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Tackle AGM conference, 2019

User
Posted 11 Jun 2019 at 22:26

This thread relates to the Tackle AGM conference which was held on Thursday 13th June, 2019 in Birmingham.

https://www.tackleprostate.org/latest-news/101-tackle-2019-agm-conference-prostate-cancer-to-screen-or-not-to-screen.php

Edited by member 14 Jun 2019 at 10:38  | Reason: Updated for post-event.

User
Posted 13 Jun 2019 at 23:00

A few notes I made during the presentations which might be of interest here.

PCUK is pleased with its campaign to require mpMRI before biopsy, and I think the compliance level is now over 80% (but I didn't write that down at the time). However, the reason this is done isn't always to improve the selection for biopsy and targeting of the samples which was the aim of the PCUK campaign - often it's to meet the diagnosis window targets.

PCUK is pushing to replace TRUS with transperineal biopsies. One recent advance which has made this possible is the ability to do transperineal with just local anaesthetic now, which avoids the costs and waiting list for theatre time. A portable trolley has been developed with everything required that can be wheeled into a consulting room to perform a transperineal biopsy. Leicester, Bristol, Oxford, and UCLH are now doing this. Barts and Newham have also switched to transperineal only.

The internal NHS hospital lab cost for a PSA test is £2. There are additional costs in the requesting department (e.g. urology), such as the syringe, needle, sterile wipe, etc. The costs for the Graham Fulford Charitable Trust to do the charity tests for a reasonable number of people is around £15 each, including hiring the phlebotomists.

Interesting talk by Prof Tim Oliver suggesting some prostate cancer may have its roots in what happens to the prostate during puberty. Two factors thought to increase the chance are reduced sunlight exposure to generate vitamin D during puberty (correlated from a lack of playing outdoors), and having acne (anaerobic acne bacteria are found in some prostate cancers). There's also been the suggestion that people with dark skin in countries without equatorial sun levels during puberty will hit the lack of vitamin D issue, but currently this has been seen as too sensitive an issue for further research along these lines, and research is concentrating more on looking for a genetic difference to explain why black men are twice as likely to get PCa.

Lots of talk on screening programs. There are no wholesale screening programs anywhere in the world currently, with the big issue being no good/reliable test for PCa, resulting in over treatment and cancers being missed. The main objection raised is that of overtreatment, and it is thought this has been reducing as we get better at testing and understanding the results, and was estimated at around 4% in 2017. Selection for biopsy is getting better too - in 2008, 25% of those biopsied had PCa (3 out of 4 had negative biopsies), but this had risen to 65% in 2018 (i.e. 1 in 3 had negative biopsies).

Across Europe:
PCa is the most common cancer for Males.
417,000/year diagnosed, 1 in 7 develop PCa before age 85, more than 2M living with PCa, 92,200/year deaths.
Annual cost of €9B.

PSA, although a poor test of PCa, is a useful biomarker for PSA risk stratification. For example, men with PSA < 1 at age 60 are extremely unlikely to die of PCa, and don't merit any further testing. That accounts for 35% of men.
Using multiple risk stratifications, the NNI (number needed to invite) to multiple PSA tests to avoid one death is around 1428, which is quite achievable. Without risk stratification, the number will be too high to be manageable.

User
Posted 14 Jun 2019 at 06:41

Thank you for that insight.

Old Barry reproduced the latest NICE guidelines out for consultation, which suggest that a transperineal biopsy should NOT be used for first diagnosis, unless part of a clinical trial, leaving many men with ambiguous results from a TRUS having to undergo a second transperineal one. I wonder what that percentage is?

They should scrap bloody TRUS biopsies altogether, and I am pleased to hear it’s happening in some hospitals already.

There is a new needle called ‘CamPROBE’ - developed in Cambridge - which facilitates transperineal biopsies under a local anaesthetic, which may be what you referred to above.

All the gory details are here: 

https://www.urotoday.com/imaging-center-coe-videos/958-embedded-media2018-05-29-15-36-12.html

Cheers, John.

Edited by member 14 Jun 2019 at 07:14  | Reason: Not specified

User
Posted 14 Jun 2019 at 07:08

Hi Barry,

That's probably one of the schemes - I believe there are two different ones. The original requiring a more expensive single use local anaesthetic, and a different one which didn't require this. The video is perhaps the second.

I note that video is transperineal, but not a template biopsy. This is not something I picked up in the presentations.

User
Posted 14 Jun 2019 at 07:18
Did you note from the video that they can take multiple samples from all over the gland, usually with only one puncture per side?

Cheers, John.

User
Posted 14 Jun 2019 at 08:28

Yes, but that's not a template biopsy which accurately creates a matrix of samples in the chosen areas. It's like the more random TRUS, but through the perineum instead.

Having said that, no one asked if any of these local anaesthetic transperineal biopsies are template biopsies (I just assumed they were), so this might be the case with the other variation(s) of them too.

If none of them are template biopsies, then this probably doesn't replace the current template biopsies, but just the TRUS, and a proper template biopsy might still be required afterwards.

Edited by member 14 Jun 2019 at 08:32  | Reason: Not specified

User
Posted 14 Jun 2019 at 15:47

Here's the description of another version of the procedure from UCL:

Targeted Transperineal Prostate Biopsy: A Local Anaesthetic Approach

So just to be clear, neither are template biopsies. The main purpose is to:

1) Avoid the 3% of TRUS biopsies which result in infections.

2) Avoid the overheads and delays of a transperineal template biopsy which requires a general anaesthetic and theatre time.

3) Can access the whole prostate (TRUS can't normally access the anterior).

The expectation is that they will be targeted using prior mpMRI.

User
Posted 15 Jun 2019 at 06:32

Yes, I can see in the fullness of time that they could also be targeted by prior MRI scan and real-time ultra sound scanning via the rectal probe. What’s not to like, apart from the result they might come up with?😉

Cheers, John.

Edited by member 15 Jun 2019 at 06:33  | Reason: Not specified

 
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