Forget Brexit, it’s all about TRexit – and urology nurses are leading the way

Forget Brexit, it’s all about TRexit – and urology nurses are leading the way

Jonah Rusere, Advanced Nurse Practitioner for South East London Accountable Cancer Network, outlines an opportunity for urology nurses to make a difference to prostate cancer pathways.

Everyone knows that Brexit didn’t happen on the 29th March, 2019. But ‘TRexit’ did – and it’s great news for prostate cancer patients all over the country. Confused? Let me explain. TRexit is the name given to a national initiative for hospitals to phase out TRUS biopsies and replace them with transperineal biopsies under local anaesthetic (LA TP). The roots of the initiative are in South East London Accountable Cancer Network, where hospitals set a deadline of 29th March – the original ‘Brexit Day’ – to eliminate TRUS procedures. Thankfully, unlike our politicians, we’ve delivered on that promise: TRUS biopsies have left the building, and in their place, LA TP biopsies are being safely carried out by nurses and clinicians in outpatient settings.

It’s a great story – and it’s one that once again underlines the important role that urology nurses play along the prostate cancer pathway. Ultimately, greater adoption of LA TP paves the way for Advanced Nurse Practitioners to provide even greater value in the delivery of safe, timely and efficient care, fuelling a better patient experience and better patient outcomes. For urology nurses, ever passionate about patient care, this is our opportunity to drive positive change and make a difference. These are exciting times for the profession.

The urology pathway story at South East London (SEL) Accountable Cancer Network is a great example of collaborative, multi-disciplinary change management. I’m proud to be playing my part. Last November, having been a urology Clinical Nurse Specialist (CNS) in London for many years, I took on a new role as an Advanced Nurse Practitioner (ANP) for the network on a one-year secondment to establish fully operational LA TP clinics across all our hospitals; Guy’s & St. Thomas’, King’s College, Queen Elizabeth Lewisham & Greenwich, Beckenham Beacon and the Princess Royal University. The appointment, championed by consultant urologist and NHS Innovation Accelerator Mr Rick Popert, made me the first ANP to work for the whole Network, rather than a single trust. Mr Popert is a leading advocate of LA TP biopsies and has done much to raise awareness of their clinical and operational benefits.

It’s increasingly recognised that there are risks in traditional TRUS biopsies compared to LA TP; there’s evidence that TRUS biopsies can yield inaccuracies in identifying potential cancer cells, while the nature of the procedure brings an increased likelihood of infection. Uptake of the alternative, transperineal (TP) approach - while providing a more thorough sampling of the prostate with less risk of infection - has historically been hampered by its need to be conducted under a general anaesthetic, leading to increased costs, longer waiting lists and subsequent delays in diagnosis. Patients whose biopsies are delayed are more likely to breach.

However, the latest advances in transperineal biopsy – such as PrecisionPoint – have made this technique available under local anaesthetic through a freehand approach that allows the practitioner to freely manoeuvre the ultrasound probe to align the access needle to target the desired locations with certainty for targeted and systematic biopsies. It represents a safer and more accurate method to detect potential cancer cells at an earlier stage of progression, with lower costs and fewer side effects including sepsis. The procedure has been operational at St. Guy’s & St. Thomas’ Hospital for over a year and has transformed clinical practice. The opportunity to spread this innovation – and all its inherent gains – across the NHS is something we cannot afford to squander.

A major advantage of the PrecisionPoint technique is that it does not need to be carried out by doctors or surgeons – it can also be conducted by nurses in outpatient settings. As such, the emergence of LA TP biopsy presents a fantastic opportunity to put clinical nurse specialists at the forefront of clinical practice to add huge value to a cancer pathway that – at the national level – i