A group of doctors is calling on health secretary Matt Hancock to stream some of the recently announced £75 million funding for prostate cancer into greater provision of a new method for diagnosing the condition.
Last December the National Institute for Health and Care Excellence (NICE) announced that men at risk of prostate cancer could be spared needless surgery, as it recommended a non-invasive MRI scan as a first-line investigation for people with suspected clinically localised prostate cancer. The NHS became one of the first health care systems in the world to make such a recommendation.
In an open letter to health secretary Matt Hancock MP, a collection of medical professionals “greatly welcomed" this development, as it is "well recognised and documented that improved diagnosis is associated with greater treatment options and improved survival rates.”
However, the letter goes on to say “whilst the use of MRI in the prostate cancer pathway has seen significant advances in recent years, the current ‘de facto’ standard method for prostate cancer diagnosis in the UK remains the transrectal ultrasound (TRUS) guided or transrectal biopsy”.
This is a process that involves a biopsy needle going through the gut wall of the rectum, a technique that was developed over 35 years ago and has hardly changed since.
The letter details an “effective alternative solution that allows more accurate, safer biopsies and could facilitate the elimination of the use of antibiotics and make this the single largest contributor to the NHS target to reduce gram negative septicaemia by 50%.”
Over the last year, Guy’s & St Thomas’ Hospital has adopted the transperineal approach where the biopsy needle is inserted into the prostate through the skin between the scrotum and the anus (perineum), providing a more thorough sampling of the prostate with less risk of infection than transrectal biopsies.
They have stopped transrectal prostate biopsies altogether and are now able to deliver outpatient based transperineal biopsies in a timely fashion within the confines of the timed prostate cancer pathway. The whole initiative is called ‘TREXIT’.
The letter calls upon the health secretary "to allocate some of the £75 million funding for prostate cancer research to support us in the scaling up and rolling out of this proven methodology to deliver TREXIT.”
The long-term ambition is to have delivered a UK TREXIT by 2023, and become the first health care system in the world to not only offer pre-biopsy MRI but to also abandon the transrectal (or transfaecal) biopsy.