Centralising a Nurse-Led Local Anaesthetic Transperineal Biopsy Service during COVID-19 Pandemic

What is it about?

The study describes the successful implementation of a centralized, nurse-led transperineal (TP) biopsy service for prostate cancer diagnosis in the United Kingdom. The service was implemented in response to guidelines issued by the British Association of Urological Surgeons Section of Oncology during the COVID-19 pandemic, which reduced the use of general anesthesia and initiated COVID-secure 'green' site diagnostics. The TP biopsy service was carried out by urology advanced nurse practitioners under local anesthesia, with a select few occurring under general anesthesia. The service was successful in improving waiting times for prostate cancer diagnostics and freeing up valuable resources and staff. The results showed a significant reduction in waiting time for biopsies before and after the implementation of the new service. The study also found that the use of antibiotics was reduced to less than 3% of cases, and there were no admissions for post-biopsy sepsis. Additionally, the study suggests that converting to a nurse-led LA TP approach could save the trust money in the long term while ensuring advanced nurse practitioners can use their specialist skills to their full potential.

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Why is it important?

The research is important because it highlights the successful implementation of a centralized, nurse-led transperineal biopsy service in a procedural unit, which has improved the efficiency and performance of the service while reducing waiting times for patients. This change from transrectal ultrasound-guided biopsies to transperineal biopsies has significant benefits, including a lower risk of sepsis, increased detection rates of cancer in the anterior prostate, and a higher sensitivity in diagnosing Gleason 3 + 4 and Gleason 4 + 3 prostate adenocarcinoma when used with multiparametric magnetic resonance imaging (mpMRI). Key Takeaways: 1. The research successfully implemented a centralized, nurse-led transperineal biopsy service, which improved the efficiency and performance of the service. 2. The service has been sustainable and efficient, with a significant reduction in waiting times for patients. 3. Transperineal biopsies have several advantages over transrectal ultrasound-guided biopsies, including a lower risk of sepsis and higher detection rates of cancer in the anterior prostate. 4. The research highlights the importance of quality improvement methodology and the usefulness of run charts in monitoring and evaluating the impact of new services over time. 5. The implementation of this service has the potential to save resources and money in the long term by freeing up theatres, anaesthetists, operating department theatres, scrub nurses, and urologists. 6. Further randomised control trials would be useful to determine parity in accuracy between local anaesthesia transperineal biopsies and general anaesthesia transperineal biopsies.