An Updated Review of NHS England Prostate Biopsy Data during the COVID-19 Pandemic (2019-2021)

Introduction The abandonment of traditional transrectal (TR) towards transperineal (TP) prostate biopsies, or TREXIT, is in vogue. Following our evaluation (Tamhankar et al. BJUI 2020; 126: 133-141) of nearly half a million prostate biopsies in the NHS over a decade (2008-2019), the reduced sepsis and emergency readmission rates with the TP approach were alluded to. During the last two years of this cohort (2017-19) the majority of biopsies remained TR (67.2%). Has the current COVID-19 pandemic proved a catalyst for increasing TP biopsy uptake? Methods The Hospital Episode Statistics (HES) data over the most recent two years (2019-21) were analysed. This included biopsy approach, setting, complications (28 days post-procedure), non-elective (NEL) readmissions and associated NHS expenditure. Results In this dataset, between 2019-2021, 93,041 prostate biopsies were undertaken (44,706 TR and 48,335 TP). In 2019/20 43.2% of these were via the TP approach compared with 65.7% in 2020/21, amid the COVID-19 pandemic. The number of TP biopsies undertaken in the outpatient setting increased by 150% from 2019/20 to 2020/21. Across the 2 years the post-procedural sepsis, urinary tract infection and NEL readmission rates were significantly higher following TR biopsy (p<0.0001). Total costs for readmission were £4,193,828.48 and £2,790,528.46 for the TR and TP approaches respectively. Conclusions The increasing adoption of TP prostate biopsies, particularly in the outpatient setting, has been accelerated during these extraordinary times. Cancer diagnostic services have had to adapt and this appears to have benefited the move away from TR biopsy.