Introducing a safe, efficient streamlined biopsy service model in a high-volume centre.

Abstract

Background: Delays to prostate cancer care has been greatly affected by the COVID19 pandemic, adding to waitlist pressures and requires innovative and sustainable strategies. To streamline our prostate cancer diagnostic pathway, our Australian institution has introduced PrecisionPointTM Transperineal Access System (PPTAS) - A novel efficient device - which can be performed as an outpatient procedure under local anaesthetic (LA). The objectives were (1) to assess the safety of PPTAS and to determine the potential (2) economic and (3) environmental impact of PPTAS. Method(s): Initially PPTAS was prospectively evaluated under general anaesthesia to assess prostate cancer detection and complications rates compared to standard template biopsy in 2022. Based on current waitlists, theatre expenditures and disposable wastage was modelled. Result(s): 34 and 106 patients underwent PPTAS and standard template biopsy respectively, with similar clinically significant cancer detection rates (50% vs. 53.8%). No complications were recorded in the PPTAS cohort. Costs analysis when transitioned to LA predict savings of $804 per case, totalling $265,320 per annum. Theatre time savings of approximately 17 min allows addition of an extra biopsy per session, and relocation to outpatients enables main theatre use for other elective or emergency operations. Disposable waste generated would decrease by 818 g per biopsy case, preventing 270 kg of landfill waste per annum. Conclusion(s): These results demonstrate comparable cancer detection rates, assuring the safety of this procedure. The predicted analysis suggests this model will have upstream effects of reducing our overburdened surgical and clinic waitlist, improve sustainability impacts with greater use of existing resources.