Four new diagnostic devices for men with suspected prostate
cancer, which reduce the chances of biopsy related sepsis, have
been recommended for use by NICE.
The new diagnostics guidance looks at local anaesthetic
transperineal (LATP) prostate biopsy, using the freehand needle
positioning devices PrecisionPoint, EZU-PA3U device, Trinity
Perine Grid, and UA1232 puncture attachment, which are
recommended as options for helping to diagnose prostate cancer.
Prostate cancer is the most diagnosed cancer in men in the UK
according to Cancer Research UK. It mainly affects people over 50
and the risk is higher for people of African family background
and people with a family history of prostate cancer.
At present NICE guidance recommends offering people with
suspected clinically localised prostate cancer a multiparametric
MRI as the first-line investigation.
If prostate cancer is still suspected based on the MRI image, a
prostate biopsy is offered so that samples of the prostate can be
collected for analysis. There are two ways of doing a prostate
biopsy. In a transrectal ultrasound guided (TRUS) biopsy samples
are collected using a biopsy needle inserted through the rectal
wall via the anus.
However TRUS can be associated with serious infections, sometimes
requiring hospital admission and antibiotics.
In a LATP biopsy, the needle enters the body through the
perineum, the skin area between the anus and the scrotum. A
freehand needle positioning device can be used for LATP – these
devices attach to the ultrasound probe to help target biopsy
sampling. This could greatly reduce the risk of biopsy-related
sepsis compared with a TRUS biopsy, and therefore may reduce
hospital admissions and the need for preventive antibiotics.
Both diagnostic procedures take place under local anaesthetic.
Evidence presented to the committee suggested that the detection
rates of cancer did not differ significantly between a TRUS
biopsy and an LATP biopsy using a freehand needle positioning
device.
The economic modelling showed that LATP is likely to be a
cost-effective use of NHS resources.
Dr Mark Kroese, chair of the NICE diagnostics advisory
committee, said: “People with suspected prostate cancer
can now have a different option when it comes to having a biopsy.
“The committee heard from patient experts that there are concerns
they are not getting clear and accurate information about having
a biopsy, they are worried about an associated risk of infection,
and the severity and duration of side effects.
“LATP using a freehand needle positioning device for taking a
prostate biopsy should reduce unnecessary infections and
therefore antibiotic use, benefitting both the patient and the
NHS.”
The guidance also recommends clinicians are encouraged to ask
people with suspected prostate cancer to sign up to the ongoing
TRANSLATE clinical trial which will provide further comparative
evidence on prostate biopsy tests.
ENDS
About the guidance
- The draft guidance will be available at https://www.nice.org.uk/guidance/indevelopment/gid-dg10043
from Tuesday 15 February 2022.
