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Fiducial Markets and CT Simulation Timelines

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Prostate Cancer
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Posted 5/30/2014 3:56 PM (GMT 0)
Hubby is scheduled for fiducial markers on Wed., June 4. This was a reschedule from last week when he had a severe cough. He was already scheduled for the CT simulation on June 5, which would have been one week from the original marker placement. Now the cancer center is telling us to keep the June 5 CT simulation appointment even though the markers would have only been placed the day before. I assume hubby will be swollen/healing and coming off any prep (enemas). Wouldn't that make it difficult if not outright inaccurate for the CT simulation?
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Age 58 at surgery
Sep 2013 PSA 3.7, clinical stage T1c, 3+4
RRP (Patel in Celebration) 10/31/2013, path stage pT3bN0Mx
SVI bilaterally, LVI, pos margin at apex (3+3), EXE at base
4+3 w/ tertiary 5 (65% 4, 35% 3, 5% 5)
December 2013, February 2014, April 2014 PSA's all undetectable
Posted 5/30/2014 4:44 PM (GMT 0)
They are placing the fiducials in the prostate fossa, a muscle bed, rather than in the soft tissue of the prostate, which is now gone. In the prostate, they are worried that the fiducials will move before scar tissue seals them in place, but that's less of a consideration in the prostate fossa. Many RO's don't bother with fiducials with adjuvant radiation because precision isn't nearly as important, there is no prostate jiggling around, and they can use the bones for alignment.

More importantly, I hope he will be getting at least 70 Gy.

- Allen
Posted 5/30/2014 10:55 PM (GMT 0)
My markers disappeared so I'm going back Monday to have them re installed if that's the right term. Then I start SRT on Wednesday. The leg mold is still to be used of course. What's the purpose of these markers? I was told by Radonco they were the focal point for radiation treatments so they needed to be restored. How important is it to have 16ounces of fluid in bladder every time? Anything else to be concerned about before each treatment?
Thanks
Bob
Posted 5/31/2014 12:33 AM (GMT 0)
With the newest LINACS, the machines that deliver the radiation dose, the gold implants are no longer needed..The machine has a built-in CAT scanner that insures proper alignment..Tiny tattoos are applied to position you on the table in the leg mold..Inflating your bladder with water moves it out of the way of the radiation beam. The water also absorbs any stray radiation preventing tissue damage...
Posted 5/31/2014 3:06 AM (GMT 0)
Bob,
Your fiducials disappeared? They are made of gold so as to be really visible on a CT scan. (there's another kind (Calypso) that sends out a radio signal when activated). Maybe you ought to ask someone to locate them? You don't want pieces of metal floating around at random. They are used to align the beam. The tattoos only give a rough alignment.

Water in bladder is critically important. It keeps the bladder tissue off the fossa that they will be irradiating and prevents excess bladder injury. The newer machines are so fast that you won't have to hold it in very long.

- Allen
Posted 5/31/2014 4:13 AM (GMT 0)
Fairwind,

Thanks for clarifying the gold markers issue. I just finished 25 IMRT treatments in March. I did not have the gold markers. The RO told me the everyday scan was used to make the adjustment. I assumed this was the newer equipment. I was shown the overlay on the monitor one of the days I was pulled off the table for not having a full bladder. I was also told having an empty rectum was very important. The rad. techs ran the scan and would not administer the treatment unless I had a full bladder and an empty rectum. As I got into about the third week it was a little more difficult for me to retain a full bladder while on the table.
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