance have spearheaded the UK “TRexit” Initiative to fully transition from TRUS to LA TP. Over the last two years, over 200 urologists, and 95 Clinical Nurse Specialists have attended training courses at Guy’s Hospital. During the Covid-19 Pandemic these training opportunities have been more limited and have been converted to Webinars. A key concept of the “TRexit” Initiative is to expand the support and training of Core Trainees and Advanced Nurse Practitioners in Urology to deliver outpatient LA TP biopsies freeing up the time of Urology Consultants and valuable operating lists. A UK “TRexit” was always going to be ambitious but the increased uptake of Outpatient LA TP biopsies, precipitated by the Covid-19 pandemic, has provided an opportunity rather than a challenge.

The YHEC report and further details on the PrecisionPoint™ transperineal access system can be found here: https://covid19.nhsaccelerator.com/innovation/precisionpoint-transperineal-access-system/