TREXIT Catalyst: NHS Prostate Biopsy Data during COVID-19

What is it about?

The article discusses the shift towards transperineal biopsy and its benefits over the traditional transrectal approach in terms of reduced sepsis and emergency readmission rates. The European Association of Urology Guidelines now recommend the use of the transperineal approach. Analysis of Hospital Episode Statistics data from 2019 to 2021 during the COVID-19 pandemic showed that the total number of prostate biopsies decreased by 36.3%, with a significant reduction in the number of transrectal biopsies. Transperineal biopsies were found to have lower rates of infection, sepsis, and non-elective readmission compared to transrectal biopsies. The study also highlights the impact of the pandemic on prostate cancer diagnosis, with fewer biopsies being performed and more advanced cancer being detected.

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Why is it important?

This research is important because it provides valuable insights into the impact of the COVID-19 pandemic on prostate biopsy procedures and cancer diagnosis. The study highlights the shift towards transperineal biopsy and the advantages it offers over the traditional transrectal approach. The research also emphasizes the importance of understanding the risk factors associated with complications and readmissions after prostate biopsy. Key Takeaways: 1. The COVID-19 pandemic has had a significant impact on the delivery of cancer services, particularly prostate biopsy procedures. 2. Between 2019 and 2021, there was a 36.3% reduction in the total number of prostate biopsies undertaken, with a substantial decrease in 2020/2021. 3. The proportion of transperineal biopsies increased from 48.0% in 2019/2020 to 52.0% in 2020/2021, with a 150% increase in outpatient transperineal biopsies. 4. Transperineal biopsies have lower rates of sepsis, NEL readmission, and acute urinary retention compared to transrectal biopsies. 5. During the pandemic, the preference was for local anesthetic (LA) transperineal biopsy, which balanced the potential risks of COVID-19 transmission and the risk of delaying the diagnosis and potential treatment of clinically significant prostate cancer. 6. Further research is needed to determine the specific contributing factors to the higher rates of acute urinary retention following transperineal biopsy. 7. The future adoption of pre-biopsy magnetic resonance and real-time ultrasonography-fused imaging may offer improved targeting of lesions and systematic biopsies from the remainder of the peripheral zone, avoiding excessive targeting of the transition zone. 8. The TRANSLATE trial, a UK-based randomized controlled trial comparing transrectal vs LA transperineal biopsy, is eagerly awaited.