Open Letter to the Rt Hon Matt Hancock MP - Re: Time for ‘TREXIT’

Dear Secretary of State,

Last year Mrs May pledged £75 million funding for prostate cancer research, paving the way for breakthroughs in the diagnosis, treatment and prevention of this most prevalent cancer in men in the UK. The recent NICE Guidance on prostate cancer has made a positive recommendation that all patients referred with suspected prostate cancer should have an MRI scan before a decision is made on prostate biopsy. The NHS has become one of the first health care systems in the world to make such a recommendation.

This is greatly welcomed, as it is well recognised and documented that improved diagnosis is associated with greater treatment options and improved survival rates.

However, 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 – a process whereby the biopsy needle goes through the gut wall of the rectum. This is a technique that was developed over 35 years ago and has hardly changed. It is increasingly recognised that this method has risks compared to the alternative transperineal biopsy – both in terms of inaccurate identification of potential cancer cells as well as increased likelihood of infection associated with the biopsy and the necessity for routine antibiotic use – increasing the risks of the spread of antibiotic resistant microorganisms.

There is now 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%[1].

The transperineal (TP) approach where the biopsy needle is inserted into the prostate through the skin between the scrotum and the anus (perineum), provides a more thorough sampling of the prostate with less risk of infection than transrectal biopsies. Whilst not a new procedure, due to its need for complicated equipment TP has historically been conducted under a general anaesthet