Placing Markers in Prostate Before RT

Just met with my Uro reviewing my Bx and scan results and treatment options. He mentioned if I choose RT, I will come to his office and go thru something similar to the biopsy procedure but with fewer "sticks", and markers will be placed in the prostate to guide the RT process. First I have heard about this. Is this common?

IGRT, image guided radio therapy. They place usually three gold seeds that they see on the CT scan to align the radiation beam to the target. It is not as common as it was 10 years ago as the imaging is improved. But it is still in use and is a very effective method.

Yes image guided technology is becoming popular and significantly reduces side effects. For high dose SBRT the guidance is critical. Typically you have three very tiny gold markers inserted into the prostate. That can be done through the rectum using the same TRUS technique that most biopsy uses. I found it to be no more uncomfortable than the biopsy. Some Urologists use a transperoneal technique that requires more sedation. The transperoneal reduces infection risks. If a gel spacer (SpaceOre) is being used that too can be done at the same time. Some facilities use the spacer and some do not. The gold markers can easily be seen on a CT scan and precisely locate the prostate. During your first planning session a detailed CT scan identifies the exact location of all the organs surrounding the prostate. A custom radiation plan is developed for each person and keys on those markers. During the actual delivery of radiation mini CT scans find the markers before the radiation is delivered. It’s kind of like the difference between carpet bombing and smart bombs. There is considerably less collateral damage with smart bombs. I found the whole process to be incredibly precise.

hmmmm. I got two tattoos

InTheShop said...
I got both.

I wonder if I got gold markers when I had brachy? hmmmmmmm

I completed SBRT in August 2019. I had the gold fiducials and the SpaceOAR (Organs At Risk) placed during an outpatient surgery procedure (transperineal) with anesthesia. I don't know why they decided to use anesthesia for this part of the process when they previously used sedation for the biopsy. My four gold markers are stranded in pairs. Before treatment began there was a planning day that included a MRI with a specific amount of fluid in my bladder. This provides baseline imagery to help locate the prostate in relation to surrounding anatomy. When in the Cyberknife suite, there are two imaging machines in the ceiling pointing towards the table where the patient lies. The two machines are updating periodically during the treatment process and triangulate your position on the table with the Cyberknife arm. There are two staff members in the control room monitoring your treatment. One is a radiation therapist that actually does all the positioning of your body on the table and is primarily responsible for keeping you within a specified location on the table. The table is on a six axis gimble and can move ever so slightly to maintain positioning. Should you move "out of range" the machine will pause. Even though you may remain perfectly still during the process, your internal anatomy can move slightly from gas in your intestines. The second person in the control room is a nuclear medicine specialist and I had no interaction with that person at all. The radiation therapist told me that it takes both of them to monitor all the variables during treatment.

I had SBRT and received 4 gold fiducials in the prostate.

I had IMRT, external beam with tattoos only, little black dots actually. They also made a mold for my feet to rest in while microwaved. No internal markers needed, and that was back in 2013.

Paxton said...

My only frustration with the whole fiducial/marker thing was that since gold is a "precious" metal, why didn't I feel any more precious after the procedure than before?

Well at least your "net worth" increased.

I figured, when I got the biopsy before surgery, "at least I'll never have to go through this again after surgery".
Then before SRT, they implanted the gold seeds. "It's pretty much just like your biopsy".