Résumé
Introduction & Objective: Prostate Biopsy remains the gold standard for histological confirmation of prostate cancer. The near exponential increase in the need for biopsies, in selected men, has ushered an evolving need for improving detection rates while reducing side effects. Diagnostic accuracy and infection complication rates remain obstacles in transrectal prostate biopsy. PrecisionPoint is a disposable, low cost device which enables transperineal biopsy in the outpatient setting under local anaesthetic. We present data from a predominantly nurse-performed LATP service using PrecisionPoint, which was newly started in July 2019. Initial indications were;repeat biopsy, anterior lesions, and active surveillance patients. Service was expanded in March 2020 to all prostate pathway patients following national COVID guidance. Methods: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD >0.15. PIRADS 3-5 lesions were targeted with ≥3 cores (sent separately). Systematic Ginsburg protocol biopsies were also performed (each zone sent separately). Tamsulosin was started for BOO patients. No antibiotics were used unless immunocompromised or previous sepsis. A prospective database at point of care was created detailing patient information, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. Results: 750 consecutive patients analysed. Detection of significant cancer (Gl ≥3 + 4) in PIRAD1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected significant cancer in 36%, systematic plus targeted achieved 63%. Of AS patients;40% with Gl3 + 3 were upgraded, and 49% with Gl3 + 4 were upgraded to Gl ≥4 + 3. 5 experienced vasovagal episodes. Only 5 patients were readmitted (0.6%): 2 UTI, 2 AUR, 1 urosepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further biopsies (89%). Conclusions: Adoption of this new technology into an integrated prostate cancer diagnostic pathway has enabled us to set up a safe, effective, antibiotic free LATP biopsy service in the outpatient setting. Data shows high cancer detection rates and low complication rates. PROMs data suggests this iswell tolerated by patients.
Résumé
INTRODUCTION AND OBJECTIVE: A LATP service using PrecisionPoint™ was newly started in July 2019, with procedures performed by both surgeon and nurse practitioners. Initial indications were: repeat biopsy, anterior prostate lesions, and Active Surveillance patients. Service was expanded in March 2020 to all prostate pathway patients according to British Association of Urology COVID guidance. METHODS: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD>0.15. Systematic Ginsburg protocol biopsies were performed for all patients (each zone sent separately), and PIRADS 3-5 lesions were targeted with ≥3 cores (also sent separately). Alpha-blockers were started for patients with Bladder Outlet Obstruction. No antibiotics were used unless patients were immunocompromised or had a previous history of urinary sepsis. A prospective database at point of care was created detailing patient demographics, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. RESULTS: 750 consecutive patients are analysed. Detection of clinically significant prostate cancer (Gl≥3+4) in PIRADS 1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected clinically significant cancer in 36%, whereas systematic plus targeted biopsy achieved 63%. Of Active Surveillance patients;40% with Gl 3+3 were upgraded, and 49% with Gl3+4 were upgraded to Gl≥4+3. n=5 (0.6%) experienced vasovagal episodes causing delayed discharge. Only n=5 patients were readmitted (0.6%): 2 urinary tract infection, 2 acute urinary retention, 1 urinary sepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further repeat biopsies (89%). CONCLUSIONS: We have set up a safe, effective, antibiotic free LATP biopsy service, with high cancer detection rates and low complication rates. PROMs data suggests this is well tolerated by patients.
Résumé
Introduction: A predominantly nurse-performed LATP service using PrecisionPoint was newly started in July 2019. Initial indications were repeat biopsy, anterior lesions, and AS patients. Service was expanded in March 2020 to all prostate pathway patients according to BAUS COVID guidance. Methods: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD >0.15. PIRADS 3-5 lesions were targeted with 3 cores (sent separately). Systematic Ginsburg protocol biopsies were also performed (each zone sent separately). Tamsulosin was started for BOO patients. No antibiotics were used unless immunocompromised or previous sepsis. A prospective database at point of care was created detailing patient information, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. Results: 750 consecutive patients analysed. Detection of significant cancer (Gl3+4) in PIRAD1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected significant cancer in 36%, systematic plus targeted achieved 63%. Of AS patients;40% with Gl3+3 were upgraded, and 49% with Gl3+4 were upgraded to Gl4+3. 5 experienced vasovagal episodes. Only 5 patients were readmitted (0.6%): 2 UTI, 2 AUR, 1 urosepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further repeat biopsies (89%). Conclusion: We have set up a safe, effective, antibiotic free LATP biopsy service, with high cancer detection rates and low complication rates. PROMs data suggests this is well tolerated by patients.
Résumé
Public awareness and political concern about the environmental impact of the growth of civil aviation has grown significantly over the past 30 years. First the noise, later the air pollution and today the carbon dioxide emission. This is not overridden by the fact that today the international aviation industry, like all sectors of the economy, is severely affected by the COVID-19 pandemic, which may temporarily overshadow the previous challenges. We all seen the visible change of international airspace in March, April and May 2020, but life is expected to return to its normal way in one or two years and although the crisis may shake the industry, serious issues in international aviation remain the same. The most important, as it was mentioned, is the rising value of CO2 emissions in the light of climate change, regarding the 5 percent per year growth rate of aviation. This article presents the difficulties faced by aircraft engine manufacturers today regarding the engine efficiencies, which have one of the closest relations to the CO2 emission, supported by theoretical background information. © 2020 Kaunas University of Technology. All rights reserved.